RARE Toolkits

Below is a list of all of our current RARE Toolkits.

ADVOCATING FOR YOUR CHILD WITH A RARE DISEASE AT THEIR SCHOOL
Meal Accommodation

Special Accommodations with Meals

The U.S. Department of Agriculture’s (USDA) nondiscrimination regulation (7 CFR 15b), as well as the regulations governing the National School Lunch Program and School Breakfast Program, make it clear that substitutions to the regular meal must be made for children who are unable to eat school meals because of their disabilities, when that need is certified by a licensed physician.

Meal Accommodation

Three federal legislative acts mandate that school food service programs will serve children with special dietary needs because of their disabilities:

• Section 504 of the Rehabilitation Act of 1973;
• Individuals with Disabilities Education Act (IDEA); and
• Americans with Disabilities Act (ADA).

In most cases, children with disabilities can be accommodated with little extra expense or involvement. The nature of the child’s disability or diagnosis, the reason the disability prevents the child from eating the regular school meal, and the specific substitutions needed must be specified in a statement signed by a licensed physician. Usually, the substitutions can be easily made. When major modifications are needed, additional equipment, outside expertise, or specific technical training and expertise, it is important that school food service managers be involved in IEP or 504 process. They should be invited to attend the meetings where nutrition and dietary needs will be discussed.

To receive special dietary accommodations or meals, most schools will require you to complete a “Medical Statement for Children with Special Dietary Needs.” Some states have a form that they require statewide. This varies from state to state. To see a sample form, turn to the Resource Guide of this toolkit.

Each special dietary request must be supported by a statement, which explains what is being requested. It must be signed by a recognized medical authority (physician, physician assistant, or nurse practitioner). The medical statement must include:

• An identification of the medical or other special dietary condition that restricts the child’s diet;
• The food(s) to be omitted from the child’s diet; and
• The food or choice of foods to be substituted.

If the child receives free or reduced priced meals, the school cannot increase the charge for the meal or start charging for the meal.

Although not required, it is especially helpful to have the physician complete a prescription for the meals that specifies a calorie goal and possibly other dietary goals.  This holds the school accountable to meet not just the restriction, but to provide meals that support the child’s entire nutritional needs.

If your child has a dietitian, it is helpful to have him or her talk with the foodservice department and help with menu development or nutritional analysis. Many schools have a dietitian, but these dietitians do not always understand the medical nutrition therapy required by your child.

Meal Accommodation

If your child needs feeding assistance or has feeding equipment, the school nurse needs to be part of the IEP/ 504 process as well. Additional people on the IEP/504 committee could be a dietitian, occupational therapist and speech pathologist. An occupational therapist can help with the “big picture” approach to mealtimes. They will help select adaptive equipment, modify the feeding environment and address any mechanics of plate-to-mouth feeding. They will also address sensory deficits that limit mealtime participation. The speech-language pathologist will help with swallowing, safety issues, and may be needed to train school-based personnel.

Food allergies are generally not a disability or defined under Section 504 of the Rehabilitation Act and the Individuals with Disabilities Education Act, Part B. The school is not required to make accommodations in this situation. When the food allergy results in a severe, life-threatening reaction, a child’s condition would rise to the level of a disability. The school would then be required to accommodate the prescribed diet ordered by a physician.

The main goal is to meet the child’s nutrition needs in the least restrictive environment which includes having as much of a typical meal experience as possible, comfortable seating, not being secluded, and sitting with age related peers.

For additional information on policies regarding school nutrition, go to the FNS Instruction 783-2, Revision 2, Meal Substitutions for Medical or Other Special Dietary Reasons.

If you encounter difficulty in obtaining specialized meals, you may want to talk with the USDA regional office for the Food and Nutrition Services. Information on this can be found on the USDA website.