The USDA is updating their "Child and Adult Care Food Program" Guidelines - Meal Pattern Revisions Related to the Healthy, Hunger-Free Kids Act of 2010 in the Federal Register.  You can access it at https://www.gpo.gov/fdsys/pkg/FR-2016-04-25/pdf/2016-09412.pdf.  Some key statements from the ruling: "expressed breastmilk is considered an acceptable fluid milk substitute for children of at any age in CACFP."   Additionally, the proposed rule at 7 CFR 226.20(i)(1) would allow non-dairy beverages (does "non-dairy" mean "breastmilk"? - the above statement indicates the answer as "yes") are nutritionally equivalent to milk (is breastmilk nutritionally equivalent to "milk"? Many of us on Lactnet would agree that breastmilk is superior to cow milk or other substitutes) to be served in place of fluid milk for children or adults with medical or special dietary needs. This final rule allows non-dairy beverages that are nutritionally equivalent to milk and meet the nutritional standards for fortification of calcium, protein, vitamin A, vitamin D, and other nutrients to levels found in cow’s milk, as outlined in the NSLP regulations at 7 CFR 210.10(m)(3), to be served in place of fluid milk for children or adults who cannot consume fluid milk due to a medical or special dietary need. This allowance was first provided via the September 2011 memorandum discussed under the section below titled Children 2 years old and older, and requires a parent or guardian, or by, or on behalf of, an adult participant to request the substitution in writing, without a medical statement . Note: the “Infant feeding” section does make quite a few references to "breastfeeding", but breastfeeding is not addressed in the older child (over 1) except as above "expressed breastmilk is considered an acceptable fluid milk substitute for children of at any age in CACFP."  The issue of the day care requesting a note does not appear to be required.  The day care is reimbursed for food costs when the appropriate food items are served - therefore, careful menu planning is necessary in order for the provider to receive payment.  This may be what the provider in question is concerned about: getting reimbursed for not serving milk.  Of note, but not directly related to the above concern: The proposed rule at 7 CFR 226.20(b)(2) would allow for reimbursement of meals when the mother directly breastfeeds her infant at the child care center or home.  Note that the previous sentence says "infant" - which would be under 1 year of age, according to the definition of the CACFP. 

Tina Lavy, MS, IBCLC.

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