Food and Nutrition Service 

Feeding Infants

in the Child and Adult Care Food Program
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations 

and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering 

USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender 

identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, 

income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil 

rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). 

Remedies and complaint filing deadlines vary by program or incident. 

Persons with disabilities who require alternative means of communication for program information (e.g., 

Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or 

USDA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal 

Relay Service at (800) 877-8339. Additionally, program information may be made available in languages 

other than English. 

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, 

AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office 

or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To 

request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: 

(1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence 

Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. 

USDA is an equal opportunity provider, employer, and lender. 

March 2019
About Team Nutrition 

What Is Team Nutrition? 

Team Nutrition is an initiative of the United States Department of Agriculture’s 

Food and Nutrition Service that supports national efforts to promote lifelong 

healthy food choices and physical activity by improving the nutrition practices of 

the Child Nutrition Programs. We provide resources to schools, child care, day 

care, afterschool, and summer meals sites that participate in these programs. 

Team Nutrition Messages 

The Dietary Guidelines for Americans are the basis 

of Federal nutrition policy, education, outreach, 

and food assistance provided through the Child 

Nutrition Programs. The Team Nutrition initiative 

helps schools, child care settings, summer meal 

sites, parents/caregivers, and children put the 

Dietary Guidelines for Americans into action 

through training, technical assistance, and 

nutrition education. 

The MyPlate icon uses a familiar image—a 

place setting for a meal—to prompt 

consumers to build a healthy plate at 

mealtime. MyPlate also illustrates the five 

food groups, reminding everyone that these 

foods are the building blocks of a healthy 

diet. Team Nutrition helps communicate 

MyPlate messages to children and their 

caregivers through a variety of innovative 

delivery methods including hands-on 

activities, electronic games, songs, videos, 

lessons, stories, events, tweets, graphics, 

and gardens.

What Strategies Does Team Nutrition 

Use To Change Behavior? 

Team Nutrition uses three strategies to 

change behavior: 

1. Provide training and technical assistance to 

child nutrition professionals to enable them 

to prepare and serve nutritious meals that 

appeal to children. 

2. Increase nutrition education through multiple 

communication channels to help children 

have the knowledge, skills, and motivation 

to make healthy food and physical activity 

choices as part of a healthy lifestyle. 

3. Build support for healthy school and child 

care environments that encourage nutritious 

food choices and physically active lifestyles. 
Every day, the United States Department of 

Agriculture’s (USDA) Child and Adult Care 

Food Program (CACFP) serves millions 

of infants, children, and adults across the 

United States. The CACFP provides a great 

opportunity to introduce infants and children 

to healthy eating habits. Good nutrition 

is important at every age, but is critical for 

the growth and development that occurs 

during a baby’s first year. 

Tip: 

Handouts are included within the chapters 

of this guide. These can be used as quick 

reminders posted at your child care site. 

Or, you may wish to share them with 

parents as part of a conversation on what 

their baby is eating at child care.

How To Use This Guide 

This guide will help child care providers 

understand the CACFP meal pattern requirements 

that were published in April of 2016, with an 

implementation date of October 1, 2017. It also 

includes best practices for feeding babies in a 

way that supports their growth and development. 

All child care centers and family child care homes 

that participate in the CACFP must offer meals 

to all infants in their care. This guide can help you 

do that. 

Use this guide to answer questions you have 

about what to feed babies and how to offer 

meals that are reimbursable in the CACFP. Before 

reading this guide, take the Feeding Infants 

pre-test in Appendix H on page 176. Then, after 

reading the guide, take the test again to see how 

much you've learned. 

Note 

Every effort has been made to ensure the 

accuracy of the information in this guide. The 

guidelines provided align with CACFP 

policy memorandums as well as best feeding 

practices for babies. Several reviewers, including 

pediatricians, sponsoring organizations, State 

agencies, and Federal staff with expertise 

in the CACFP and infant nutrition provided 

Introduction 

feedback. Additionally, interviews were held 

with center-based and home-based child 

care providers to gather feedback from our 

target audience. 

While this guide provides information on feeding 

infants within the CACFP, it does not include all 

of the information you may need when providing 

a healthy feeding environment for each individual 

baby in your care. For this reason, always talk 

with each baby’s parents about their baby’s usual 

eating habits. 

If you are interested in reviewing the CACFP 

policy memorandums, they can be found online 

at: https://www.fns.usda.gov/cacfp/policy. 

Use this guide to answer questions you 

have about what to feed babies. 
The Importance of Partnering With Parents 

Parents give you important information to help you 

care for their babies. Communicating with parents 

will help you know when to give certain foods to 

a baby and which foods to avoid. Each baby in 

your care has his or her own eating abilities. This 

is because babies grow and develop at different 

rates. You can make sure the babies are getting 

the best care possible by speaking with parents 

regularly and working together as a team. 

Talk to parents icon 

This icon is included throughout 

this guide to indicate different 

opportunities for you to interact 

with parents. Pause when you see 

this icon to discover new ways to 

connect with the families in your 

child care site. 

There are several parent handouts in this guide 

that you can use to communicate with parents 

on a variety of topics. In the Table of Contents, 

look for the handout icon to quickly find those 

resources. All of the parent handouts have a title 

that starts with "For Parents" to make it clear 

which handouts are specifically designed for child 

care providers to share with parents. 

In developing this guide, USDA conducted 

formative research to make sure the materials 

were clear and helpful for child care providers, 

child care directors, expecting mothers, and 

current mothers. Both providers and mothers 

shared that communicating with each other was 

important to them, but a challenge. As a result, 

USDA has added an entire chapter to this guide 

dedicated to communicating with parents (see 

Chapter 12: Partnering With Families on page 

129). In the chapter, you will find tips and sample 

scenarios to make talking to parents easier. 

Visit the USDA Team Nutrition website for our 

"Breastfed Babies Welcome Here!" materials.

 

 

 
About Team Nutrition 

Introduction 

The Importance of Partnering With Parents 

Words To Know 1 

Chapter 1: Giving Babies a Healthy Start With the CACFP 6 

What Are Solid Foods? 6 

A Baby's Eating Habits 6 

Talking With Parents About Their Baby's Eating Habits 7 

How Can I Tell When a Baby Is Hungry or Full? 7 

Responsive Feeding 7 

Table 1: How Can I Tell If a Baby Is Hungry? 8 

Table 2: How Can I Tell If a Baby Is Full? 9 

Developmental Readiness 10 

A Baby’s Feeding Skills 11 

✋Parent Handout: Is Your Baby Ready for Solid Foods? 12 

Infant Age Groups in the CACFP 14 

Food Components in the Infant Meal Pattern 14 

Table 3: CACFP Infant Meal Pattern With Food Components 15 

Serving Sizes in the Infant Meal Pattern 17 

Food Components Provided by the Parents 17 

Key Concepts 18 

Check Your Knowledge 19 

Chapter 2: Feeding the Breastfed Baby 20 

Table 4: Benefits of Breastfeeding for Babies, Mothers, and Families 21 

Supporting Families of Breastfed Babies 22 

While the Mother Is Pregnant, You Can: 22 

Before Mothers Return to Work or School, You Can: 23 

When the Baby Is in Your Care, You Can: 25 

✋Parent Handout: Breastfeeding? Tell Us About Your Breastfed Baby! 26 

Creating a Breastfeeding-Friendly Environment 27 

Feeding Breastmilk in a Bottle 28 

Breastmilk and the CACFP Infant Meal Pattern 28 

Bowel Movements 29 

Breastmilk for Babies Over 12 Months of Age 29 

Key Concepts 30 

Check Your Knowledge 31

Table of Contents 
Chapter 3: Feeding the Formula-Fed Baby 32 

Infant Formula in the CACFP Infant Meal Pattern 32 

✋Parent Handout: Feeding Your Baby Infant Formula? Tell Us More! 34 

Iron-Fortified Infant Formula 35 

Resources in the Community 35 

Soy-Based, Low Lactose, and Lactose-Free Formulas 36 

Soy-Based Infant Formula 36 

Low Lactose and Lactose-Free Infant Formula 36 

Infant Formula for Babies With Special Dietary Needs 37 

Special Dietary Needs Due to Disabilities 37 

Special Dietary Needs Due to Religious Reasons 37 

FDA Exempt Infant Formulas and Low-Iron Infant Formulas 37 

FDA Exempt Infant Formulas 37 

Low-Iron Infant Formulas 37 

Other Milks 38 

Use of Infant Formula for Babies Over 12 Months of Age 38 

Key Concepts 39 

Check Your Knowledge 40 

Chapter 4: Handling and Storing Breastmilk and Infant Formula 41 

How Does Breastmilk Look? 41 

How Does Breastmilk Smell? 42 

Handling Breastmilk and Infant Formula Before Arriving at the Child Care Site 42 

Storing Fresh Breastmilk and Infant Formula at Your Child Care Site 43 

Thawing Frozen Breastmilk at the Child Care Site 44 

Table 5: Maximum Storage Time and Temperature for Breastmilk at a 

Child Care Site 44 

Preparing a Bottle for a Feeding 45 

Purchasing Infant Formula 46 

Preparing, Storing, and Handling Infant Formula 46 

Table 6: Storing and Handling Infant Formula 47 

Key Concepts 48 

Check Your Knowledge 49 

Chapter 5: Feeding a Baby Using a Bottle and Cup 50 

Before Feeding a Baby a Bottle: 50 

How To Feed With a Bottle 51 

Do Not Allow a Baby To Carry a Bottle or Cup Around 51 

Sleeping or Resting Position Before or After Feeding 51 

How To Prevent Babies or Children From Drinking Another Child’s Bottle (or Cup) 53 

If a Child Drinks from Another Child's Bottle or Cup 53 

Drinking From a Cup 54 

How Can You Help a Baby Learn To Drink From a Cup? 54 

Transitioning From a Bottle Too Late 54
Reflux 55 

Table 7: What Should Babies Drink? 55 

Key Concepts 57 

Check Your Knowledge 58 

Chapter 6: Feeding Solid Foods 59 

Solid Foods for Babies 6 Through 11 Months 60 

When To Start Feeding a Baby Solid Foods 61 

How Can You Tell If It Is Time to Feed a Baby Solid Foods? 61 

Feeding Solid Foods Too Early 62 

Feeding Solid Foods Too Late 62 

✋Parent Handout: What Is Your Baby Eating? Let Us Know! 63 

A Baby's Feeding Skills 65 

Introducing New Foods 65 

How To Feed Solid Foods to a Baby 66 

Table 8: Introducing Different Textures of Food Based on Feeding Skills 68 

Preparing Foods in Different Textures 69 

Pureeing Foods 69 

Mashing Foods 70 

Grinding and Finely Chopping Foods 70 

What Is a Reimbursable Infant Meal or Snack for Babies 6 Through 11 Months? 70 

What Types of Grains Can Be Offered Under the Infant Meal Pattern? 71 

Dry Iron-Fortified Infant Cereal 71 

How Can I Tell If an Infant Cereal Is Iron-Fortified? 71 

Ready-to-Eat Cereals 72 

How Can I Tell When a Cereal Only Has 6 Grams of Sugar or Less Per Dry 

Ounce of Cereal? 72 

Table 9: Sugar Limits for Ready-to-Eat Cereals 73 

Breads and Crackers 74 

What Types of Meats and Meat Alternates Can Be Offered Under the 

Infant Meal Pattern? 74 

Meats and Poultry 74 

Fin Fish and Shellfish 74 

Cheese 75 

✋Parent Handout: Making Sure Your Baby Gets Enough Iron 76 

Eggs 78 

Cooked Dry Beans and Peas 78 

Nuts and Seeds 78 

Processed Meats 78 

Tofu 78 

Yogurt 79

How Can I Tell When a Yogurt Has No More Than 23 Grams of Sugar 

Per 6 Ounces? 79
Table 10: Sugar Limits for Yogurt 80 

What Types of Vegetables and Fruits Can Be Offered Under the Infant Meal Pattern? 81 

Vegetables and Fruits 81 

What Other Types of Foods Are or Are Not Creditable in the Infant Meal Pattern? 81 

Desserts 81 

Honey 81 

Table Foods 82 

Artificial Sweeteners 82 

Added Sugars, Fats, and Sodium 83 

Food Components Provided by the Parents 83 

Table 11: When a Baby Is Eating Solid Foods 84 

Special Dietary Needs Due to Disabilities 84 

Special Dietary Needs Due to Religious Reasons 84 

Feeding Solid Foods to Vegetarian or Vegan Babies 85 

Be a Role Model at Mealtime 86 

Keep Parents Updated 86 

Child Care Provider Handout: Feeding Babies in Their First Year 87 

✋Parent Handout: Varying Your Baby's Veggies 88 

It's Never Too Early To Sing and Read to Babies! 90 

Key Concepts 91 

Check Your Knowledge 92 

Chapter 7: Buying and Preparing Baby Foods 93 

Purchasing Baby Food 93 

Examples of Creditable Store-Bought Baby Foods 94 

Examples of Non-Creditable Store-Bought Baby Foods 95 

Selecting Baby Foods From the Store 95 

Storing Opened Store-Bought Baby Food 96 

Baby Food Packaging 96 

Preparing Baby Food at Your Child Care Site 97 

Tools for Preparing Baby Food 98 

Preparing and Cooking Food at Your Child Care Site 99 

Vegetables and Fruits 99 

Meat, Fish, Shellfish, and Poultry 100 

Eggs 100 

Dry Beans or Dry Peas 100 

How To Freeze Foods 101 

Thawing and Reheating 101 

Storing Solid Foods 101 

Child Care Provider Handout: Keeping Solid Foods Safe 102 

Key Concepts 104

Check Your Knowledge 105
Chapter 8: Safe Food Preparation 106 

Hand Washing 106 

When Should Your Hands Be Washed? 107 

Prevent Spreading Illness to Others 109 

If You or Another Staff Member Has an Illness 109 

Cleaning Food Preparation and Eating Areas 109 

Cleaning Dishes and Utensils 109 

Protective Clothing 109 

Refrigerator and Freezer Temperature 110 

Reducing Lead Exposure From Food or Water 110 

Child Care Provider Handout: Hand Washing 111 

Key Concepts 112 

Check Your Knowledge 113 

Chapter 9: Choking Prevention 114 

Preventing Choking During Mealtime 114 

Foods To Avoid That Can Cause Choking 114 

Preparing Foods To Lower Choking Risk 115 

Child Care Provider Handout: Making Foods Safer for Baby 116 

Key Concepts 117 

Check Your Knowledge 118 

Chapter 10: Food Allergies and Intolerances 119 

What Is a Food Allergy? 119 

What Is a Food Intolerance? 119 

Talk to Parents About Food Allergies and Intolerances 120 

Signs of an Allergic Reaction 121 

What To Do When a Baby Has a Reaction to a Food 121 

Preventing an Allergic Reaction 121 

Key Concepts 122 

Check Your Knowledge 123 

Chapter 11: Caring for Babies’ Gums and Teeth 124 

What Is Tooth Decay? 124 

What Causes Tooth Decay? 124 

Why Should Tooth Decay Be Prevented? 125 

How Can I Help Prevent Tooth Decay? 125 

How Do I Take Care of a Baby's Gums and Teeth? 126 

Teething 126 

Key Concepts 127 

Check Your Knowledge 128 

Chapter 12: Partnering With Families 129 

To Help Build a Successful Partnership With Parents, You Can: 129 

When Communicating With Parents It Is Important To: 130
Talk to Parents About Feeding Their Baby 131

Hear From Mothers and Other Providers 132

Table 12: Sharing Information With Parents 134

Bite-Size Nutrition Messages 136 

Key Concepts 137

Check Your Knowledge 138

Appendixes 139

Appendix A: Sample Infant Daily Activity Chart 139

Appendix B: Sample Infant Menu (6 Through 11 Months) 140

Appendix C: Infant Meal Pattern 143

Appendix D: Choose Breakfast Cereals That Are Lower in Added Sugars 145

Appendix E: Choose Yogurts That Are Lower in Added Sugars 147

Appendix F: Infant Foods List 149

Appendix G: CACFP Questions and Answers 172

Appendix H: Feeding Infants Pre- and Post-Test 176

Index 178

Acknowledgments 180

Bibliography 182
12 | Words To Know

Parent Handouts 

Is Your Baby Ready for Solid Foods? 12 

Breastfeeding? Tell Us About Your Breastfed Baby! 26 

Feeding Your Baby Infant Formula? Tell Us More! 34 

What Is Your Baby Eating? Let Us Know! 63 

Making Sure Your Baby Gets Enough Iron 76 

Varying Your Baby's Veggies 88 

Child Care Provider Handouts 

Feeding Babies in Their First Year 87 

Keeping Solid Foods Safe 102 

Hand Washing 111 

Making Foods Safer for Baby 116 

Tables 

Table 1. How Can I Tell If a Baby Is Hungry? 8 

Table 2. How Can I Tell If a Baby Is Full? 9 

Table 3. CACFP Infant Meal Pattern With Food Components 15 

Table 4: Benefits of Breastfeeding for Babies, Mothers, and Families 21 

Table 5. Maximum Storage Time and Temperature for Breastmilk at a Child Care Site 44 

Table 6. Storing and Handling Infant Formula 47 

Table 7. What Should Babies Drink? 55 

Table 8. Introducing Different Textures of Food Based on Feeding Skills 68 

Table 9. Sugar Limits for Ready-to-Eat Cereals 73 

Table 10. Sugar Limits for Yogurt 80 

Table 11. When a Baby Is Eating Solid Foods 84 

Table 12. Sharing Information With Parents 134

Handouts and Tables 
Words To Know | 1 

Words To Know 

Term Description 

Baby bottle tooth decay See Tooth decay. 

Child and Adult Care Food 

Program (CACFP) 

CACFP is a nutrition assistance program of the United States 

Department of Agriculture (USDA) that provides reimbursement for 

meals and snacks offered at certain child and adult care sites. Meals 

and snacks offered through the CACFP must meet nutrition standards. 

Child care site A space or building where a child care program operates. This 

includes both child care centers and family child care homes. 

Child Nutrition (CN) label 

A label on a food product that shows how the food credits towards 

one or more food components. The Child Nutrition Labeling Program 

is a Federal labeling program that is voluntary for food manufacturers. 

Commercially prepared 

baby foods See Store-bought baby foods. 

Complementary foods See Solid foods. 

Creditable foods Foods that may be counted towards meeting the CACFP meal pattern 

requirements for a reimbursable meal. 

Developmental readiness 

Over time, a baby is able to control his or her large and small 

muscles and to digest certain foods. A baby is “developmentally 

ready” to eat solid foods with varying textures when certain abilities 

can be observed. 

Enriched grains 

Enriched grains are refined grains that have been processed to remove 

the nutrient-rich bran and germ, and then have certain B vitamins 

such as thiamin, riboflavin, niacin, folic acid, and iron added after 

processing. Enriched grains can be identified by a food label that 

includes the word “enriched” or an ingredients list that lists an enriched 

grain as the first ingredient or the second after water. 

The words listed in this chart are bolded the first time they appear in each chapter. 
2 | Words To Know

Expressed breastmilk 

Milk that is removed from a woman’s breast. This can be 

accomplished by hand expression, a manual or hand pump, or an 

electric pump. 

Feeding skills 

Developmental abilities needed for a baby to drink or eat. Skills include 

having head and neck control to be able to take in a spoonful of 

pureed food and move the food into his or her throat, the ability to pick 

up finely chopped pieces of soft food with his or her own hand or a 

few fingers to feed him or herself, etc. 

Food allergy 

A food allergy is a body’s reaction to a protein in a food, called an 

allergen. Milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and 

soybeans are the most common allergens. 

Foodborne illness Sickness caused by eating unsafe food. 

Food component 

The name of a group of foods in a reimbursable meal in the CACFP. 

Food components include grains, vegetables and fruits, meat and 

meat alternates, and breastmilk/infant formula. Vegetables and fruits 

are combined into one component in the infant meal pattern. 

Food intolerance 

A food intolerance is a sensitivity to a certain food that makes it hard 

to digest. The most common intolerances are lactose intolerance and 

gluten intolerance. 

Fortified grains 

Cereal products that have certain B vitamins and iron added to them. 

To identify fortified grains, the food must be labeled as “fortified” and 

have an ingredient statement listing the vitamins and minerals that 

have been added. 

Gag reflex 

When a spoon or solid food is placed in the mouth, the food is quickly 

pushed out of the mouth on the tongue. This reflex is an important 

reason for waiting until a baby is developmentally ready to feed him or 

her solid foods. 

Health care provider 

A doctor, nurse practitioner, or other medical staff that can write 

prescriptions. In the CACFP, these are also called “State-recognized 

medical authorities.”
Words To Know | 3 

Infant A baby between the ages of birth through 11 months. 

Infant cereal 

Cereals designed for babies that are usually prepared by adding 

breastmilk or infant formula. Examples include infant wheat cereals, 

infant oat cereals, infant rice cereals, infant mixed grain cereals, etc. 

Infant cereals must be iron-fortified to meet the CACFP infant meal 

pattern requirements. 

Iron-fortified infant 

formula 

Infant formula that has iron added to it. Infant formulas must be 

iron-fortified to meet the CACFP infant meal pattern requirements. 

Mashed foods Foods prepared to have a lumpy texture. 

Medical statement 

A note written and signed by someone the State recognizes as a 

medical authority, such as a doctor or nurse who is also able to 

write prescriptions. The medical statement must include the name 

of the food to be avoided, explain how the food affects the baby, 

and be signed by the baby's health care provider. Recommended 

substitutions of foods can also be included on the medical statement. 

The medical statement must be kept on file in a secure location at the 

child care site. 

Motor development 

The development of movement. It includes gross motor development, 

which involves large muscles in the arms and legs. It also includes fine 

motor development, which involves small muscles in the fingers and 

toes. Certain types of motor development are part of child feeding, 

such as the ability to sit up, hold a spoon, and to chew foods. 

On-demand feeding Feeding a baby when he or she shows signs of being hungry. 

Palmar grasp When a baby uses his or her whole hand to pick up larger pieces of 

food or objects. 

Pincer grasp When a baby begins to use his or her thumb and index finger to pick 

up smaller pieces of food or objects. 

Product Formulation 

Statement 

A document from a food manufacturer that provides information on 

how a food product credits toward meeting the Federal meal pattern 

requirements.
4 | Words To Know

Pumped breastmilk 

Breastmilk that is collected from a woman’s breast by a manual or 

hand pump, or electric breast pump. Breastmilk is usually pumped 

and collected in bottles or containers for immediate use or to be 

refrigerated or frozen for use at a later time. 

Pureed foods Foods that are blended to a very smooth texture. 

Ready-to-eat cereal 

Breakfast cereals that can be eaten without further preparation (for 

example, corn flakes, bran flakes, and whole grain O’s). In the CACFP, 

ready-to-eat cereals must be made with enriched or whole grain meal 

or flour, or be fortified. The cereal must contain no more than 6 grams 

of sugar per dry ounce (see Appendix D: Choose Breakfast Cereals 

That Are Lower in Added Sugars on page 145). 

Reflux 

Reflux happens when some of the breastmilk or formula does not 

stay in the baby’s stomach and is spit out. Most reflux gets better on 

its own as the baby grows. 

Reimbursable meal A meal or snack in the CACFP that meets meal pattern requirements. 

Responsive feeding 

The practice of recognizing and understanding when a baby is hungry 

or full and responding to those signs. Responsive feeding is related to 

all forms of feeding including breastfeeding, bottle feeding, and offering 

solid foods. 

Rooting 

When a baby’s mouth, lips, cheek, or chin are touched by an object, 

the baby turns his or her head towards the object and opens his or her 

mouth. This reflex helps a baby find and grasp a nipple. 

Single-component foods 

Baby foods that are made up of only one CACFP food component 

(grain, vegetable, fruit, or meat/meat alternate). For example, a 

baby food that is made up of only bananas and apples is a 

single-component food because it contains only fruits. 

Solid foods 

Foods other than breastmilk and infant formula that provide nutrients 

to the baby. Solid foods may be pureed, mashed, ground, or finely 

chopped foods. Solid foods are also known as complementary foods.
Words To Know | 5 

Special Supplemental 

Nutrition Program for 

Women, Infants, and 

Children (WIC) 

Food, nutrition counseling, and access to health services are provided 

to low-income women, infants, and children under the Special 

Supplemental Nutrition Program for Women, Infants, and Children, 

popularly known as WIC. 

Store-bought baby foods 

Baby foods that are made by a company and can be purchased 

at the grocery store. These are also called commercially prepared 

baby foods. 

Sudden Infant Death 

Syndrome (SIDS) 

The unexpected death of a baby less than 1 year of age. SIDS usually 

occurs during sleep. 

Texture 

The look, feel, and consistency of a food. Solid foods fed to babies 

may be changed in their textures based upon the developmental 

readiness of the baby. Descriptions of textures may include smooth, 

lumpy, chopped, ground, soft, or crunchy. 

Tongue thrust 

When the lips are touched, the baby’s tongue moves out of the mouth. 

This reflex lets babies feed from the breast or bottle, but not from a 

spoon or a cup. When solid foods are started too early, the baby’s 

tongue thrust reflex may push the food back out. 

Tooth decay 

Damage to the teeth caused by sugar from foods and beverages. The 

sugar is used by bacteria in the mouth to make acids that can cause 

damage to the teeth. This can happen when a baby drinks from a 

bottle for long periods of time, allowing the sugar in the liquid to pool 

around the teeth and gums and cause damage to the baby teeth. This 

is also known as baby bottle tooth decay. 

Wean 

A process by which the baby gradually gets used to something else. 

For example, a baby should be weaned off the bottle and switched to 

a cup before 18 months of age.
6 | Chapter 1 • Giving Babies a Healthy Start With the CACFP

What’s In This Chapter? 

By the end of this chapter, child care 

providers will be able to: 

Describe how a baby’s usual eating 

habits fit within the CACFP infant 

meal pattern. 

Recognize when a baby is hungry 

or full. 

List at least three feeding skills 

babies are born with or develop. 

Use tools to help talk to parents 

about their baby’s eating habits. 

Identify when a meal or snack is 

reimbursable. 

1 

2 

3 

4 

Chapter 1 

Giving Babies a Healthy 

Start With the CACFP 

Taste preferences and eating habits are formed 

early in a child’s life, making your child care site

an important part of a child’s experiences with 

food. As a child care provider, you support the 

development of children’s eating habits and can 

help them get a healthy start. During the first year 

of life, infants’ mouths change from being able to 

only suck and swallow breastmilk or infant formula 

to being able to chew solid foods. Early in their 

first year, babies need your help during a feeding. 

At around 8 months of age, they begin to learn 

how to feed themselves. As babies continue to 

grow, they are able to eat different kinds of foods. 

Feeding babies the right foods at the right times 

helps them enjoy new tastes and textures, get 

the nutrition they need, and avoid choking. 

What Are Solid Foods? 

Solid foods, also known as complementary 

foods, are foods that are changed to the right 

texture (e.g., pureed, mashed, ground, finely 

chopped, etc.) and can be fed to a baby when he 

or she is developmentally ready. 

A Baby’s Eating Habits 

Babies may get hungry at times outside of typical 

mealtimes. They may need to eat more or less 

often than older children. Babies may also eat 

smaller or larger amounts from day to day. For 

this reason, physicians and dietitians recommend 

that babies be fed on demand, which means 

feeding them when they show signs of being 

hungry. Babies should be offered food when they 

are hungry even if that is not during the regular 

meal schedule at your child care site. In rare 

cases, a parent may provide written instructions 

that the baby be fed on a strict schedule for a 

medical reason. 

The CACFP infant meal pattern takes a baby’s 

usual eating habits into account. As long as all 

of the required foods and amounts of foods are 

offered to the baby during the day, the “meals” 

are reimbursable under the CACFP. Some 

babies may eat less than what you offer them, 

and that’s okay! Never force a baby to finish what 

is in the bottle, bowl, or plate. 

How can I get reimbursed 

when a baby does not eat at a 

normal mealtime? 

You can claim reimbursement for a meal 

in the CACFP even if the baby eats the 

foods at two different times in the day. 

For example, the baby may be offered 

breastmilk at 9 a.m. for the breakfast meal 

and then be offered infant cereal and 

pureed fruit at 10:30 a.m. based on when 

the baby shows signs of being hungry.

5 
Giving Babies a Healthy Start With the CACFP • Chapter 1 | 7 

Parents also rely on you for information to plan 

for the best care for their baby, such as knowing 

how much breastmilk to bring for the day. One 

way to provide information to parents is through 

a daily activity chart that you can send home 

each day. It could include things like what the 

baby ate, bowel movements and number of wet 

diapers, number and length of naps, and other 

important notes. Child care licensing in your 

State may already require this. See Appendix A: 

Sample Infant Daily Activity Chart on page 139

for an example. 

For more tips on communicating with parents, see Chapter 12:

Partnering with Families on page 129. 

How Can I Tell When a Baby 

Is Hungry or Full? 

Feeding "on demand" means feeding a baby 

when he or she shows signs of being hungry 

and stopping the feeding when the baby shows 

signs of being full. But how can you tell if a baby 

is hungry or full? Many people think that babies 

will cry when they are hungry. However, crying is 

a late sign of hunger. Crying can also mean other 

things besides hunger, such as wanting to be held 

or needing a new diaper. Babies may also cry 

because of gas or other sources of pain. Instead 

of waiting for a baby to cry, you can look for other 

signs that a baby is hungry, such as opening and 

closing his or her mouth or making sucking noises 

and motions. The next two tables in this guide 

on pages 8 and 9 list and show pictures of other 

ways you can tell if a baby is hungry or full. 

Responsive Feeding 

Babies feel comforted and understood when 

you can quickly tell when they are hungry or full. 

If a baby shows signs of being hungry, prepare 

the breastmilk, infant formula, or solid foods for 

feeding. Feed the baby and let the baby stop 

eating when he or she is full. This gives the baby 

control over how much he or she eats during a 

feeding. It also helps the baby learn to eat when 

he or she is hungry and stop when he or she 

is full. Later in life, this will be an important skill 

for the child to have. Babies usually consume 

enough food to grow and develop when following 

this eating practice. If you or the parents have 

concerns that this is not the case, encourage the 

parents to discuss the baby’s weight and eating 

habits with their health care provider.

Tip: 

The CACFP does not require that you 

provide a daily activity chart, but it is a great 

way to communicate with parents. 

Talking With Parents About Their 

Baby’s Eating Habits 

Talk with parents often about 

their baby’s eating habits. Some 

important things you can learn by 

talking with parents are: 

• their decision to feed breastmilk 

or infant formula. 

• when and how much their baby 

typically eats at home. 

• when the baby has started eating solid foods. 

• when new foods have been given to the baby. 

• information about any food allergies

and intolerances. 

• foods the family does not eat because 

of religious or other reasons. 
8 | Chapter 1 • Giving Babies a Healthy Start With the CACFP

How Can I Tell If a Baby Is Hungry or Full?

Benefits for 

Mothers

Table 1 How Can I Tell If a Baby Is Hungry? 

• Opens and closes 

mouth 

• Rooting • Makes sucking noises 

and motions, or sucks 

on lips, hands, fingers, 

toes, toys, or clothing 

• Moves head towards 

spoon or tries to 

bring food to his or 

her mouth 

• Reaches or points 

to food 

Don't wait until the baby is crying before feeding him or her. It may be harder to 

get the baby to eat once he or she is upset. Look for some of the earlier signs of 

hunger above.

• Gets excited when he 

or she sees food 

Look for one or more of these hunger signs. Just remember, every baby is different! 

You might find a baby shows a combination of these or only one. 
Giving Babies a Healthy Start With the CACFP • Chapter 1 | 9 

• Falls asleep 

Table 2 How Can I Tell If a Baby Is Full? 

You will normally see more than one of these signs together. When you see 

more than one sign, it is time to stop the feeding. This gives the baby control 

over how much he or she eats during a feeding.

Look for one or more of these signs that the baby is full: 

• Sucks slowly or stops 

sucking 

• Turns head away

• Pushes food away • Seals lips together • Looks around and does 

not pay attention during 

a feeding 
10 | Chapter 1 • Giving Babies a Healthy Start With the CACFP

All babies develop at their own rate. The foods fed 

to a baby at different times during his or her first 

year are based upon the baby’s development. 

This is related to how well the baby can control 

his or her muscles and digest certain foods. 

Although age and size are often related to 

developmental readiness, these should not be 

used as the only factors in deciding what and how 

to feed babies. A baby’s feeding skills are a 

good clue of what food textures the baby may be 

ready to eat. 

The CACFP infant meal pattern provides flexibility. 

This allows you, as the child care provider, the 

ability to feed babies based on their developmental 

readiness, ensuring that babies get what they 

need to grow and be healthy. We will talk more 

about this flexibility later in the chapter. 

Developmental Readiness 

A baby’s feeding skills are a good clue of what textures of food the baby may be ready to eat. 

Feeding Breastmilk to Baby Emma 

Baby Emma is 2 months old and was 

just enrolled in a family child care home. 

Baby Emma’s mom works nearby and lets 

Marta, the child care provider, know she 

would like to breastfeed Emma during her 

lunch break. Marta is very supportive of the 

mom’s decision to breastfeed and has a 

place for Baby Emma’s mom to breastfeed. 

Baby Emma’s mom is happy she can 

breastfeed her baby during the day. Marta 

is able to claim this breastfeeding session 

as part of a reimbursable lunch. 

"A lot of parents may not know what developmental readiness is but this 

breaks it down. Just because they are 4 months old, it does not mean that 

they are ready to eat" - Director of a Child Care Center in New Mexico 

speaking about pages 10 and 12. 
Giving Babies a Healthy Start With the CACFP • Chapter 1 | 11 

Palmar grasp - When the 

baby uses his or her whole 

hand to pick up larger pieces 

of food or objects. 

A Baby’s Feeding Skills 

Rooting - When a baby’s 

mouth, lips, cheek, or chin 

are touched by an object, 

the baby turns his or her 

head towards the object 

and baby opens his or her 

mouth. This reflex lets a baby 

find and grasp a nipple. 

As a baby grows and develops, he or she is able to eat different foods and textures. Below are feeding 

skills a baby will use that can tell you when he or she is ready for a new food. 

Suck and swallow - When a 

baby’s mouth is touched and 

he or she opens his or her 

lips and starts to suck. As 

liquid moves into the baby’s 

mouth, his or her tongue 

moves it to the back of the 

mouth for swallowing. 

Tongue thrust - When the 

lips are touched, the baby’s 

tongue moves out of the 

mouth. This reflex lets babies 

feed from the breast or bottle,

but not from a spoon or a 

cup. When solid foods are 

started too early, the baby’s

tongue thrust reflex may be 

confused with the baby not 

liking the food that was given. 

Gag reflex - When a spoon 

or solid food is placed in the 

mouth, the food is quickly 

pushed out of the mouth 

on the tongue. This reflex 

is an important reason 

for waiting until a baby is 

developmentally ready for 

solid foods. 

Pincer grasp - When a 

baby begins to use his or her 

thumb and index finger to 

pick up smaller pieces of food 

or objects.
12 | Chapter 1 • Giving Babies a Healthy Start With the CACFP

Feeding your baby the right foods at the right time helps him or her get the nutrition needed for good 

health. Your baby will grow to enjoy many types and textures (smooth, lumpy, and so on) of food during 

his or her first year. 

For Parents: Is Your Baby Ready for Solid Foods? 

How Can You Tell When Your Baby Is Ready To Eat Solid Foods? 

Why Does Your Baby Need To Try Solid Foods? 

Starting solid foods when your child is developmentally ready 

is important because: 

• Your baby is getting bigger and needs more calories and 

nutrients that can come from solid foods. 

• It gives your baby a chance to try different foods so he or 

she will like them at an early age and will continue to eat 

them as he or she gets older. 

• Uses his or her tongue to 

move food from the spoon 

into his or her mouth. 

The tongue does not 

automatically push the food 

out of his or her mouth. 

Your baby is ready to start solid foods if he or she: 

Tip: Many, but not all, babies show signs that they are developmentally ready for 

solid foods at around 6 months.

Food and Nutrition Service

• Opens his or her mouth 

when foods come his or 

her way or reaches for 

food. 

• Sits in a high chair with 

good head control. 
Giving Babies a Healthy Start With the CACFP • Chapter 1 | 13 

Baby’s Name (first and last):

For Parents: Have You Already Started Giving 

Your Baby Solid Foods? Please Let Us Know! 

Are there foods your family does not eat due to religious reasons? 

• If yes, which foods does your family not eat? 

Is there anything else we should know about what or how your baby eats? 

Parent’s Signature: 

Parent’s Name (first and last): 

Today’s Date: Baby’s Birth Date: 

Yes 

Name:

What foods have you given to your baby? 

Has your baby had an allergic reaction to any foods? 

Please complete this handout and give it to your child care provider. 

 • If yes, which foods should we not serve to your baby in child care?

Did your baby’s health care provider tell you that your baby has a food allergy or intolerance? 

 No 

If your baby has a reaction to a food, who should we call? 

If your baby has a reaction to a food at child care, is there medication your baby’s health care provider 

said to give to him or her? 

Phone number: 

Yes No 

.

A handout from Feeding Infants in the Child and Adult Care Food Program 

https://teamnutrition.usda.gov • FNS 786A • March 2019 

USDA is an equal opportunity provider, employer, and lender.

Relationship: 
14 | Chapter 1 • Giving Babies a Healthy Start With the CACFP

Infant Age Groups in the CACFP 

Each meal and snack under the infant meal 

pattern is made up of food components, such as 

breastmilk or formula and vegetables and fruits. In 

some cases, there are several foods you may offer 

to meet the food component; these are indicated 

by the use of the word “or” after each component 

in Table 3, CACFP Infant Meal Pattern With Food 

Components on page 15. 

A meal or snack is reimbursable as long as all 

required food components are offered to the baby 

during the course of the day while the baby is in 

your care. For example, if a baby was breastfed at 

home before arriving at child care, the baby may 

See Appendix B: Sample Infant 

Menu on page 140.

Food Components in the Infant Meal Pattern 

Did you know? 

The CACFP infant meal pattern reflects 

how babies grow and develop and when 

they are typically ready for solid foods. 

Older baby eating small pieces of bread at snack. 

There are two infant age groups under the 

CACFP infant meal pattern. They are birth 

through 5 months and 6 through 11 months. 

not be hungry for the breakfast meal when he or 

she first arrives. Your child care site may offer the 

breakfast later in the morning when the infant is 

hungry and can still claim it for reimbursement. 

Babies do not need to eat the entire meal offered 

for the meal to be reimbursable. As long as the 

baby is offered all the required food components, 

the meal is still reimbursable. 
Giving Babies a Healthy Start With the CACFP • Chapter 1 | 15 

Table 3 CACFP Infant Meal Pattern With Food Components 

Prepare all foods to the appropriate texture in order to match the baby’s 

feeding skills and to prevent the baby from choking. For more information on 

textures, see Chapter 6: Feeding Solid Foods on page 59. Amounts below 

are minimum serving sizes that must be served in order for the meal to 

be reimbursable. For more information, see “Serving Sizes in the Infant Meal 

Pattern” on page 17. 

Abbreviations 

fl. oz. = fluid ounces 

oz. = ounces 

tbsp. = tablespoons 

Breakfast 0 through 5 Months 6 through 11 Months 

Breastmilk or infant 

formula 4–6 fl. oz. breastmilk1 or formula2 6–8 fl. oz. breastmilk1 or formula2 

Grains or meat/meat 

alternates, or 

a combination 

0–4 tbsp. infant cereal,2 meat, fish, 

poultry, whole eggs, cooked dry 

beans or peas; or 

0–2 oz. cheese; or 

0–4 oz. cottage cheese; or 

0–4 oz. (1⁄2 cup) yogurt3; 

or a combination of the above4 

Vegetables, fruit, 

or both 0–2 tbsp. vegetables, fruit, or both4

,

5 

Lunch or Supper 0 through 5 Months 6 through 11 Months 

Breastmilk or infant 

formula 4–6 fl. oz. breastmilk1 or formula2 6–8 fl. oz. breastmilk1 or formula2 

Grains or meat/meat 

alternates, or 

a combination 

0–4 tbsp. infant cereal,2 meat, fish, 

poultry, whole eggs, cooked dry 

beans or peas; or 

0–2 oz. cheese; or 

0–4 oz. cottage cheese; or 

0–4 oz. (1⁄2 cup) yogurt3; 

or a combination of the above4 

Vegetables, fruit, 

or both 

0–2 tbsp. vegetables, fruit, or 

both4

,

5

Table 3 continued on pg 16
16 | Chapter 1 • Giving Babies a Healthy Start With the CACFP

Snack 0 through 5 Months 6 through 11 Months 

Breastmilk or infant 

formula 4–6 fl. oz. breastmilk1 or formula2 2–4 fl. oz. breastmilk1 or formula2 

Grains 0–1⁄2 bread slice6; or 

0–2 crackers6; or 

0–4 tbsp. infant cereal2,6; or 

0–4 tbsp ready-to-eat cereal4,6,7 

Vegetables, fruit, 

or both 

0–2 tbsp. vegetables, fruit, or 

both4

,

5 

1 Breastmilk or formula, or portions of both, must be served; however, it is recommended that breastmilk 

be served in place of formula from birth through 11 months. For some breastfed infants who regularly 

consume less than the minimum amount of breastmilk per feeding, a serving of less than the minimum 

amount of breastmilk may be offered, with additional breastmilk offered at a later time if the infant will 

consume more. 

2 Infant formula and dry infant cereal must be iron-fortified. 

3 Yogurt must contain no more than 23 grams of total sugars per 6 ounces. 

4 A serving of this component is required when the infant is developmentally ready to accept it. 

5 Fruit and vegetable juices must not be served. 

6 All grains served must be made with enriched or whole grain meal or flour. Ready-to-eat breakfast cereals 

and infant cereals that are fortified are also creditable. 

7 Ready-to-eat breakfast cereals must contain no more than 6 grams of sugar per dry ounce (no more than 

21.2 grams sucrose and other sugars per 100 grams of dry cereal). 

See Appendix C: Infant Meal Pattern on page 143 to view the chart found in the 

Child and Adult Care Food Program: Meal Pattern Revisions Related to the Healthy, 

Hunger-Free Kids Act of 2010 Final Rule (7 CFR Parts 210, 215, 220, et al.). This can 

also be found online at: https://www.fns.usda.gov/cacfp/meals-and-snacks.

Table 3 continued from pg 15
Giving Babies a Healthy Start With the CACFP • Chapter 1 | 17 

The infant meal pattern lists minimum serving 

sizes of breastmilk, infant formula, and solid foods 

as a range of numbers, rather than one specific 

number. For example, for vegetables and fruit, the 

serving size for infants 6 through 11 months is 

0–2 tablespoons. This means that the infant must 

be offered 0 to 2 tablespoons of vegetables and/ 

or fruit for the meal to be reimbursable. The baby 

does not have to eat the entire amount served for 

the meal to be reimbursed. 

Minimum serving sizes are listed as ranges for 

infants because not all babies are ready to eat 

solid foods at the same time. A baby that has not 

yet started solid foods would receive a serving 

size of 0 tablespoons. A baby that has just 

started eating a certain vegetable may receive 

1 tablespoon. Once a baby has been regularly 

eating a specific solid food, he or she would 

receive 2 tablespoons. In all of these instances, 

the meal would be reimbursable. 

Serving Sizes in the Infant Meal Pattern 

One food component provided by parents that meets the infant meal pattern requirements may also be 

part of a reimbursable meal. If a parent brings in a food component (e.g., pureed meat), you must offer 

iron-fortified infant formula and all other required food components. If a baby is only drinking breastmilk or 

infant formula and the parent provides the breastmilk or infant formula, the meal is reimbursable. Likewise, 

the meal is reimbursable if a mother breastfeeds her baby at your child care site. 

Food Components Provided by the Parents 

Child care provider feeding a baby solid food. 

As a child care provider, start offering a baby solid 

foods after the parents have told you that the 

child is developmentally ready and is eating solid 

foods at home. You can use the "For Parents: 

Is Your Baby Ready for Solid Foods?" handout on 

page 12 to help talk to parents about solid 

foods for their baby. Once an infant is regularly 

eating solid foods, you must offer all required 

food components. 

In this chapter, you have learned about how a baby’s eating habits fit within the CACFP infant 

meal pattern, hunger and fullness signs, feeding skills, and food components within the 

CACFP infant meal pattern. You will use this information in the next chapter when we learn 

more about offering breastmilk to a baby at your child care site.

In This Chapter 
18 | Chapter 1  Giving Babies a Healthy Start With the CACFP

Key Concepts

The two infant age groups under the CACFP infant meal pattern are: 

(1) birth through 5 months, and 

(2) 6 through 11 months.

By telling parents the amount of breastmilk consumed by their baby each day, 

you can help families know the amount of breastmilk needed at child care.

Serve solid foods once the parents tell you the baby is developmentally ready 

and eating solid foods at home. This is usually around 6 months of age.

The range of serving sizes (i.e., 0–2 tablespoons) for solid foods in the infant 

meal pattern shows that all babies are not developmentally ready to eat solid 

foods at the same time. The range of serving sizes, starting at “0”, supports 

the gradual introduction of solid foods. Once a baby has been introduced to a 

food, you would offer the baby the full amount.

The CACFP infant meal pattern includes food components and amounts that 

must be offered to the baby for a meal or snack to be reimbursable under the 

CACFP. The baby does not have to eat all the food offered in order for the meal 

or snack to be reimbursed.

Feed babies when they show signs of hunger instead of on a set schedule. 

You can still be reimbursed for the meal as long as all of the food components 

are offered during the day.

Talking often with parents of babies can help you know when the baby is 

developmentally ready for solid foods. Use the “For Parents: Is Your Baby 

Ready for Solid Foods?" handout on page 12 to help you talk to parents about 

solid foods.

Giving Babies a Healthy Start With the CACFP
Giving Babies a Healthy Start With the CACFP • Chapter 1 | 19 

1. Fill in the blank: What are the two age groups under the CACFP infant meal 

pattern? and . 

2. A father brings in organic pureed carrots for his 6-month-old baby to 

have at lunch. As the child care provider, what foods do you need to offer to 

the baby to claim reimbursement for lunch? 

3. A mother breastfeeds her baby before she brings him to child care. He is 

asleep when he arrives and stays asleep until 11 a.m. You did not have a 

chance to offer him breakfast since he was asleep. What do you do in order 

to claim reimbursement of the breakfast meal? 

Birth through 5 months and 6 months through 11 months. 1. ANSWER: 

Since the organic pureed carrots count as the one parent-provided food 2. 

on-fortified component, you must offer all other food components. This could include ir

infant cereal or a meat or meat alternate, such as pureed chicken or mashed beans, 

and iron-fortified infant formula. Be sure to offer the minimum serving size of each item 

in order to be reimbursed. 

If the baby shows signs of being hungry when he wakes up at 11 a.m., offer him or 3. 

her the breakfast you would have offered earlier that morning. Babies do not eat on a 

set schedule, so feeding them when they are hungry is okay. As long as you offer the 

breastmilk or infant formula and foods once the baby shows signs of being hungry, 

eimbursement for the breakfast meal. you can claim r

Check Your Knowledge 
20 | Chapter 2 • Feeding the Breastfed Baby

What’s In This Chapter? 

By the end of this chapter, child care 

providers will be able to: 

Describe the benefits of 

breastfeeding for babies, mothers, 

and their families. 

List at least three ways to support 

breastfeeding mothers. 

Identify the minimum amount of 

breastmilk that must be offered to 

an infant at each meal or snack. 

Chapter 2 

Feeding the Breastfed Baby 

Breastmilk is the best source of nutrition for 

babies. It is the only food healthy babies need for 

about the first 6 months of their lives. Breastmilk is 

easy to digest and helps keep babies healthy by 

boosting the baby’s immune system. A mother’s 

breastmilk is made for her baby and contains 

just the right amounts of nutrients. As the baby 

grows and changes, the mother’s breastmilk also 

changes. This helps the baby get the nutrients he 

or she needs to stay healthy and grow. Babies 

from birth to around 6 months typically do not 

need extra water or foods added to the bottle, 

such as infant cereal. 

Breastmilk is still important for babies even after 

solid foods, also known as complementary 

foods, are started. Babies should continue to 

receive breastmilk until their first birthday or 

longer. If a mother chooses to give her baby 

breastmilk, let her know that she is welcome to 

breastfeed at your child care site or can provide 

expressed or pumped breastmilk in bottles for 

her baby. 

Child care provider feeding a baby a 

bottle of breastmilk. 

1 

2 

3 

Tip: 

As a best practice, the CACFP

encourages you to offer a quiet, private 

area that is comfortable and clean for 

the mother to breastfeed her baby. As 

a CACFP provider, you will still receive 

reimbursement for meals and snacks 

when the mother has provided pumped 

breastmilk or has breastfed her baby at 

your child care site even after the child’s 

first birthday.
Feeding the Breastfed Baby • Chapter 2 | 21 

What is so good about 

breastfeeding? 

Breastfeeding is good for the baby, 

mother, and family. 

Benefits for 

Babies 

Benefits for 

Mothers 

Benefits for 

Families 

• Breastfed babies 

may have: 

• lower risk of asthma. 

• fewer stomach 

problems like diarrhea. 

• fewer infections that 

cause vomiting and 

diarrhea. 

• fewer ear and lower 

respiratory infections. 

• lower risk of Sudden 

Infant Death 

Syndrome (SIDS). 

• lower risk of becoming 

obese. 

• Babies taste different 

flavors in breastmilk 

based on what the 

mother eats. This may 

help babies accept 

new flavors from solid 

foods more easily. 

• Skin-to-skin contact 

during breastfeeding 

may help moms and 

babies bond. 

• Mothers who 

breastfeed may: 

• have less blood loss 

after childbirth. 

• feel more relaxed. 

• have lower risk of 

ovarian and certain 

types of breast cancer. 

• have lower risk of Type 

2 diabetes. 

• Skin-to-skin contact 

during breastfeeding 

may help moms and 

babies bond. 

• Families with mothers 

who breastfeed often: 

• spend less money 

because they do not 

have to buy infant 

formula. 

• take fewer sick days 

from work since 

babies who are 

breastfed tend to have 

fewer infections. 

• spend less on doctor’s 

visits since their baby 

is sick less often. 

• Family members 

can help with feeding 

by giving the baby 

breastmilk that the 

mother has pumped 

and put into bottles.

Table 4 Benefits of Breastfeeding for Babies, 

Mothers, and Families 
22 | Chapter 2 • Feeding the Breastfed Baby

Share information about 

breastfeeding. 

Give the “Breastfed Babies Welcome Here! 

A Mother’s Guide” to expectant mothers. 

This guide provides information about 

breastfeeding and how child care can 

support the mother’s efforts to continue 

breastfeeding even when she goes back to 

work or school. 

Create an 

inviting space. 

Display the “Breastfed Babies Welcome 

Here!” poster and message graphic to let 

families know your child care site is 

breastfeeding friendly. See "Creating a 

Breastfeeding-Friendly Environment" on 

page 27 for more ideas. 

Find the “Breastfed Babies Welcome Here!” 

guide, poster, and message graphic online at: 

https://www.fns.usda.gov/tn/ 

breastfed-babies-welcome-here. 

Supporting Families of Breastfed Babies 

Even mothers who have breastfed before can face challenges feeding a new baby, 

because every baby is different. As a child care provider, you can support families of 

breastfed infants every step of the way. 

While the Mother Is Pregnant, You Can: 

"Moms would want to know about whether it was ok to breastfeed but might be afraid 

to ask. The poster would break the ice, get moms asking questions about it. Plain and simple.” 

– Director of a Family Child Care Home in New Mexico

 

 

 
Feeding the Breastfed Baby • Chapter 2 | 23 

Before Mothers Return to Work or School, You Can: 

Encourage Mothers To 

Continue Breastfeeding. 

• Let mothers know that your child care site 

will support their breastfeeding efforts. 

• Let mothers know that it’s best to wait to 

give a baby a pacifier until he or she gets 

used to breastfeeding, usually around 1 

month of age. 

Encourage Mothers To Prepare To Go Back 

to Work or School. 

• Recommend to mothers that they may want 

to try expressing or pumping their breastmilk 

several weeks before they go back to 

work or school and when they are not 

breastfeeding their baby directly. A mother’s 

body makes breastmilk based on how much 

and how often she nurses or pumps. Nursing 

and pumping often will help mothers keep up 

their milk supply. 

• Suggest that families get the baby used to 

taking breastmilk from a bottle that is offered 

from someone other than the mother 2 

weeks before the baby starts child care. The 

baby should be at least 3-4 weeks old before 

introducing a bottle. 

Encourage Mothers To Talk to Their Baby’s 

Health Care Provider. 

• Parents should speak to their baby’s health 

care provider regularly to be sure their baby is 

getting the food and nutrients he or she needs 

as he or she develops.

Tip: 

Ask parents to introduce a bottle 2 weeks 

before the baby starts child care. 

Creating a welcoming environment for 

breastfeeding mothers can help mothers 

breastfeed longer. 
24 | Chapter 2 • Feeding the Breastfed Baby

For more information on WIC, 

including how to apply, please see: 

https://www.fns.usda.gov/wic/ 

who-gets-wic-and-how-apply. 

See “Creating a Breastfeeding-Friendly 

Environment” on page 27 for ideas 

on how to create an inviting space for 

breastfeeding mothers.

• If mothers participate in the Special 

Supplemental Nutrition Program for Women, 

Infants, and Children (WIC), they can contact 

their local WIC nutritionist, a WIC peer counselor, 

or WIC support group for advice and help with 

breastfeeding. 

• If they do not participate in WIC, they can find 

a breastfeeding specialist through the local or 

State health department, local breastfeeding 

coalition, International Lactation Consultant 

Association (http://www.ilca.org), or a local 

hospital. 

• Some insurance plans may cover the cost of 

breastfeeding counseling and breast pumps. 

Encourage mothers to call their insurance 

provider to see if they offer these benefits. 

• Depending on the State the mothers live 

in, Medicaid may also cover the cost of 

breastfeeding counseling and a pump for 

breastfeeding mothers. 

Encourage Mothers To Breastfeed 

at Your Child Care Site. 

If available at your child care site, let mothers 

know that you have a quiet, private area that 

is comfortable and clean for mothers who 

choose to breastfeed their babies on site. 

Tell Mothers About Resources in 

the Community. 

Having a place where moms can breastfeed at your child care 

site can make it possible for moms to pump less often. 

WIC 
Feeding the Breastfed Baby • Chapter 2 | 25 

For more tips on how to support parents, see Chapter 12: 

Partnering With Families on page 129.

See Table 1, How Can I Tell If a 

Baby Is Hungry? and Table 2, 

How Can I Tell If a Baby Is Full? 

on pages 8 and 9. 

Babies should be fed when they show signs of 

being hungry. Talk with the parents about how 

the baby shows that he or she is hungry and full. 

You can use the “For Parents: Breastfeeding? 

Tell Us About Your Breastfed Baby!” handout on 

page 26 to help you talk to parents about feeding 

their baby. 

If a mother requests that her baby receive 

infant formula in addition to breastmilk, 

encourage the mother to continue to 

breastfeed and pump her milk to keep up 

her milk supply. If a mother breastfeeds or 

pumps less often, her body may make less 

breastmilk. Giving a baby both breastmilk 

and infant formula in the same meal or snack 

is creditable in the CACFP. Be sure to feed 

the baby the breastmilk first, and then the 

infant formula. 

When the Baby Is in Your Care, You Can: 

Encourage parents to provide a back-up 

supply of frozen or refrigerated breastmilk 

for times when the baby wants to eat more 

or the parent is running late. All breastmilk 

should be clearly labeled with the baby’s full 

name and the date the milk was pumped. 

Ask the parents about the baby’s usual eating habits. 
26 | Chapter 2 • Feeding the Breastfed Baby

How many fluid ounces of breastmilk does your baby usually drink when you feed him or her? 

We will always feed your baby breastmilk if you provide it. If your baby is still hungry after we feed him or 

her the breastmilk, what would you like us to give your baby? 

For Parents: Breastfeeding? Tell Us About Your Breastfed Baby! 

As your child care provider, we want to make sure we are meeting your baby’s needs. Please share how 

you know when your baby is hungry and what you feed your baby. 

Yes No We have a space for you to breastfeed at our child 

care site! Would you be interested in using it? 

Let us know if you want to breastfeed your baby at pick up and we will make sure your baby is ready. 

Parent’s Signature: 

Today’s Date Baby’s Name (first and last) 

Baby’s Birth Date Parent's Name (first and last) 

What signs does your baby give you to tell you that he or she is hungry?

You are also welcome to 

bring a back-up supply 

of breastmilk that we can 

keep in the refrigerator or 

freezer. 

Tip: 

Remember: when you bring in breastmilk, please 

label the bottle with your baby’s full name and the 

date you pumped the breastmilk. 

☐ Opens and closes mouth ☐ Sucks hands and other objects

☐ Tries to bring food to his or her mouth ☐ Reaches or points to food

☐ Cries ☐ Makes sucking noises and motions 

☐ Roots or turns his or her head and opens his or her mouth

☐ Other

.

A handout from Feeding Infants in the Child and Adult Care Food Program 

https://teamnutrition.usda.gov • FNS 786B • March 2019 

USDA is an equal opportunity provider, employer, and lender.

Food and Nutrition Service
Feeding the Breastfed Baby • Chapter 2 | 27 

Creating a BreastfeedingFriendly Environment 

A welcoming environment for breastfeeding mothers 

can help mothers breastfeed longer. 

Offer a mother a clean, comfortable, and quiet place to 

breastfeed her baby or pump breastmilk. This could be a 

space in a small room, or a corner of a classroom or office 

with a privacy screen or curtain. See below for some 

ideas on how to create a breastfeeding-friendly space 

at your child care site. Remember that a breastfeedingfriendly space at your child care site is not required in the 

CACFP, but it is a best practice. 

This Space Can Include: 

 A pillow to 

support the baby. 

Drinking water for mom. Disinfectant wipes 

to clean up before 

and after pumping. 

A table to place her 

pumping equipment. 

An electrical outlet for 

the breast pump. 

A stool for mom's feet 

to help support her 

back while nursing. 

A comfortable 

chair, such as a 

rocking chair. 

A sink to wash her 

hands and the pumping 

equipment. 
28 | Chapter 2 • Feeding the Breastfed Baby

Feeding Breastmilk in a Bottle 

Breastfed babies usually eat every 11⁄2 to 3 hours 

in the first few months and every 3 to 4 hours 

after that. As with all babies, breastfed babies 

go through growth spurts. During these growth 

spurts, babies may need more breastmilk or 

need to eat more often. All babies should be fed 

based on signs of when they are hungry. Stop the 

feeding when the baby shows signs of being full. 

When babies are adjusting to a new place, some 

babies may only drink a little breastmilk. Talk 

about the baby’s usual eating habits with the 

parents. A baby who drinks less breastmilk during 

the day may drink a lot more at home to make up 

for it. 

See Table 1, How Can I Tell If a Baby 

Is Hungry? and Table 2, How Can 

I Tell If a Baby Is Full? on pages 8 

and 9. 

What if the baby is still 

hungry after a feeding, 

but there is no more 

breastmilk? 

Use the "For Parents: Breastfeeding? Tell 

Us About Your Breastfed Baby!" handout 

on page 26 to talk to the baby’s parents 

about what they would like you to do if 

you run out of breastmilk. They may want 

to bring a back-up supply of breastmilk to 

your child care site for that meal or have 

you offer the iron-fortified infant formula 

you have at your child care site.

is 4–6 fluid ounces. The minimum amount of 

breastmilk for babies 6 through 11 months is 6–8 

fluid ounces at breakfast, lunch, and supper, and 

2–4 fluid ounces at snack. Some babies may 

regularly drink less than the minimum amount of 

breastmilk required. In this case, you may offer 

less than the minimum amount of breastmilk at 

each feeding as long as more breastmilk is offered 

later when the baby is hungry. 

For example, if a baby was breastfed at home 

right before arriving at your child care site, he or 

she may not be hungry for the breakfast meal 

when he or she first arrives. You can offer the 

meal to the baby later in the morning when the 

baby is hungry. You can still claim it as part of a 

reimbursable meal even if the baby does not eat 

all of it. 

Breastmilk and the CACFP Infant 

Meal Pattern 

As long as the baby is offered the minimum 

amount of breastmilk required by the CACFP, you 

can claim it as part of a reimbursable meal even 

if the baby does not drink all of it. The minimum 

amount of breastmilk for babies 0 through 5 

months at breakfast, lunch, supper, and snack 

Bottles of breastmilk labeled with baby's full name 

and the date the breastmilk was pumped. 

Tip: 

As long as the baby is offered the minimum 

amount of breastmilk required by the CACFP, 

you can still claim it as part of a reimbursable 

meal or snack even if the baby does not drink 

all of it. 
Feeding the Breastfed Baby • Chapter 2 | 29 

Be sure to talk to breastfeeding 

mothers to see if they plan to 

breastfeed at pickup. If they do, ask 

if they would like you to wait to 

feed the baby if the baby is hungry right 

before pickup time. This can help make sure 

the baby is hungry enough to nurse once 

mom arrives. 

Remember, you may claim reimbursement of 

meals when a mother nurses her baby at your 

child care site. This includes meals when the 

baby is only drinking breastmilk. 

Bowel Movements 

Stool of babies given only breastmilk are loose 

and seedy looking. Sometimes it can be 

mistaken for diarrhea. The bowel movements for 

formula-fed babies tend to be darker and firmer 

with a stronger smell. Usually, breastfed babies 

have more bowel movements than formula-fed 

babies. However, as breastfed babies grow, they 

may have fewer bowel movements and even go 

for days without one. This is normal as long as 

the bowel movement is soft. 

 

It is important to talk with parents 

about the number and types of 

diaper changes the infant had 

during the day. This way, they will 

be aware of anything that might be unusual 

and can talk to the baby’s health care provider 

as needed. 

Breastmilk for Babies Over 

12 Months of Age 

Breastmilk may be used to meet the fluid milk 

component in the meal pattern for children. If a 

parent wants his or her child (1 year old or older) 

to be served breastmilk in place of fluid milk, a 

written request by the parent is not required. 

Mothers may breastfeed on site or parents 

can provide pumped breastmilk for their child. 

Parents do not need to provide a written request 

for the meal to be reimbursed. 

If a mother is unable to provide enough breastmilk 

to meet the minimum fluid milk requirement of 4 

fluid ounces (1⁄2 cup) at each meal or snack for a 

child 1 through 2 years old, unflavored whole milk 

may be offered, after breastmilk, to meet the 

minimum requirement. For children older than 2, 

unflavored fat-free (skim) or low-fat (1%) milk may 

be served after breastmilk to meet the minimum 

fluid milk requirement for that age group. Discuss 

this with the parents before giving a child fluid milk. 

Tip: 

Breastmilk may be served in place of fluid 

milk for children one year of age and older. A 

written request from parents is not required. 

In This Chapter 

In this chapter, you have learned about the 

benefits of breastfeeding, how to support 

breastfeeding mothers, and how to offer 

breastmilk within the CACFP infant meal 

pattern. In the next chapter, you will learn 

more about offering infant formula to a 

baby at your child care site.
30 | Chapter 2 • Feeding the Breastfed Baby

Breastmilk provides benefits to babies, mothers, and families. Share 

these benefits with families to support breastfeeding mothers at your child 

care site. See Table 4, Benefits of Breastfeeding for Babies, Mothers, and 

Families on page 21 for a full list of benefits. 

If a parent provides pumped breastmilk for the baby, the meal is still 

reimbursable as long as you provide all other required food components. 

If a mother breastfeeds her child at your child care site, you may claim that 

milk as part of a reimbursable meal as long as you provide all other required 

food components. 

The infant meal is still reimbursable if the infant does not finish the 

required minimum serving size of pumped breastmilk as long as it is 

offered to him or her. 

By offering a place where the mother can breastfeed her baby on site, you 

can support continued breastfeeding. 

For children age 1 year and older, breastmilk can be used to meet the 

CACFP fluid milk component of a meal. A written request from the parent is 

not required.

Key Concepts Feeding the Breastfed Baby 
Feeding the Breastfed Baby • Chapter 2 | 31 

1. All of the following statements about the benefits of breastfeeding are true, except: 

A Breastmilk helps a baby’s immune system to fight infections, like ear infections. 

B Mothers that breastfeed may have a lower risk of Type 2 diabetes. 

C Families cannot help with feeding a breastfed baby. 

D Babies taste different flavors in breastmilk, which may help babies accept new flavors later 

when they start eating solid foods. 

2. A child care provider can support breastfeeding mothers by doing all of 

the following, except: 

A Let mothers breastfeed in the bathroom. 

B Share information about the Special Supplemental Nutrition Program for Women, Infants, 

and Children (WIC). 

C Distribute the "Breastfed Babies Welcome Here! A Mother's Guide" to visiting mothers, 

and display the "Breastfed Babies Welcome Here!" poster and message graphic at the

 child care site. 

D Encourage mothers to continue breastfeeding even when they go back to work or school. 

3. The minimum amount of breastmilk for babies 0 through 5 months at breakfast, lunch, 

supper, and snack is fluid ounces. The minimum amount of breastmilk for babies 

6 through 11 months is fluid ounces at breakfast, lunch, and supper, and fluid 

ounces at snack. 

4. A mother wants to come to your child care site at lunch to breastfeed her 3-monthold baby. Can you claim reimbursement for the lunch meal? 

A. Offer mothers a clean, quiet place to breastfeed her baby or pump 2. ● C. 1. ANSWERS: 

Yes, a meal or snack is 4. ● 4–6 fluid ounces; 6–8 fluid ounces; 2–4 fluid ounces. 3. ● eastmilk. br

still reimbursable even when the mother breastfeeds her baby at the child care site. To document 

the feeding, indicate on the menu that baby was breastfed on site by mom.

Check Your Knowledge 
32 | Chapter 3 • Feeding the Formula-Fed Baby

Chapter 3 

Feeding the Formula-Fed Baby 

What’s In This Chapter? 

By the end of this chapter, child care 

providers will be able to: 

Define what an iron-fortified 

infant formula is in the CACFP. 

Identify different types of 

infant formula. 

Describe when a child should switch 

from infant formula to cow’s milk. 

1 

2 

3 

In the CACFP infant meal pattern, a site 

must offer at least one iron-fortified infant 

formula that is regulated by the Food and Drug 

Administration (FDA). The FDA has strict nutrition 

and safety standards for infant formula to make 

sure infants are getting the nutrients they need 

for healthy growth. All infant formulas sold in the 

United States are regulated by the FDA. If an 

infant formula is bought from a place online or in 

person outside of the United States, it is probably 

not regulated by the FDA and should not be used. 

Contact your sponsoring organization or State 

agency if you are unsure if the infant formula you 

offer is regulated by the FDA and is creditable. 

Infant Formula in the CACFP 

Infant Meal Pattern 

While you must offer at least one iron-fortified 

infant formula, the type of infant formula fed 

to a baby is a decision that should be made by 

the baby’s parents and health care provider. 

Speak with parents about the type 

of formula that you provide at your 

child care site. 

The baby’s parent may decide to: 

1. use the iron-fortified infant formula you 

provide; 

2. decline the offered iron-fortified infant formula 

and bring their own infant formula; 

3. provide breastmilk only, including breastfeeding 

their baby at your child care site; 

4. provide breastmilk and supplement with the 

iron-fortified infant formula you provide; or 

5. provide breastmilk and supplement with their 

own infant formula. 

You can claim the meal for reimbursement in any 

of these situations as long as you provide all other 

required food components. 

Parent bringing iron-fortified infant formula 

to the child care site.
Feeding the Formula-Fed Baby • Chapter 3 | 33 

A parent may wish to provide breastmilk and 

supplement with either your iron-fortified infant 

formula or an infant formula they provide. 

Giving a baby both breastmilk and infant 

formula is creditable in the CACFP, but be sure 

to feed the baby their mother’s breastmilk first 

and then the infant formula. 

If a parent declines the iron-fortified infant 

formula that your site offers and chooses to 

For information on preparing, handling, and storing infant formula, see Chapter 4: 

Handling and Storing Breastmilk and Infant Formula on page 41.

Parent giving a child care provider the baby's iron-fortified infant formula. 

provide his or her own infant formula, explain 

that the parent must provide a formula that is 

iron-fortified and regulated by the FDA. 

If a parent sends a pre-prepared 

bottle to the site, ask what type 

of formula it is and make sure the 

bottle is labeled with the baby’s full name and 

the date the formula was prepared. 

As a child care provider, you may choose to 

have parents sign a form that says they do not 

want you to feed their baby the iron-fortified 

infant formula you offer and that they will provide 

either breastmilk or a different iron-fortified infant 

formula. See the handout "For Parents: Feeding 

Your Baby Infant Formula? Tell Us More!" on page 

34 for an example. However, this handout is not a 

requirement in the CACFP. 

Tip: 

Your child care site must offer at least one 

iron-fortified infant formula. 
34 | Chapter 3 • Feeding the Formula-Fed Baby

For Parents: Feeding Your Baby Infant Formula? Tell Us More! 

How does your baby let you know that he or she is hungry? 

Today’s Date Baby’s Name (first and last) 

Baby’s Birth Date Parent Name (first and last) 

Parent's Signature:

Child Care Providers, please fill out the following: 

At our child care site, we offer type of iron-fortified infant formula. 

What infant formula would you like us to serve your baby? Please answer below. 

Please give my baby the infant formula you have at the child care site.

I will provide breastmilk. Please do not give my baby the infant formula you have at the child care site.

My baby has a disability and needs a special infant formula. 

Thank you for letting us know! We will be reaching out to you for more information about your 

baby's disability. 

My baby does not have a disability, but I want to provide different infant formula than the one you 

have at the child care site. Please do not give my baby the infant formula you have at the child 

care site. 

Thank you for letting us know! Since we participate in the Child and Adult Care Food Program 

(CACFP), the infant formula served in our site and the one you provide must be iron-fortified.

To tell if a formula is iron-fortified, look for “Infant Formula With Iron,” or a similar statement on the 

front of the formula package. It must also be purchased in the United States. 

A handout from Feeding Infants in the Child and Adult Care Food Program 

https://teamnutrition.usda.gov • FNS 786C • March 2019 

USDA is an equal opportunity provider, employer, and lender.

Food and Nutrition Service
Feeding the Formula-Fed Baby • Chapter 3 | 35 

Iron-fortified infant formula is required in the CACFP for babies who are not breastfed or are partially 

breastfed. Iron supports the baby’s growth and brain development. To make sure the iron-fortified 

infant formula you offer is creditable in the CACFP, you can: 

Iron-Fortified Infant Formula 

Use the Nutrition Facts label as a guide to 

make sure the formula has enough iron. To 

be considered iron-fortified, an infant formula 

must have 1 mg of iron or more per 100 

calories of formula when prepared using the 

label directions. 

Look for “Infant Formula With Iron,” or a 

similar statement on the front of the formula 

package. 

Some parents may avoid feeding their infants ironfortified formula because they think that the iron 

causes stomachaches or other problems. Studies 

show that iron-fortified formula does not cause 

these symptoms. However, if a parent does not 

want the baby to have iron-fortified infant formula, 

another infant formula can be substituted by you 

or the parent. For more information, see “SoyBased, Low Lactose, and Lactose-Free Formulas” 

on page 36. 

Resources in the Community 

Parents who are concerned that they cannot afford 

to buy infant formula to feed their baby at home 

can be referred to the local Special Supplemental 

Nutrition Program for Women, Infants, and 

Children (WIC) program for assistance. Contact 

your local health department for more information.

WIC 

 
36 | Chapter 3 • Feeding the Formula-Fed Baby

Soy-Based Infant Formula 

Soy-based infant formula was developed for 

infants who cannot tolerate infant formula made 

from cow’s milk. Parents may choose to provide 

this formula because of an allergy or intolerance, 

if they are seeking a vegan diet for their baby, or 

for other reasons. 

Soy-Based, Low Lactose, and Lactose-Free Formulas 

Soy-based, low lactose, and lactose-free formulas are creditable in the CACFP as long as they 

are iron-fortified. A medical statement is not required for you to serve these formulas as part of 

a reimbursable meal or snack. 

For more information on creditable 

infant formulas in the CACFP, 

please check with your sponsoring 

organization or State agency. 

Low Lactose and Lactose-Free 

Infant Formula 

Lactose intolerance means the body cannot 

digest a sugar found in milk products, called 

lactose. Lactose intolerance is very rare in 

healthy babies. Sometimes babies may have a 

short period of lactose intolerance after 

having diarrhea, but they usually recover 

quickly. There are both cow’s milk-based 

formulas and soy formulas that can be used for 

infants with lactose intolerance. If the baby has 

a lactose intolerance, encourage his or her 

parents to speak to the health care provider 

about other formulas the baby can tolerate. 

A parent may choose to provide an alternate 

formula due to an allergy or intolerance.

Provider feeding a baby iron-fortified formula. 
Feeding the Formula-Fed Baby • Chapter 3 | 37 

Special Dietary Needs Due to Disabilities 

As a child care site participating in the CACFP, 

you must make substitutions to meals for 

participants with a disability. If the iron-fortified 

infant formula you offer does not meet the needs 

of a baby with a disability due to special dietary 

needs, then another infant formula can be 

substituted by you or the parents. Infant formulas 

that are not iron-fortified, or have low or no iron, 

may be creditable if the substitution is supported 

by a medical statement. 

Special Dietary Needs Due 

to Religious Reasons 

If a parent requests a different infant formula 

due to religious reasons, then another ironfortified infant formula can be substituted by 

you or the parents and will still be reimbursable. 

It is recommended to have a parent’s note 

and signature on file showing that this request 

was made. 

Infant Formula for Babies 

With Special Dietary Needs 

Sometimes a baby’s health care provider 

indicates that a baby should be fed a specific 

formula to meet his or her special dietary 

needs. These formulas can include: 

The medical statement must include the name of the infant formula to be avoided, 

explain how the infant formula affects the baby, and be signed by the baby's health 

care provider. Recommended substitutions of infant formula can also be included 

on the medical statement. Keep the medical statement on file in a secure location 

at your child care site.

FDA Exempt Infant Formulas 

FDA Exempt Infant Formulas are special infant 

formulas that are meant only for babies who 

have an unusual medical or dietary restriction. 

An exempt infant formula can only be served 

as part of a reimbursable meal if the 

substitution is supported by a medical 

statement signed by the baby’s health care 

provider. 

Low-Iron Infant Formulas 

A low-iron infant formula contains less iron than 

iron-fortified infant formula. 

Formulas with labels that say, “additional iron 

may be necessary,” “nutritionally incomplete,” 

“reduced iron,” and formulas with other similar 

statements are not reimbursable in the CACFP. 

These formulas may only be served as part of 

a reimbursable meal if the substitution is 

supported by a medical statement signed by 

the baby’s health care provider. 

FDA Exempt Infant Formulas 

and Low-Iron Infant Formulas 

The following sections review the guidance 

and paperwork needed to serve special 

formulas. 
38 | Chapter 3 • Feeding the Formula-Fed Baby

The following milks are a few examples not 

recommended for babies younger than 12 

months of age. These are milks that are not 

creditable in the CACFP infant meal pattern 

unless supported by a medical statement 

signed by a baby’s health care provider: 

• almond milk 

• cow’s milk 

• dry milk, reconstituted 

• evaporated cow’s milk or home-prepared 

evaporated cow’s milk formula 

• goat’s milk 

• hemp milk 

• nondairy creamer 

• rice milk 

• soy milk 

• sweetened condensed milk 

• follow-up or weaning formulas 

Use of Infant Formula for Babies 

Over 12 Months of Age 

Some parents may request to continue feeding 

their babies infant formula after 12 months of 

age at your child care site. The CACFP allows 

a transition time of 1 month (from the date an 

infant turns 12 months to the time the child turns 

13 months of age) to help babies get used to 

unflavored whole milk. Both unflavored whole 

milk and infant formula can be served during this 

1-month transition time. No medical statement is 

needed during this time. 

Other Milks 

However, if a parent requests that you continue 

to serve the infant formula beyond the age of 

13 months, a medical statement signed by the 

baby’s health care provider must explain the need 

for the substitution and must be kept on file in a 

secure location at your child care site. 

For more information on creditable infant 

formulas in the CACFP, please check with 

your sponsoring organization or State agency. 

Did you know? 

The CACFP allows a transition time of 

1 month (from the date an infant turns 

12 months to the time the child turns 13 

months of age) to help babies get used to 

unflavored whole milk. A medical statement 

is not needed during this time. 

In This Chapter 

In this chapter, you have learned about different types of infant formula and serving infant formula 

within the CACFP infant meal pattern. You will use this information in the next chapter when we learn 

more about preparing, handling, and storing breastmilk and infant formula.
Feeding the Formula-Fed Baby  Chapter 3 | 39 

Key Concepts

You must offer at least one type of iron-fortified infant formula 

regulated by the Food and Drug Administration at your child 

care site.

A child care site may claim reimbursement of meals when 

a parent provides a creditable infant formula that you 

serve to his or her infant. You must offer all other required 

food components.

If an infant needs an infant formula that is not iron-fortified or is 

not regulated by the Food and Drug Administration, the 

parent must provide a medical statement that includes the 

name of the infant formula to be avoided, an explanation of how 

the infant formula affects the baby, and the signature of the 

baby's health care provider. Recommended substitutions of 

infant formula can also be included on the medical statement. 

Keep the medical statement on file in a secure location at your 

child care site.

Soy-based, low lactose, and lactose-free formulas that are 

iron-fortified and regulated by the Food and Drug Administration 

are creditable in the CACFP. A medical statement is not 

required to receive reimbursement for meals and snacks.

The CACFP allows a transition time of 1 month (from the 

date an infant turns 12 months to the time the child turns 13 

months of age) to help babies get used to unflavored whole 

milk. No medical statement is needed during this time.

Feeding the Formula-Fed Baby
40 | Chapter 3 • Feeding the Formula-Fed Baby

1. A father does not want you to give his baby the iron-fortified infant 

formula you serve at your child care site. His baby has a disability and he 

wants to provide his own infant formula. He gives you a medical statement 

that includes the name of the infant formula to be avoided, explains how 

the infant formula affects the baby, and is signed by the baby's health care 

provider. Can you serve the infant formula the father gives you to his baby 

and still claim it as part of a reimbursable meal? 

2. A baby at your child care site turns 13 months old and is still drinking 

iron-fortified infant formula instead of unflavored whole milk. Can you 

continue to give the baby iron-fortified infant formula without a medical 

statement on file at your child care site and be reimbursed for the meal? 

Yes. As long as the parents provide a medical statement signed by the 1. ANSWERS:

baby’s health care provider, you can serve a different infant formula to their baby and 

still claim it as part of a reimbursable meal. This includes infant formulas that may or 

may not be iron-fortified. 

No. Between 12 through 13 months of age, a baby may be served infant formula 2. 

while introducing the baby to unflavored whole milk. However, by 13 months of age the 

eastmilk baby should no longer be drinking infant formula and should only be drinking br

or unflavored whole milk. If a child is 13 months old or older and is still drinking 

health care provider must formula, then a medical statement signed by the baby’s infant 

be kept on file in a secure location at your child care site for the meals and snacks to 

be reimbursable.

Check Your Knowledge 
Handling and Storing Breastmilk and Infant Formula • Chapter 4 | 41 

Chapter 4

Handling and Storing 

Breastmilk and Infant Formula 

What’s In This Chapter? 

By the end of this chapter, child care 

providers will be able to: 

Describe the differences between 

breastmilk and formula. 

Give parents information on the best 

ways to bring breastmilk or infant 

formula to the child care site. 

Describe how to safely store 

breastmilk and infant formula. 

Identify how to prepare breastmilk 

and infant formula for feeding. 

1 

2 

3 

4 

It is helpful to understand the difference between 

breastmilk and infant formula before reviewing the 

steps for handling and storage. 

How Does Breastmilk Look? 

Breastmilk may look different from day to day, and 

that’s okay! The color of breastmilk can change 

based on what the mother eats and what the 

baby needs. It is normal for breastmilk to look 

slightly blue, yellow, or even green in color. 

Breastmilk may look thinner than infant formula, 

especially if the fat, or creamy part, has separated 

from the breastmilk and risen to the top. This does 

not mean the breastmilk is spoiled. Just gently swirl 

it (do not shake) to mix the layers back together. 

Breastmilk stored in the refrigerator at 40 °F.

Breastmilk with the fat separated at the top. 
42 | Chapter 4 • Handling and Storing Breastmilk and Infant Formula

How Does Breastmilk Smell? 

Breastmilk does not smell like infant formula or 

cow’s milk. A mother’s breastmilk may also smell 

different from day to day, and that’s okay too! If 

you think the breastmilk has spoiled, check with 

the baby’s parents first to see what they would 

like you to do. Some parents may want you to 

throw it out, while others may want you to save it 

for them to take home.

For more information on the proper storage time and temperature, see Table 5, 

Maximum Storage Time and Temperature for Breastmilk at a Child Care Site on 

page 44 and Table 6, Storing and Handling Infant Formula on page 47.

Handling Breastmilk and 

Infant Formula Before 

Arriving at the Child Care Site 

Ask parents to: 

• label the bottle with the baby’s full name and 

the date the breastmilk was pumped or the 

infant formula was made. 

• refrigerate or freeze breastmilk right after it 

is pumped, and refrigerate formula right after 

it is made. 

• if possible, fill bottles with at least the 

minimum amount of breastmilk required 

in the CACFP infant meal pattern for a 

meal or snack. 

• bring breastmilk or infant formula in smaller 

amounts (1–2 fluid ounces) in case the baby 

wants more after a feeding. 

• bring breastmilk or infant formula to the 

child care site in a cooler with ice packs to 

keep it cold. 

Bottles of breastmilk labeled with the baby’s full 

name and the date the breastmilk was pumped. 

Containers of breastmilk being stored in the 

freezer at 0 °F. 

Parent bringing breastmilk to the child care site. 
Handling and Storing Breastmilk and Infant Formula • Chapter 4 | 43 

Storing Fresh Breastmilk 

and Infant Formula at Your 

Child Care Site 

• Do not accept or use an unlabeled bottle. 

• Keep breastmilk and formula refrigerated until 

it's time to feed the baby. 

• Store breastmilk or formula in the back of 

the refrigerator where the temperature is 

always cold. The front of the refrigerator can 

be warmer because of the door opening. 

• Store breastmilk and formula so the bottle with 

the oldest date is served first. One way to do 

this is to put the new bottles towards the back 

of the line and move the older bottles towards 

the front. When it's time to feed the baby, it 

will be easy to reach the older bottles since 

they will be in the front. 

• If breastmilk is pumped at the child care site, this 

can be served with refrigerated breastmilk during 

a feeding. If you want to serve them together 

in one bottle, the freshly pumped breastmilk

should be cooled before it's mixed with the 

refrigerated breastmilk. See diagram below. 

Breastmilk in a container labeled with the 

baby’s full name and the date the breastmilk 

was pumped. 

Pumped on 

January 5th Cooled on January 5th 

Added milk from cooled 

bottle to older bottle.
44 | Chapter 4 • Handling and Storing Breastmilk and Infant Formula

If your State or local authorities have stricter health and 

safety regulations for handling and storing food, including 

breastmilk or formula, then follow those regulations. 

• Only thaw the amount of breastmilk needed 

for one feeding to prevent or reduce waste. 

Thaw additional breastmilk if the infant is 

hungry and shows signs of wanting more. 

• Thaw the container of breastmilk in the 

refrigerator overnight, under warm running 

water, or in a container of warm water. 

Write the date the milk was thawed on the 

bottle or container. 

Countertop 

77 °F or colder 

(25 °C) 

Refrigerator 

40 °F (4 °C) 

Freezer 

0 °F or colder (-18 °C) 

Freshly Pumped 

Breastmilk 

Do not use 

after 4 hours 

Do not use 

after 3 days 

(72 hours)* 

Within 6 months is best. 

Do not use after 12 months. 

Thawed 

Breastmilk 

Do not use after 

1–2 hours 

Do not use after 

1 day (24 hours) Never refreeze thawed breastmilk. 

Leftover from a 

feeding (baby 

did not finish 

the bottle) 

Do not use after 2 hours after the baby is finished feeding. 

*Per policy memorandum CACFP 02-2018: Feeding Infants and Meal Pattern Requirements in the 

Child and Adult Care Food Program; Questions and Answers, this is the storage time for breastmilk in 

a child care setting. 

Table 5 Maximum Storage Time and Temperature for 

Breastmilk at a Child Care Site 

• Do not thaw breastmilk at room temperature, 

by mixing with warm breastmilk, placing in 

boiling water, or heating in a microwave. 

The breastmilk may become very hot when 

heated in a microwave, which could burn the 

baby even though the bottle may feel cool. 

Also, heating damages some of the important 

nutrients in breastmilk. 

Thawing Frozen Breastmilk at the Child Care Site 
Handling and Storing Breastmilk and Infant Formula • Chapter 4 | 45 

• Wash your hands before preparing a bottle of

breastmilk or infant formula.

• Prepare at least the amount of breastmilk or

infant formula required in the CACFP. 

• For breakfast, lunch, and supper, babies

0 through 5 months of age need 4 to

6 fluid ounces. Babies 6 through 11

months of age need 6 to 8 fluid ounces.

• For snack, babies 0 through 5 months of 

age need 4 to 6 fluid ounces. Babies 6 

through 11 months of age need 2 to 4

fluid ounces.

• Gently swirl the bottle of breastmilk before

feeding the baby because breastmilk may

separate into two layers when it is stored. This

separation is normal. It is also normal to see

bubbles in breastmilk.

• Bottles can be served cold from the refrigerator 

and do not have to be warmed. However, if 

you choose to warm the bottles, hold the 

bottle under warm (not hot) running water or 

place it in a bowl of warm water immediately 

before serving. Do not heat in a microwave. 

Microwaving can destroy important nutrients in 

the breastmilk and cause hot spots, which can 

burn the baby. 

Tip: 

Never put cereal in a bottle. If it is mixed 

in a bottle with breastmilk or infant 

formula, then the cereal and breastmilk 

or infant formula cannot credit towards a 

reimbursable meal or snack.

Preparing a Bottle For a Feeding 

• If the bottle was warmed, make sure the

breastmilk or infant formula is not too hot

before feeding the baby.

• Do not put cereal or other food in the bottle.

According to the American Academy of

Pediatrics, putting cereal in the bottle can be a

choking hazard. It can also cause the baby to

gain weight too quickly. If cereal is mixed with

breastmilk or infant formula, the child care site

cannot claim the cereal or the breastmilk or

infant formula in the bottle unless this practice

is supported by a medical statement signed

by the baby’s health care provider. The

statement must be kept on file in a secure

location at the child care site.

• Babies should only be fed their mother's

breastmilk or the infant formula that was

chosen for them by their parent. Never give

a baby breastmilk or infant formula that

is not labeled or that is meant for another

baby.

• Do not use the unused breastmilk left in the

bottle 2 hours after the baby has finished

a feeding. Throw away any unused infant

formula left in the bottle right after a feeding.

If an infant is receiving breastmilk 

and regularly drinks less than the 

minimum amount required, you 

may prepare bottles with smaller 

amounts. See Chapter 2: Feeding the 

Breastfed Baby on page 20 for more 

information on breastmilk and the 

CACFP infant meal pattern. 
46 | Chapter 4 • Handling and Storing Breastmilk and Infant Formula

Purchasing Infant Formula 

• Do not buy or use infant formula if the 

container has dents, bulges, pinched tops or 

bottoms, puffed ends, leaks, rust spots, or has 

been opened. The formula in these containers 

may be unsafe. 

• Check the infant formula “use by” date. If the 

“use by” date has passed, the quality of the 

formula may not be as good and you should 

not buy it. 

• Store unopened containers of infant formula in 

a cool, dry, indoor place—not in a refrigerator 

or freezer, or in vehicles, garages, or outdoors. 

In these places, the cans are exposed to 

moisture and temperature changes, which can 

affect the quality of the formula. 

Make sure the water used to mix the infant formula 

is from a safe source approved by the local health 

department. If there is doubt, ask the local health 

department to test the water to make sure it is safe 

and does not contain anything that might harm 

a baby or child, such as lead, bacteria, nitrate, 

pesticides, or other chemicals. 

The U.S. Environmental Protection Agency 

recommends that child care sites routinely test their 

drinking water for lead and other unsafe 

contaminants to make sure it is safe. If the drinking 

water is not safe, the local health department 

should recommend a safe source of water. 

If a safe source of water is unavailable, water can 

be purchased for use at your child care site. The 

purchase of water must be considered necessary 

by your sponsoring organization or State agency. 

Prepare, use, and store infant formula according 

to the product directions on the container or as 

directed by the baby's health care provider. For 

powdered formula, measure the amount of 

formula using the scoop provided with the 

container. The instructions for preparing infant 

formula are different for each product. Using more 

or less water and powdered formula than 

instructed changes the amount of calories and 

nutrients in the bottle. This can affect a baby’s 

growth and development. Formula that is not 

prepared correctly cannot credit towards a 

reimbursable meal or snack in the CACFP. If a 

parent asks you to prepare formula in a way that 

is different from what is stated on the container, a 

written medical statement from the baby’s health 

care provider must be kept in a secure location at 

your child care site. 

Preparing, Storing, and Handling Infant Formula 

Important: Read and follow 

instructions on the container of 

infant formula.
Handling and Storing Breastmilk and Infant Formula • Chapter 4 | 47 

Table 6 Storing and Handling Infant Formula 

Storing prepared 

infant formula 

Keep bottles of prepared infant formula in the refrigerator 

at a temperature at or below 40 °F (4 °C) until ready to use. 

Never freeze infant formula. 

Use infant formula that has been in the refrigerator within 24 

hours after it is prepared. 

Handling prepared infant 

formula before a feeding 

Do not take infant formula out of the refrigerator more than 2 

hours before a feeding. 

Handling prepared infant 

formula after a feeding 

Once you start feeding a baby, make sure the infant formula is 

consumed within 1 hour. 

Throw away any leftover infant formula that is in the bottle.* 

*Germs can get into the bottle during a feeding. This can cause bacteria to grow, which can make a baby 

sick if the leftover infant formula is given to the baby at a later time. 

In This Chapter 

In this chapter, you have learned how to properly handle and store breastmilk and infant 

formula. In the next chapter, you will learn about feeding a baby with a bottle or cup at your 

child care site.
48 | Chapter 4  Handling and Storing Breastmilk and Infant Formula

Key Concepts

Breastmilk can be refrigerated at the child care site (at 

40  ̊F or below) for up to 72 hours (3 days) from the date 

the breastmilk was pumped. If your State or local health 

and safety regulations are stricter, follow those guidelines.

Always prepare and store infant formula according to the 

instructions on the back of the container. Putting too much 

water or not enough infant formula in the bottle can affect 

a baby's growth and development.

Bottles can be served cold from the refrigerator and do 

not have to be warmed. If you choose to warm a bottle, 

hold it under warm running water or place the bottle in a 

bowl of warm water before serving.

Routinely have water used for preparing infant formula 

tested for lead and other unsafe contaminants. Contact 

your local health department if you have any concerns 

regarding the safety of your drinking water.

Provide parents with information about how to safely bring 

labeled breastmilk or infant formula to the child care site to 

help prevent spoilage and waste.

Handling and Storing 

Breastmilk and Infant Formula
Handling and Storing Breastmilk and Infant Formula • Chapter 4 | 49 

1. A mother brings in powdered infant formula for her baby. The child care 

provider has worked with babies for years, and prepares the infant formula the 

same way she does with all other formulas without checking the instructions on 

the package. Is the child care provider preparing the infant formula correctly? 

Why or why not? 

2. A child care provider adds more water to the infant formula than what 

is recommended on the label of the container because she thinks the baby 

weighs more than he should. Is this acceptable? Why or why not? 

3. A child care provider has been busy watching all of the children in his care 

and accidentally leaves a bottle of infant formula out on the counter for 2 1⁄2 

hours. Can he put it back in the refrigerator and use it later? Why or why not? 

4. A mother asks the child care provider to add iron-fortified dry infant cereal 

to her baby’s bottle of breastmilk before naptime. She says it helps her baby 

sleep better. The child care provider knows that she will not be able to claim the 

infant cereal or breastmilk in the bottle as part of a reimbursable meal or snack 

since they are served in the same bottle and the mother did not have a medical 

statement. What should she tell the baby’s mother? 

Check Your Knowledge 

No. The child care provider is not preparing the infant formula the 1. ANSWERS:

correct way. She should always follow the instructions on the package to make sure 

she is adding the correct amount of water to the powdered infant formula. 

No. Adding more water than instructed is not acceptable. Adding more water to 2. 

dilute the formula means the baby will not get the calories and nutrients he or she 

needs to grow. 

No. The child care provider should not put the bottle of infant formula that he left out 3. 

. Once you begin feeding a baby on the counter for 2 1⁄2 hours back into the refrigerator

infant formula, it should be consumed within 1 hour. Any leftover formula should be 

thrown away. The baby's saliva can get into the bottle of formula during a feeding. This 

can cause bacteria to grow and can make the baby sick. 

The child care provider can let the mother know that putting cereal in a bottle can 4. 

d and can cause a baby to gain weight too quickly. Therefore, it is be a choking hazar

e site cannot do this unless there is a not a recommended practice and the child car

medical statement signed by the baby's health care provider. 
50 | Chapter 5 • Feeding a Baby Using a Bottle and Cup

Chapter 5 

Feeding a Baby Using a 

Bottle and Cup 

What’s In This Chapter? 

By the end of this chapter, child care 

providers will be able to: 

Describe the proper way to 

bottle feed. 

State when a child should switch 

from a bottle to a cup. 

List beverages that are appropriate 

to serve babies in a bottle and cup. 

1 

2 

3 

Most infants will be fed with a bottle while in child 

care and then move to drinking from a cup when 

ready. Breastmilk and iron-fortified infant 

formula are the only liquids that can be offered to 

a baby as part of a reimbursable meal or snack. 

Bottle of breastmilk held upside down with drops falling slowly, not a stream.

Before Feeding a Baby 

a Bottle: 

• Wash your hands well with soap and water 

before preparing the bottle. 

• Prepare the bottle. See Chapter 4: Handling 

and Storing Breastmilk and Infant Formula on 

page 41 for information on how to prepare a 

bottle of breastmilk and infant formula. 

• After preparing the bottle, but before feeding 

the baby, hold the bottle upside down over 

a sink or other container. Make sure falling 

drops from the nipple follow each other closely 

but do not fall in a stream. A stream means 

the opening in the nipple is too big and could 

allow the liquid to come out too quickly. This 

can cause the baby to choke or drink more 

than he or she wants. 

Tip: 

Never put cereal in a bottle. If the cereal 

is mixed in a bottle with breastmilk or 

infant formula then the breastmilk or infant 

formula would not be creditable. 
Feeding a Baby Using a Bottle and Cup • Chapter 5 | 51 

Tip: 

Follow the baby’s lead. Let the baby 

pause and take breaks as needed. If the 

baby is drinking quickly, pause to let the 

baby burp. If the baby wants to continue 

eating, he or she will show it by opening his 

or her mouth and sucking on his or her lips. 

When full, the baby’s sucks will slow down, 

his or her arms and hands will relax, and 

he or she will turn away from the bottle or 

even push the bottle away. A typical feeding 

session will take 15–20 minutes but should 

be based on the baby’s fullness signs. 

How To Feed With a Bottle 

Feeding a baby can be enjoyable for both you 

and the baby and should not be rushed. Make 

sure to always hold the baby upright to prevent 

choking. Proper positioning also allows you to 

see when the baby is showing signs of being full. 

Paced bottle feeding is a bottle feeding method 

that is sometimes used with breastfed babies. 

During paced bottle feeding, the baby tends to 

have more control over the feeding so it is similar 

to breastfeeding. 

Never force a baby to finish what is in the bottle. 

Babies will stop eating when they are full. They 

may eat more when they are going through a 

growth spurt, or less if they are sick, tired, or just

not hungry. Forcing a baby to finish a bottle can 

lead to the baby developing unhealthy eating 

habits and be more likely to become overweight or 

obese later on in life. Do not force a baby to finish 

a bottle if he or she shows signs of being full. 

Do Not Allow a Baby To Carry a Bottle or 

Cup Around 

Babies who carry around a bottle or cup can 

hurt themselves by dropping it, breaking it, 

and/or hitting themselves or others with it. 

They may also try to share their bottles or cups 

with other babies. Sleeping or Resting Position 

Before or After Feeding 

Ask parents if their baby's health care provider

prefers the baby to be in a certain position after 

eating. Often, babies will nap after a feeding. Most 

doctors recommend placing babies on their back 

when resting or sleeping at all times unless there 

is a medical reason not to. Babies who sleep on 

their backs are at much lower risk of Sudden 

Infant Death Syndrome (SIDS) than babies who 

sleep on their stomach or on their sides.

Child care provider watching the baby for 

signs of fullness. 

 ⃠
52 | Chapter 5 • Feeding a Baby Using a Bottle and Cup

When feeding a baby a bottle, remember to: 

Burp during natural 

breaks in the feeding or at 

the end of the feeding. 

Burp the baby by gently 

patting or rubbing the baby’s 

back while he or she is 

resting on your shoulder or 

sitting on your lap. 

Hold the bottle mostly 

sideways, not straight up. 

Make sure the tip of the 

nipple is filled with breastmilk 

or infant formula and not air. 

This will lower the amount of 

air the baby swallows. 

Holding the bottle mostly 

sideways is used in paced 

bottle feeding. See “How To 

Feed With a Bottle” on page 

51 for more information on 

paced bottle feeding. 

Switch which arm you 

use to hold the baby. 

Every so often when feeding 

a bottle, switch the baby 

from one arm to the other so 

the baby has different things 

to look at. This can also 

help the baby continue to 

enjoy feeding on both sides; 

something that is important 

when breastfeeding. 

Hold the baby during 

feeding. 

Feed a baby while he or she 

is awake. Do not prop the 

bottle up on a pillow or other 

item for the baby to feed 

him or herself. Propping a 

bottle may cause choking or 

suffocation, as well as ear 

infections and tooth decay. 

Use a slow flow bottle 

nipple. 

This helps the baby control 

how much he or she eats 

and can reduce spit ups. 

Hold the baby in the cradle 

of your arm, so that he 

or she is almost upright. 

This keeps the baby secure, 

helps you see if the baby is 

showing signs of hunger or 

fullness, and can help prevent 

the baby from choking or 

getting too much liquid at 

once. 

Brush the nipple of the 

bottle across the baby’s 

upper lip. 

Wait for the baby’s mouth to 

open before feeding.

 ⃠
Feeding a Baby Using a Bottle and Cup • Chapter 5 | 53 

Do not let babies or children carry around bottles 

or cups. If a child drops a bottle, pick it up 

immediately, place it out of reach of other children, 

and clean up any spilled breastmilk or formula 

with soap and water. 

• When children are drinking from a cup, clearly 

label the cup with the child’s full name. It may 

also be helpful to give each child his or her 

own distinct-looking cup. This way, you and 

the child can identify the cup easily. This may 

help prevent another child from drinking from a 

cup that is not his or her own. 

• At the end of the day, send all bottles home 

with the parent who brought the bottles. Never 

leave used bottles sitting around. 

If a Child Drinks From Another Child's 

Bottle or Cup 

If a child has been mistakenly fed or 

has drunk from another child’s bottle 

or cup of breastmilk, inform the 

parents of both children and follow 

guidance from the Centers for Disease Control 

and Prevention (CDC): 

• Tell the mother who provided the 

breastmilk that the bottle was given to the 

wrong child, and ask: 

• When the breastmilk was pumped and 

how it was handled before it was taken 

to your child care site. 

• Whether she has ever had a Human 

Immunodeficiency Virus (HIV) test and, 

if so, would she be willing to share the 

results with the parents of the child who 

drank her breastmilk. 

• If she does not know whether she has ever 

been tested for HIV, would she be willing to 

contact her health care provider and find 

out if she has been tested. 

• If she has never been tested for HIV, 

would she be willing to be tested and 

share the results with the parents of the 

other child. 

• Discuss the mix up with the parent of the 

child who was given the wrong bottle: 

• Tell them that their child was given 

breastmilk meant for another child. 

• Tell them that the risk of transmission of 

HIV and other diseases is very small. 

• Encourage the parent to notify the child’s 

health care provider of the exposure. 

• Give the parents information on when 

the milk was pumped and how the milk 

was handled before it was taken to the 

child care site. This way, they can inform 

their own health care provider who can 

provide information on what steps or 

precautions are needed.

For more information on what to do 

if an infant or child drinks the wrong 

breastmilk, visit the CDC’s website: 

https://www.cdc.gov/breastfeeding/ 

recommendations/other_moth 

ers_milk.htm. Check with your local 

health department to see if there are 

additional steps you need to follow. 

How To Prevent Babies or 

Children From Drinking 

Another Child’s Bottle (or Cup) 

Parent providing breastmilk that is labeled 

with the baby's full name and date the breastmilk 

was pumped. 
54 | Chapter 5  Feeding a Baby Using a Bottle and Cup

It is recommended that babies stop using a bottle 

entirely and use only cups by the time they are 

18 months, or as developmentally appropriate. 

Children still drinking from a bottle beyond 18 

months of age may:

How Can You Help a Baby Learn To 

Drink From a Cup?

Whether an infant is drinking from a bottle or a cup, there are many beverages that he or she should and 

should not try in their first year. Table 7, What Should Babies Drink? on pages 55 and 56 gives more 

details on what babies should try, and why.

• be more likely to develop tooth decay.

• drink so much milk that they don’t eat enough 

solid foods.

• not get enough nutrients.

• be delayed in developing feeding skills.

Transitioning From a Bottle Too Late

Child care provider offering a cup to a baby.

• Hold the cup for the baby.

• Start with small amounts (2 to 3 fluid ounces) 

of breastmilk or infant formula in a cup. You do 

not need to fill the entire cup.

• Let the baby drink very slowly by tilting the cup 

slightly so only a very small amount of breastmilk 

or formula leaves the cup. This allows the baby to 

swallow at his or her own pace.

• Introduce a cup in place of a bottle at mealtime 

when older children may be drinking from cups 

around them.

• Allow babies to practice drinking from a cup 

before they stop using a bottle completely.

Drinking From a Cup

Many babies are able to drink small amounts from 

a cup held by another person around 6 months of 

age or later. Babies are usually developmentally 

ready to drink from a cup when they can sit 

without support and seal their lower lip on the rim 

of the cup.

Child care provider helping a baby 

drink from a cup.

Did you know?

Cups with lids that help prevent spilling, 

such as sippy cups, should only be used as 

a training tool to help a baby learn to drink 

from a cup.
Feeding a Baby Using a Bottle and Cup • Chapter 5 | 55 

Table 7 What Should Babies Drink? 

Beverage Should I serve 

this to a baby? Why or why not? 

Breastmilk Yes 

Breastmilk is the best source of nutrition for babies. It is the 

only food healthy babies need for about the first 6 months of 

their lives. It is still important for babies even after they start 

eating solid foods. 

Iron-fortified 

infant formula Yes 

Iron-fortified infant formula is a good alternative to breastmilk. 

It contains the right amount of nutrients a baby needs to 

grow and be healthy. Iron-fortified infant formula is not 

creditable after a baby turns 13 months. 

Juice No 

Juice, even 100% juice, does not credit towards a 

reimbursable meal or snack in the CACFP infant meal 

pattern. Doctors recommend not giving juice to children 

under 12 months of age.

Continued on pg 56

Reflux 

Healthy babies may spit up during or after you 

feed them. Nearly half of all babies have what is 

known as “reflux” in the first few months of life. 

Reflux is what happens when some of the 

breastmilk or formula does not stay in the baby’s 

stomach and the baby spits it out. Reflux usually 

goes away as babies get older, but sometimes 

they may need medicine. You can help a baby 

spit up less by: 

• burping the baby at natural breaks during a 

feeding or at the end of a feeding. 

• using the “paced bottle feeding” method. 

• holding the baby upright for 30 minutes after 

giving a bottle. 

• stopping the feeding when the baby shows 

signs of being full. See Table 2, How Can I Tell 

If a Baby Is Full? on page 9. 

Vomiting is different from spitting up. Vomiting 

is usually more powerful and in much larger 

amounts. While reflux is common in babies, 

vomiting can be a sign of something more 

serious. If you see any of the following signs, 

you should let the parents know right away: 

• fever 

• bile, a green colored substance, in the vomit 

• vomiting and fussiness that doesn't stop 

• baby refuses more than one feeding 

• blood in the vomit or in the diaper 

• baby is breathing harder 

• baby does not seem as alert as usual 
56 | Chapter 5 • Feeding a Baby Using a Bottle and Cup

Beverage Should I serve 

this to a baby? Why or why not?

Water* Maybe 

Babies do not need to drink water in about the first 6 months 

of life. Breastmilk and infant formula are the only beverages 

babies need. Once the baby has started eating solid foods, a 

baby’s health care provider may recommend small amounts 

of water be given to him or her. On hot days, small amounts 

of water may also be needed. Parents can check with their 

health care provider to find out how much and how often 

their babies can drink water. 

Cow’s milk or 

goat’s milk No 

Cow’s milk and goat’s milk are not recommended for babies 

younger than 12 months of age. These milks have too much 

protein and minerals for a baby. Cow’s milk and goat’s milk 

may not credit towards a reimbursable meal for infants 

without a signed medical statement from the baby’s health 

care provider. 

Sodas, sports 

drinks, sugar 

water, and 

fruit drinks 

No 

Sodas, sports drinks, sugar water, and fruit drinks should not 

be served to infants. Added sugars may lead to tooth 

problems and too much weight gain when he or she is older. 

Tea** and Coffee No 

It may be common in some cultures to serve tea or coffee 

to a baby. However, according to the American Academy 

of Pediatrics, beverages with caffeine, including coffee and 

teas, are not recommended for babies. 

Continued from pg 55

* It is important to make sure the water offered to 

infants is from a safe source and does not contain 

unsafe amounts of lead or other contaminants. 

** In addition to caffeine, teas may also have 

other things that can make a child sick. According 

to the Food and Drug Administration, teas 

brewed with a spice called "star anise" may cause 

vomiting, twitching, and seizures. 

Caution: Never serve raw milk, or 

unpasteurized milk, to a baby. Raw 

milk is milk from cows, goats, or 

sheep that has not been heated 

to kill harmful bacteria. This raw, 

unpasteurized milk may have 

harmful bacteria that can make a 

baby very sick.
Feeding a Baby Using a Bottle and Cup  Chapter 5 | 57 

Key Concepts

Many babies are developmentally ready to drink from a cup 

when they can sit without support and seal their lower lip on 

the rim of the cup.

Hold babies or make sure they are seated in a high chair 

during a feeding. Making sure a baby is seated can lower a 

baby's risk of choking. It can also help prevent another child 

from drinking from the same bottle.

The only liquids an infant should be served are breastmilk, 

infant formula, and, around 6 months of age, water.

Feeding a Baby Using 

a Bottle and Cup

In This Chapter

In this chapter, you have learned about how to feed a baby using a bottle and cup. 

In the next chapter, you will learn about feeding a baby solid foods. 
58 | Chapter 5 • Feeding a Baby Using a Bottle and Cup

1. True/False: Adding cereal to a baby’s bottle is good for the baby's health. 

2. A 19-month-old enrolls at your child care site and is still drinking from a 

bottle even though he is developmentally ready to drink from a cup. What are 

some issues that may come from using a bottle at this age? 

A Because it's easier to drink from a bottle than a cup, the child may drink so 

much milk that he is not hungry for other foods. 

B Drinking from a bottle regularly may lead to tooth decay. 

C Not drinking from a cup may mean that some important feeding skills may 

not develop, or may be delayed. 

D All of the above. 

3. The parents of a 9-month-old tell you that they are going to switch their 

baby from formula to whole cow’s milk. This is because the rest of the family 

drinks cow’s milk and purchasing one type of milk will be cheaper. Which of 

the following would be an appropriate response: 

A Cow's milk should not be served to infants (those younger than 12 months) 

because it has too much protein and minerals that make it hard for a baby 

to digest. 

B This may be difficult since cow’s milk tastes different. Adding flavor or 

sweetener can help the baby transition. 

C Formula can be expensive, but there is a local WIC clinic that can help. 

D A and C. 

E All of the above. 

Check Your Knowledge 

False. Adding cereal to a baby's bottle is not good for the baby's 1. ANSWERS: 

D. These are all issues that may come up from using a bottle at 19 2. ● health.

D. Let parents know that cow’s milk is not recommended for 3. ● months of age.

children under 12 months, and recommend community resources for infant formula.
Feeding Solid Foods • Chapter 6 | 59 

Chapter 6

Feeding Solid Foods 

What’s In This Chapter? 

By the end of this chapter, child care 

providers will be able to: 

Identify solid foods that are 

creditable as part of a reimbursable 

infant meal or snack in the CACFP. 

Describe when a baby is 

developmentally ready to start 

eating solid foods. 

Offer different textures of foods 

based upon the baby’s feeding skills. 

List strategies for when and how to 

communicate with parents about 

solid foods. 

1 

2 

3 

4 

Before around 6 months of age, most babies do 

not have the muscle control and coordination to 

eat solid foods. They are not “developmentally 

ready.” When a baby is not developmentally 

ready to eat solid foods, he or she: 

• is not able to sit in a high chair and hold his or 

her head up. 

• may not be able to move his or her tongue to 

help swallow the food. 

• may not open his or her mouth when foods 

come towards him or her. 

Solid foods are foods that are easy and 

safe for a baby to eat once he or she is 

developmentally ready, usually around 6 

months of age. Solid foods can be pureed, 

mashed, ground, or finely chopped to 

allow a baby to swallow the food without 

choking. Solid foods are also known as 

complementary foods. 

What are solid foods? 

For more information about when a 

baby is developmentally ready 

for solid foods, see Chapter 1: Giving 

Babies a Healthy Start With the 

CACFP on page 6. 

These feeding skills are needed for the baby to 

eat solid foods. The CACFP infant meal pattern 

allows for solid foods starting around 6 months 

of age. The term “around” is used because not all 

babies are developmentally ready for solid foods 

at exactly 6 months of age. Some babies may be 

ready for solid foods at 5 months, others at 61⁄2 

months. 

The amounts of solid foods listed in the infant 

meal pattern are provided as a range, such as 

0–2 tablespoons. This provides you with the 

flexibility to offer the right amount of solid foods 

based upon the baby’s developmental readiness. 

You would give 0 tablespoons of a solid food if 

the baby has not yet started eating solids. You 

might give the baby less than 1 tablespoon of a 

solid food if he or she just started eating a solid 

food. Once the baby has been introduced to the 

solid food, you would offer the baby the full 2 

tablespoons of the solid food.
60 | Chapter 6  Feeding Solid Foods

The CACFP infant meal pattern for babies 6 through 11 months

includes solid foods, such as:

iron-fortified dry 

infant cereals fish poultry meats

whole eggs

(yolk and whites)

cooked dry 

beans or peas

cheese and 

cottage cheese yogurt

vegetables fruits

ready-to-eat 

cereals (snack only)

breads and crackers 

(snack only)

For more information on how these foods fit within the CACFP infant meal pattern, 

see Table 3, CACFP Infant Meal Pattern With Food Components in Chapter 1: Giving 

Babies a Healthy Start With the CACFP on page 15.

Solid Foods for Babies 6 Through 11 Months

 

 

 
Feeding Solid Foods  Chapter 6 | 61 

How Can You Tell If It Is Time To Feed a 

Baby Solid Foods?

Talk with the baby’s parents, so 

you know when they have started 

giving their baby solid foods. If 

you've noticed signs that the baby is ready for 

solid foods, you may also want to share the “For 

Parents: Is Your Baby Ready for Solid Foods?” 

handout on page 12 with parents. At this time, 

you may want to ask the baby’s parents to 

provide a written note or response about starting 

or delaying solid foods. 

When To Start Feeding a Baby Solid Foods

A medical statement from the 

baby’s health care provider is not 

required if parents choose to start 

their baby on solid foods or delay 

the start of solid foods.

If the parents inform you that the baby is eating 

solid foods, then you must serve solid foods in 

order to claim reimbursement for the infant meal 

or snack in the CACFP. You can also ask parents 

to fill out the “For Parents: What Is Your Baby 

Eating? Let Us Know!” handout on page 63 so 

you can keep track of what the baby has tried or 

might try.

If the parents indicate that the baby is not yet 

eating solid foods, continue to offer the 

infant the required amount of breastmilk or 

iron-fortified infant formula. The infant meal is 

still reimbursable if solid foods are not served 

because the baby may not be developmentally 

ready for solids. Provide the parent with 

information on the benefits of offering the baby 

solid foods once the baby is developmentally 

ready. Encourage the parents to talk with their 

baby’s health care provider about introducing 

solids. Ask the parents to let you know when they 

have started feeding their baby solid foods. 

Is Baby Jonathan 

Ready for Solid Foods?

Baby Jonathan is 5 months old. He can 

sit when his mom is holding him tight, 

but he does not have good control of his 

head and neck. Jonathan’s parents are 

not sure if he is ready for solid foods. The 

child care provider hands them the “For 

Parents: Is Your Baby Ready for Solid 

Foods?” handout on page 12 to offer more 

information. They learn that since Baby 

Jonathan cannot sit up well and does not 

have good head and neck control, he is not 

ready for solid foods. They make a plan to 

watch for signs that he is ready for solids.
62 | Chapter 6  Feeding Solid Foods

Did you know?

A baby crying often is not a sign that the baby 

is ready for solid foods. Babies eat often 

because their stomachs are very small and 

they are growing quickly. Breastmilk and 

formula can give the baby the nutrients he or 

she needs until around 6 months of age.

Feeding solid foods before a baby is 

developmentally ready may increase the chance 

that he or she will:

• choke on the food.

• drink less breastmilk or infant formula than 

needed in order to grow.

• be overweight or obese later in life.

Feeding solid foods before a baby is ready:

• does not help the baby sleep through 

the night.

• does not make the baby eat fewer 

times in a day.

Feeding Solid Foods Too Early

Delaying the introduction of solid foods 

beyond the time when babies are 

developmentally ready may prevent them 

from eating the variety and amounts of 

food they need. This may increase the 

risk that babies will:

• not get the nutrition they need, 

especially iron and zinc.

• not grow normally.

• reject foods when they are given at a 

later age.

• have delayed speech and 

motor development.

Feeding Solid Foods Too Late

Delaying solid foods may not reduce the risk of 

developing food allergies. According to the American 

Academy of Pediatrics, 6 to 8 months of age is 

considered an important time for introducing solid 

foods to babies. By the time babies are 7 to 8 months 

of age, and if developmentally ready, they should be 

consuming solid foods from all CACFP food 

components such as vegetables, fruits, grains, and 

meat and meat alternates, along with breastmilk or 

iron-fortified infant formula. Encourage parents to talk 

about solid foods with the baby’s health care provider.

If parents report fussiness and/or sleeping problems 

as a reason for wanting to start solid foods early, 

encourage them to discuss their concerns with their 

baby’s health care provider. Sometimes ideas for 

other ways to calm or soothe a crying baby can be 

helpful. Crying does not always mean that the baby 

is hungry.
Feeding Solid Foods • Chapter 6 | 63 

For Parents: What Is Your Baby Eating? 

Let Us Know! 

Today’s Date Baby’s Name (first and last) 

Baby’s Birth Date Parent's Name (first and last) 

Is your baby eating solid foods? ☐ Yes ☐ No 

What texture(s) of food do you give to your baby? 

☐ pureed ☐ mashed ☐ ground ☐ finely chopped 

.

Which of these foods does your baby currently eat? 

Food and Nutrition Service

☐ crackers ☐ iron-fortified infant cereal (check all that apply) 

☐ barley cereal ☐ oat cereal 

☐ wheat cereal ☐ rice cereal 

☐ ready-to-eat cereal (such as whole-grain o-shaped cereal) 

☐ pieces of bread/toast ☐ pieces of pita bread ☐ pieces of soft tortilla 

Grains 

☐ beans ☐ beef ☐ pork ☐ chicken ☐ cottage cheese 

☐ eggs ☐ fish ☐ turkey ☐ cheese ☐ yogurt ☐ shellfish

Meat and Meat Alternates (Protein Foods and Dairy) 
64 | Chapter 6 • Feeding Solid Foods

.

Which of these foods does your baby currently eat? 

☐ apples ☐ apricot ☐ bananas ☐ blueberries ☐ mangos 

☐ peaches ☐ pears ☐ prunes ☐ strawberries ☐ other: __________________ 

Fruits 

What else does your baby eat? 

Parent's Signature: 

A handout from Feeding Infants in the Child and Adult Care Food Program

https://teamnutrition.usda.gov • FNS 786D • March 2019 

USDA is an equal opportunity provider, employer, and lender.

☐ broccoli ☐ butternut squash ☐ cauliflower ☐ corn ☐ spinach ☐ peas 

☐ carrots ☐ sweet potatoes ☐ tomatoes ☐ green beans ☐ other: ______________ 

Vegetables 
Feeding Solid Foods • Chapter 6 | 65 

Babies are born with feeding skills that allow them 

to drink breastmilk or infant formula. As babies 

get older, they develop new skills to eventually 

help them feed themselves with your supervision. 

Offering babies different textures of food as 

they get older helps them learn or strengthen 

different feeding skills. 

While it used to be thought that babies 

needed to try new foods in a certain order, we 

now know that is not the case. However, ironfortified infant cereals and pureed meats are 

good first foods because they provide iron and 

zinc that babies need around 6 months of age. It 

is a recommended practice that parents introduce 

the baby to one new food at a time over the 

course of a few days. This allows parents to 

watch the baby closely for any allergic reactions 

to the food. 

Encourage parents to keep you 

informed of any new foods they are 

offering their baby and any history 

of allergic reactions.

Remember, babies can still have a reaction to a 

food even if they did not have a reaction the first 

time they tried the food. Always pay close 

attention to the baby during feeding. 

A Baby’s Feeding Skills 

See Table 8, Introducing Different 

Textures of Food Based on Feeding 

Skills on page 68. 

Introducing New Foods 

For more information on signs a 

baby is having an allergic reaction to 

food, see Chapter 10: Food Allergies 

and Intolerances on page 119. 

Did you know? 

Babies begin losing iron after birth and 

have a significantly lower amount by 

the time they are 6 months of age. For 

breastfed babies, it’s especially important 

to introduce iron-fortified infant cereal 

and pureed meats or poultry when the 

baby is ready to eat solid foods because 

they provide iron and zinc that babies 

need as they grow. 

What if a baby doesn’t 

like a food when trying it 

for the first time? 

Infants and children may not like a particular 

food the first few times trying it. Infants and 

children may need to be offered a new food 

more than 10 times before a child might like 

it. Do not give up! Continue to offer foods 

babies did not like the first time to see if they 

will give it another try.
66 | Chapter 6 • Feeding Solid Foods

1. Look for signs of hunger before feeding a baby. 

2. Wash your hands. 

3. Spoon baby food from the jar or container and put it 

in a small bowl. 

4. Wash the baby’s hands and place the baby in an 

age-appropriate feeding chair. Have the baby eat with 

other children when possible. 

5. Put a bib on the baby. 

6. Sit with the baby while he or she is eating. Talk to the 

baby during the feeding and have good eye contact. 

7. When the baby is developmentally ready, let the 

baby try feeding him or herself. Soft finger foods 

give babies a chance to feed themselves without 

assistance. You can also let the baby try eating with 

a spoon. Monitor the baby during eating for any signs 

of choking or allergic reactions. 

Feed a baby from a bowl or plate 

instead of directly from the baby

food container. If the spoon used 

for feeding is put back into the 

jar, bacteria in the baby’s saliva 

can cause the food in the jar to 

spoil. If more food is needed 

from the container, always use 

a clean spoon to move it from 

the container to the baby's plate 

or bowl.

How To Feed Solid Foods to a Baby 

Child care provider feeding solid foods to a baby. 
Feeding Solid Foods • Chapter 6 | 67 

8. Help the baby practice drinking breastmilk or formula 

from a cup, if developmentally ready. 

9. Talk to the baby in a soft and encouraging voice. 

Keep good eye contact and smile. Games and 

other disruptions can be distracting or overwhelming 

to a baby. 

10. Watch for signs that the baby is full. 

11. After feeding, wash the baby’s hands and face. 

Remove the bib. 

12. Discard uneaten food from bowls, trays, 

or bottles. 

Offer the baby a variety of foods and textures that are

appropriate for his or her feeding skills. See Table 8, 

Introducing Different Textures of Food Based on Feeding 

Skills on page 68 for more information. 

Do not heat the baby food 

container in a microwave. This 

may create “hot spots” in the 

food, which could burn the 

baby’s mouth. If baby food has 

to be heated, pour the food into 

a bowl, plate, or pot and heat 

on the stove or with a food 

warmer until warm. Then, stir 

and test the temperature to 

make sure the food is not too 

hot before feeding.

A baby showing signs of fullness. 

How To Feed Solid Foods to a Baby (continued) 
68 | Chapter 6 • Feeding Solid Foods

Birth – 5 Months Around 6 – 8 Months Around 8 – 12 Months 

Feeding Skills 

Baby can 

suck/swallow 

Baby can move food 

from spoon to back of 

mouth and swallow 

Baby can pick up pieces 

of foods with fingers 

Texture of Food 

Liquids (breastmilk 

or iron-fortified 

infant formula) 

Pureed and mashed 

soft solid foods 

Liquids (breastmilk 

or iron-fortified infant 

formula) 

Ground or finely chopped 

soft solid foods* 

Ready-to-eat cereal, such 

as whole-grain o-shaped 

cereal. Strips of breads. 

Small pieces of crackers.** 

Liquids (breastmilk 

or iron-fortified infant 

formula) 

Feeding Style 

Breastfeeding or 

bottle feeding 

Spoon-fed by you 

Introduce a cup 

Baby can feed self with 

a spoon or pick up finger 

foods

Table 8 Introducing Different Textures of Food 

Based on Feeding Skills 

*To help prevent choking, grind or finely chop foods to no more than 1⁄2 inch in size or cut into thin slices 

that can easily be chewed. 

** Choose crackers without seeds, nuts, or whole grain kernels to avoid choking. 
Feeding Solid Foods • Chapter 6 | 69 

Always cut foods to no more than 

1⁄2 inch size or cut into thin slices 

that can easily be chewed to avoid 

choking. Look at the shape, size, and 

texture of foods before serving them 

to babies. 

For more information on specific 

foods that should not be served 

to a baby, see Chapter 9: Choking 

Prevention on page 114. 

Pureeing Foods 

Pureed foods are foods that are blended to a 

very smooth texture. Iron-fortified infant cereal, 

vegetables, fruits, meats, poultry, and other solid 

foods can be blended with cooking liquid or water 

to puree the food so the texture is appropriate for 

a younger baby. As the baby gets older, add less 

liquid to create a thicker puree. If you are cooking 

for one baby, you can use breastmilk or infant 

formula to change the texture of the food. For 

packaged foods, like iron-fortified infant cereal, 

follow the preparation directions on the package. 

Did you know? 

Some vitamins, like B vitamins and 

vitamin C, can leak out of foods during 

cooking. Using the liquid leftover from 

cooking to puree foods allows you to 

add some of the vitamins back into the 

dish you are preparing!

As a baby develops, it is important to give him 

or her the chance to try different textures of solid 

foods, moving from pureed foods to those that 

are mashed, ground, or finely chopped. This helps 

the baby develop feeding and chewing skills. It 

also helps the baby get used to the feel of 

different textures of foods in his or her mouth. 

You can use fresh, cooked, canned, or frozen 

foods to make foods that are the right texture for 

the baby. Start by offering pureed solid foods and 

move to foods mashed by a fork, ground, or finely 

chopped. You can also buy baby foods that are 

different in texture. 

Preparing Foods in Different Textures 

Butternut squash being pureed in a food processor. 

processor.
70 | Chapter 6 • Feeding Solid Foods

Mashing Foods 

Once a baby is used to pureed foods, mashed 

foods are a good texture to try next. Mashed 

foods are lumpier than pureed foods. Similar 

to pureed foods, iron-fortified infant cereal, 

vegetables, fruits, meats, poultry, and other solid 

foods can be mixed with cooking liquid or water 

before they are mashed with a fork or other 

kitchen equipment. If you are cooking for one 

baby, you can use breastmilk or infant formula to 

change the texture of the food. 

The infant meal pattern is made up of different 

food components, as shown in Table 3, CACFP 

Infant Meal Pattern With Food Components on 

page 15. From 0 through 5 months, breastmilk 

or infant formula is the only food component 

required. The infant meal pattern for babies 

that are 6 through 11 months includes solid 

foods as additional food components once the 

baby is developmentally ready. These additional 

solid food components include grains, meat 

and meat alternates, and vegetables and fruits. 

The food components are offered as part of 

a meal or snack, but since babies do not eat 

on a set schedule, the components may be 

offered throughout the course of the morning 

or afternoon. For example, a baby may eat part 

of his or her breakfast at 9 a.m. and more of 

his or her breakfast at 10:30 a.m. This is still 

reimbursable as the breakfast meal. 

For more information on how to 

prepare different foods for babies, 

see Chapter 7: Buying and Preparing 

Baby Foods on page 93.

Grinding and Finely Chopping Foods 

At around 8 through around 12 months of age, 

the baby may be ready for new textures. Grind or 

finely chop or dice soft foods into small pieces, no 

larger than 1⁄2 inch, or thin slices to avoid choking. 

Foods should be easy for the baby to chew. At 

this time, the baby should be able to use his or 

her pincer grasp (thumb and index finger) to pick 

up the small pieces of food. 

What Is a Reimbursable Infant Meal or 

Snack for Babies 6 Through 11 Months? 

A baby using the pincer grasp to pick up 

a ready-to-eat cereal.
Feeding Solid Foods • Chapter 6 | 71 

Grains served must be made with enriched or 

whole-grain meal or flour. Ready-to-eat breakfast 

cereals and infant cereals that are fortified are 

also creditable. There is not a whole grain-rich 

requirement in the CACFP infant meal pattern. 

See the “Grains” section of the “Food Buying 

Guide for Child Nutrition Programs” for 

information on how to determine if a grain is 

creditable in the CACFP. The “Food Buying Guide 

for Child Nutrition Programs” can be found online 

at https://foodbuyingguide.fns.usda.gov. 

Dry Iron-Fortified Infant Cereal 

Dry iron-fortified infant cereal is cereal that has 

iron added to it. Iron is an important nutrient for 

babies. Both single-grain infant cereal, such as 

wheat, oat, and barley, as well as mixed-grain 

infant cereal are creditable as long as they are 

iron-fortified. Babies should be given the 

single-grain iron-fortified infant cereal first to make 

sure he or she does not have an allergic reaction. 

If the baby does not have a reaction, then mixedgrain iron-fortified infant cereal can be offered. 

What Types of Grains Can Be Offered 

Under the Infant Meal Pattern? 

Did you know? 

Arsenic is found naturally in water, soil, and some foods, including infant rice cereal. If eaten over 

a long period of time it can be harmful. The Food and Drug Administration encourages parents 

to follow the American Academy of Pediatrics advice and feed babies a variety of grains to make 

sure babies are not eating too much arsenic.

How Can I Tell If an Infant Cereal Is 

Iron-Fortified? 

To tell if an infant cereal is “iron-fortified,” look at 

the ingredients list on the back of the infant cereal 

package. As long as one of the ingredients listed 

is “iron,” “ferric fumarate,” “electrolytic iron,” or 

“iron (electrolytic),” then the cereal is iron-fortified. 

Examples of grains in the infant meal pattern. 
72 | Chapter 6 • Feeding Solid Foods

If you use a cereal from a 

WIC-approved cereal list, 

make sure the ready-to-eat 

cereal is made with enriched 

or whole-grain meal or flour 

or is fortified. 

Ready-to-Eat Cereals 

Ready-to-eat cereals include flakes, 

rounds, and o-shaped cereals that older 

babies can pick up and eat. These cereals 

can only credit towards snacks, not meals. 

The cereal must not contain more than 

6 grams of sugar per dry ounce of cereal 

and must be iron-fortified. Some readyto-eat cereals may be a choking hazard. 

Choose cereals that dissolve easily in the 

mouth and do not include nuts, dried fruits, 

or other hard food items. 

How Can I Tell When a Cereal Only Has 

6 Grams of Sugar or Less Per Dry Ounce 

of Cereal? 

Almost all infant cereals meet this sugar limit, and there 

are many types of ready-to-eat cereal that meet this 

sugar limit as well. There are a couple of ways to figure 

out if a cereal meets the sugar requirement. You can: 

• Use any cereal that is listed on any State agency’s 

Special Supplemental Nutrition Program for 

Women, Infants, and Children (WIC)-approved 

cereal list, found as part of the State’s approved 

food lists. 

• Use the chart in USDA Team Nutrition’s training 

worksheet “Choose Breakfast Cereals That Are 

Lower in Added Sugars.” The worksheet includes 

the chart on page 73 with common breakfast 

cereal serving sizes and the maximum amount of 

sugar the breakfast cereal may contain per serving. 

This worksheet can be found in Appendix D: 

Choose Breakfast Cereals That Are Lower in Added 

Sugars on page 145 or online at: https://www.fns. 

usda.gov/cacfp-training-tools.

Example of a ready-to-eat cereal. 
Feeding Solid Foods • Chapter 6 | 73 

Table 9 Sugar Limits for Ready-to-Eat Cereals 

Serving Size Sugars 

If the serving 

size is: 

Sugars cannot 

be more than: 

0–2 grams 0 grams 

3–7 grams 1 gram 

8–11 grams 2 grams 

12–16 grams 3 grams 

17–21 grams 4 grams 

22–25 grams 5 grams 

26–30 grams 6 grams 

31–35 grams 7 grams 

36–40 grams 8 grams 

41–44 grams 9 grams 

45–49 grams 10 grams 

Serving Size Sugars

If the serving 

size is:

Sugars cannot 

be more than:

50–54 grams 11 grams 

55–58 grams 12 grams 

59–63 grams 13 grams 

64–68 grams 14 grams 

69–73 grams 15 grams 

74–77 grams 16 grams 

78–82 grams 17 grams 

83–87 grams 18 grams 

88–91 grams 19 grams 

92–96 grams 20 grams 

97–100 grams 21 grams

Find the serving size and sugars line on the Nutrition Facts 

label. In Table 9, Sugar Limits for Ready-to-Eat Cereals, look 

at the number to the right of the serving size amount. If the 

cereal has that amount of sugar, or less, your cereal meets the 

sugar requirement. 

Baby eating a ready-to-eat cereal at snack. 
74 | Chapter 6  Feeding Solid Foods

Breads and Crackers Strips or small pieces of breads and crackers 

may credit towards snacks under the infant meal 

pattern. These include, but are not limited to:

• Small strips or pieces of dry bread or toast, 

such as whole-wheat, French or Italian bread

• Small pieces of crackers without seeds, nuts, 

or whole grain kernels

• Small pieces of soft tortilla or soft pita bread

• Teething crackers, biscuits, and toasts

• Small pieces of English muffins

• Small pieces of rolls

• Small pieces of cornbread or corn muffins

What Types of Meats and Meat Alternates Can Be 

Offered Under the Infant Meal Pattern?

Meats and Poultry 

Meats and poultry, including beef, pork, lamb, veal, 

chicken, and turkey, are creditable in the CACFP 

infant meal pattern. Like iron-fortified infant cereals, 

meats and poultry are good first foods for babies 

because they provide iron and zinc that babies 

need around 6 months of age.

• All meats must be USDA inspected. 

• Store-bought baby food meats made with 

broth or gravy are creditable in the CACFP.

Thin slices and pieces of bread no larger 

than 1⁄2 inch.

Fin Fish and Shellfish

Both fin fish and shellfish purchased from a 

commercial source may be offered to infants 6 

through 11 months old when developmentally 

ready for solid foods. These include salmon, trout, 

flounder, cod, haddock, perch, tilapia, crab, 

shrimp, and other fish and shellfish. According to 

the American Academy of Pediatrics, there is no 

evidence that waiting to introduce common 

allergens, such as fish or shellfish, beyond 4 to 6 

months of age will prevent a food allergy.

Remove any bones or shells and modify the 

texture of the fish and shellfish based upon the 

feeding skills of the baby.

Help parents learn about other sources of iron by giving them the "For Parents: 

Making Sure Your Baby Gets Enough Iron" handout on page 76.
Feeding Solid Foods • Chapter 6 | 75 

The U.S. Food and Drug Administration and the 

Dietary Guidelines for Americans recommend that 

pregnant women and young children avoid eating 

fish that typically have higher mercury levels. 

These include: 

• shark • swordfish • king mackerel • tilefish 

• bigeye tuna • orange roughy • marlin 

Home-caught fish is only creditable if it meets 

State or local public health policies regarding 

food safety. 

See the “Meat/Meat Alternates” section in the 

“Food Buying Guide for Child Nutrition Programs” 

for information on processed fish products, such 

as fish sticks. The “Food Buying Guide for Child 

Nutrition Programs” can be found online at 

https://foodbuyingguide.fns.usda.gov. 

Cheese 

Pasteurized cheeses that meet the U.S. Food 

and Drug Administration’s standard of identity for 

cheese2 are allowed under the infant meal pattern 

for 6 through 11 months. This can include: 

• Pasteurized processed American cheese 

• Natural cheddar or Colby cheeses 

• Monterey jack or mozzarella (part skim or 

whole) cheeses 

• Muenster and provolone cheeses 

• Cottage cheese 

Cheese food, cheese spread, and cheese 

product are not creditable under the infant meal 

pattern because they are generally higher in salt 

and lower in protein. 

Caution. Never feed babies dairy 

products made from raw, unpasteurized 

milk. Unpasteurized milk products 

may contain harmful bacteria that 

can cause the baby to be very sick.

2Food and Drug Administration. 21 CFR Part 133. 2012. 

Information about mercury levels in 

specific fish can be found at the Food and 

Drug Administration food safety website, 

found here: https://www.fda.gov/Food/ 

FoodborneIllnessContaminants/Metals/ 

default.htm. You can also contact your 

State or local health department or call 

1-888-SAFEFOOD (1-888-723-3366) for 

more information. 

Tip: 

 

 
76 | Chapter 6  Feeding Solid Foods

For Parents: Making Sure Your Baby Gets Enough Iron

Iron is one of the key nutrients babies need during 

their first year of life. Iron helps to transport 

oxygen throughout the body, which is important 

for a baby’s growth and brain development.

Good Sources of Iron:

Babies that are only breastfed typically run out 

of the iron they are born with between 4 and 6 

months of age. Your baby’s health care provider 

may give your baby an iron supplement until your 

baby is ready for solid foods. When your baby 

is ready for solid foods, make sure your baby is 

eating foods that contain iron.

.

Continue reading on the back of this handout about good sources of vitamin C to pair 

with the iron-rich foods on this page.

Food and Nutrition Service

Iron-fortified 

infant cereal

Iron-fortified 

infant formula

Fortified 

ready-to-eat 

cereals

Leafy green 

vegetables

Chicken 

Beef

Fish Beans

Infant

Cereal

Iron-Fortified

Toasted

Os Cereal
Feeding Solid Foods  Chapter 6 | 77 

Strawberries 

Good Sources of Vitamin C

Vitamin C helps our bodies absorb iron! When you serve a baby iron-rich 

foods like the ones on the front of this handout, pair them with foods that 

contain vitamin C. Remember to prepare the following foods to the right 

texture and size to prevent choking.

Tomatoes Cooked red peppers

Kiwi Oranges Cooked broccoli 

.

A handout from Feeding Infants in the Child and Adult Care Food Program

https://teamnutrition.usda.gov  FNS 786E  March 2019

USDA is an equal opportunity provider, employer, and lender.
78 | Chapter 6 • Feeding Solid Foods

Eggs 

Shell eggs or liquid pasteurized whole eggs may 

be offered as part of a reimbursable meal or 

snack. Eggs must be federally inspected. There is 

no evidence that waiting to introduce egg whites 

beyond 4 through 6 months of age will prevent 

a food allergy. The whole egg, including both the 

egg yolk and the egg white, must be served in 

order for it to be creditable. 

Cooked Dry Beans and Peas 

Any cooked dry beans and peas, such as lentils, 

black beans, pinto beans, or chickpeas, may be 

served to babies who are developmentally ready 

to accept them. This includes canned beans and 

peas. Look for those labeled “reduced sodium.” 

Puree or mash beans and peas to avoid choking. 

Green peas are not considered a meat alternate. 

Nuts and Seeds 

Nuts, seeds, peanut butter, and other nut or 

seed butters are not creditable as part of a 

reimbursable infant meal. 

A boiled egg diced with the yolk and egg white. 

Did you know? 

If you serve cooked dry beans and 

peas, they can be credited as a 

vegetable or meat alternate in the 

infant meal pattern. However, cooked 

dry beans and peas cannot be credited 

as both a vegetable and a meat 

alternate in the same meal. This also 

applies to canned beans and peas. 

Processed Meats 

Processed meats and poultry such as hot dogs 

(frankfurters), infant meat and poultry sticks 

(not dried or semi-dried, like jerky), chicken 

nuggets, fish sticks, and sausage can be part 

of a reimbursable meal to give greater flexibility 

to the menu planner. However, they are not 

recommended. The American Academy of 

Pediatrics recommends limiting these foods 

because they are higher in sodium than other 

meat products. Some forms of these foods 

may cause choking, such as hot dogs cut into 

rounds. Instead, offer babies plain meats, poultry, 

fish, and eggs that have been changed to be 

the right texture (pureed, mashed, ground, finely 

chopped, etc.) for the baby based on his or her 

development. Remember to always cut foods 

into thin slices, and no larger than 1⁄2 inch, to 

prevent choking. 

Tofu 

Tofu is not creditable as part of a reimbursable 

infant meal.
Feeding Solid Foods • Chapter 6 | 79 

Child care provider feeding yogurt to a baby.

Tip: 

Soy yogurt and tofu are not creditable as 

part of a reimbursable meal or snack in the 

infant meal pattern. 

3Food and Drug Administration. 21 CFR 131.200. 1999. 

4Food and Drug Administration. 21 CFR 131.203. 1999. 

5Food and Drug Administration. 21 CFR 131.206. 1999. 

Yogurt 

Store-bought low-fat, reduced-fat, and whole 

milk yogurts are creditable under the infant meal 

pattern for babies 6 through 11 months. 

Homemade yogurts are not creditable. The yogurt 

must be pasteurized and meet the U.S. Food 

and Drug Administration’s standard of identity for 

whole,3 low-fat,4 or non-fat5 yogurt. Yogurt must 

contain no more than 23 grams of sugar per 6 

ounces of yogurt. See Table 10, Sugar Limits for 

Yogurt on page 80 for more information. 

• Soy yogurt is not creditable as part of the infant 

meal pattern. 

• Yogurt with fruit is creditable in the infant meal 

pattern if it meets the sugar limit. 

• Yogurt products, such as frozen yogurt, 

drinkable or liquid yogurt products, yogurt 

smoothies, homemade yogurt, yogurt flavored 

products, yogurt bars, and freeze-dried yogurt 

snacks are not creditable. 

How Can I Tell When a Yogurt Has 

No More Than 23 Grams of Sugar 

Per 6 Ounces? 

To help you identify yogurts with no more than 23 

grams of sugar per 6 ounces, you can: 

• Use the chart in USDA Team Nutrition’s training 

worksheet “Choose Yogurts That Are Lower in 

Added Sugars.” The worksheet includes the 

chart on page 80 with common yogurt serving 

sizes, including ounces and grams, and the 

maximum amount of sugar the yogurt may 

contain per serving. This worksheet can be 

found in Appendix E: Choose Yogurts That 

Are Lower in Added Sugars on page 147 or 

online at https://www.fns.usda.gov/tn/cacfpmeal-pattern-training-tools. 
80 | Chapter 6 • Feeding Solid Foods

Serving Size 

Ounces (oz.) 

Serving Size Grams (g.) (Use when the 

serving size is not listed in ounces) Sugars 

If the serving size is: Sugars must not be more than: 

1 oz. 28 g. 4 g. 

1.25 oz. 35 g. 5 g. 

1.5 oz. 43 g. 6 g. 

1.75 oz. 50 g. 7 g. 

2 oz. 57 g. 8 g. 

2.25 oz. 64 g. 9 g. 

2.5 oz. 71 g. 10 g. 

2.75 oz. 78 g. 11 g. 

3 oz. 85 g. 11 g. 

3.25 oz. 92 g. 12 g. 

3.5 oz. 99 g. 13 g. 

3.75 oz. 106 g. 14 g. 

4 oz. 113 g. 15 g. 

4.25 oz. 120 g. 16 g. 

4.5 oz. 128 g. 17 g. 

Table 10 Sugar Limits for Yogurt 

4.75 oz. 135 g. 18 g. 

5 oz. 142 g. 19 g. 

5.25 oz. 149 g. 20 g. 

5.3 oz. 150 g. 20 g. 

5.5 oz. 156 g. 21 g. 

5.75 oz. 163 g. 22 g. 

6 oz. 170 g. 23 g. 

6.25 oz. 177 g. 24 g. 

6.5 oz. 184 g. 25 g. 

6.75 oz. 191 g. 26 g. 

7 oz. 198 g. 27 g. 

7.25 oz. 206 g. 28 g. 

7.5 oz. 213 g. 29 g. 

7.75 oz. 220 g. 30 g. 

8 oz. 227 g. 31 g.
Feeding Solid Foods  Chapter 6 | 81 

What Types of Vegetables and Fruits 

Can Be Offered Under the Infant Meal Pattern?

Vegetables and Fruits

All vegetables and fruits can be offered to babies. 

They contain important nutrients and fiber. To 

avoid choking, remember to cook and prepare 

vegetables and fruits to the appropriate texture. 

Remove all pits, seeds, skins, and peels before 

serving the food. Always cut vegetables and fruits 

into thin slices, and no larger than 1⁄2 inch, to 

prevent choking.

• Fruit and vegetable juices, even 100% 

juice, are not creditable under the infant 

meal pattern.

• The American Academy of Pediatrics 

recommends that homegrown spinach, beets, 

turnips, carrots, and collard greens should not 

be fed to infants less than 6 months of age. 

These foods may contain high levels of 

nitrates. This can cause a condition which can 

make it harder for a baby’s blood to carry 

oxygen throughout the body.

Caution. Remove pits, seeds, skins, 

and peels from vegetables and fruits 

before serving.

What Other Types of Foods Are or Are Not 

Creditable in the Infant Meal Pattern?

Desserts

Grain-based desserts such as cookies, sweet 

pie crusts, doughnuts, cereal bars, breakfast 

bars, granola bars, sweet rolls, toaster pastries, 

cake, and brownies, including baby food varieties 

of these items, are not creditable as part of a 

reimbursable meal in the CACFP. These foods are 

high in saturated fats and added sugars.

Honey

Honey may contain bacteria that can cause infant 

botulism. Infant botulism is a serious illness that 

can make a baby very sick. Babies are at a higher 

risk of getting infant botulism until they turn 1 

year old. Therefore, honey should never be fed 

to babies younger than one. This includes honey 

served on its own, as a topping for other foods, 

or cooked or baked into other foods. Also avoid 

serving store-bought foods made with honey, 

including honey graham crackers, cereals with 

honey, etc.

Encourage parents to offer a variety 

of vegetables to their baby for 

healthy growth and development. 

You can use the "For Parents: 

Varying Your Baby's Veggies" 

handout on page 88 to help parents 

keep track of the vegetables their 

baby has tried.
82 | Chapter 6 • Feeding Solid Foods

Table Foods 

If you have older babies in your care (about 

10 through 12 months) they may be ready to 

try foods that older children and adults are 

also eating, known as table foods. This can be 

helpful if you are a family child care provider 

and want to cook the same foods for all the 

children in your care. 

You may need to cook foods for the baby a little 

longer so it is softer. You may also need to cut it 

into smaller pieces for babies. For example, the 

baby can have some of the sweet potato you're 

making for older children as long as you cook 

that portion just a bit longer—until it's soft—and 

mash or chop it into small pieces no larger than 

1⁄2 inch. 

If you are offering a mixed dish, first make sure 

the baby has tried all of the food ingredients 

before. With some dishes like soup, you may 

be able to separate out some of the cooked 

ingredients, such as cooked vegetables or meat, 

and change their texture further if needed. If 

your dish has foods that do not credit towards a 

reimbursable meal under the infant meal pattern,

such as the noodles in lasagna, the food can still 

be served to the baby. Only the ingredients that 

are creditable in the infant meal pattern, such as 

cheese, meat, poultry, or vegetables, will count 

towards the reimbursable meal. 

Tip: 

The American Academy of Pediatrics 

recommends introducing single ingredient 

foods to babies first before giving a mix of 

foods, or combination foods. Once the baby 

has tried each ingredient in a mixed food 

without having an allergic reaction, then 

the baby can try the combination food. For 

example, if you want to serve scrambled 

eggs with cheese, make sure the baby has 

tried eggs and cheese separately before 

serving the two mixed together.

Make sure babies have tried all food ingredients before serving a mixed dish. 

Artificial Sweeteners 

Artificial sweeteners or sugar substitutes (such 

as aspartame, sucralose, stevia, saccharin, and 

others) can be found in low-calorie foods and 

drinks. These are not recommended for babies. 

Babies grow quickly and need many nutrients 

for their health and development. To help build 

taste preferences for a variety of foods, it is 

important to introduce babies to different tastes 

and textures, and not just those that are sweet. 

For this reason, you may want to limit serving 

foods with both natural sweeteners and artificial 

sweeteners to infants. 
Feeding Solid Foods • Chapter 6 | 83 

Added Sugars, Fats, and Sodium 

Taste preferences and eating habits are formed 

early in a child's life. It is important to offer a baby 

food that is lower in added sugar, saturated fat, 

and sodium (salt). Sweetened foods and foods 

high in saturated fat can make a baby feel full 

without providing the key nutrients he or she 

needs for healthy growth. 

As a reminder, grain-based desserts are not 

creditable in the CACFP infant meal pattern. 

Grain-based desserts are food items such as 

cookies, brownies, granola bars, etc. 

For a longer list of grain-based desserts, see 

"Desserts" on page 81. 

Tip: 

Cow's milk, goat’s milk, soy milk, sodas, 

sports drinks, fruit drinks, sugar water, 

juice (even 100% juice), tea, and coffee 

should not be offered to babies at your 

child care site. 

For a full list of beverages and 

foods that are creditable and 

non-creditable, see Appendix F: 

Infant Foods List, on page 149. For 

more information on beverages, 

see Table 7, What Should Babies 

Drink? on page 55. 

Food Components Provided 

by the Parents 

A food component provided by parents may also 

credit toward the reimbursable meal. For babies 

who are eating solid foods, there are two options 

to claim reimbursement. 

1. If the parent provides breastmilk or a 

creditable infant formula for the baby, then 

your child care site must provide all of the 

solid food components in order for the meal 

to be reimbursable. 

2. If the parent provides a solid food component 

for a baby, then your child care site must 

provide a creditable iron-fortified infant 

formula and all other solid food components. 

See Table 11, When a Baby Is 

Eating Solid Foods on page 84 for 

an example of parent-provided 

food components. 

Breastmilk provided by parents.

Even after a baby starts eating 

solid food, breastmilk and ironfortified infant formula are still the 

best beverages to offer babies at 

meals and snacks. 
84 | Chapter 6 • Feeding Solid Foods

Table 11 When a Baby Is Eating Solid Foods 

Special Dietary Needs 

Due to Disabilities 

As a child care site participating in the CACFP, 

you must make substitutions to meals for 

participants with a disability. If the food you offer 

does not meet the needs of a baby with a 

disability due to special dietary needs, then 

another food item within the same food 

component can be substituted by you or the 

parents. For example, if a baby in your care 

cannot eat peaches, you can provide another fruit 

such as apples, pears, or bananas as part of the 

reimbursable meal. You should always try to find a 

substitution. However, if the baby's health care 

provider writes a medical statement that notes the 

baby cannot eat any foods in that food 

component, then you do not have to serve that 

food component. If the substitution is due to a 

disability or special dietary need, the medical 

statement must include the name of the food(s) to 

be avoided, explain how the food(s) affects the 

If a parent brings in... You must offer... 

Breastmilk All other solid food components 

Iron-fortified infant formula All other solid food components 

A solid food component 

(for example, pureed meat) 

Iron-fortified infant formula 

All other solid food components 

baby, and be signed by the baby's health care 

provider. Recommended substitutions of food(s) 

can also be included on the medical statement. 

Keep the medical statement on file in a secure 

location at your child care site. 

Special Dietary Needs Due 

to Religious Reasons 

If a parent requests a meal change due to 

religious reasons, then another food item within 

the same food component can be substituted by 

you or the parents. For example, if the parents do 

not want their baby to eat pork, then a different 

meat or meat alternate can replace the pork for 

that meal. In this case, the meal would still be 

reimbursable. It is recommended to have a 

parent’s note and signature on file showing that 

this request was made. A medical statement is 

not needed.
Feeding Solid Foods • Chapter 6 | 85 

If parents have indicated that the baby is following 

a vegetarian or vegan eating pattern, you can 

still offer meals and snacks that fit within the 

infant meal pattern. The parents may provide an 

iron-fortified, soy-based infant formula without 

a medical statement, if desired. Cow's milk, 

soy milk, rice milk, almond milk, hemp milk, and 

homemade formulas may not credit towards a 

reimbursable infant meal or snack because they 

are missing important nutrients for healthy growth 

and development. 

A baby following a vegetarian eating pattern may 

be offered pureed or mashed beans, cheese, 

yogurt, or whole eggs. Tofu and soy yogurt may 

not credit towards a reimbursable meal without 

a medical statement, but you or the parents may 

choose to serve them as additional food items. 

Nut and seed butters are also not creditable 

towards a reimbursable meal under the infant 

meal pattern. Chunks of nut or seed butters pose 

a choking risk for infants. 

At 12 months of age, vegan infants can be 

transitioned from infant formula to soy milk that is 

nutritionally equivalent to cow’s milk. Babies can 

also continue to receive breastmilk in place of fluid 

cow’s milk after 1 year of age.

Feeding Solid Foods to Vegetarian or Vegan Babies 

Baby eating pureed black beans. 
86 | Chapter 6 • Feeding Solid Foods

Keep Parents Updated 

You and the parents are a team when it comes 

to feeding the baby. You need information from 

parents about what solid foods to feed to the 

baby, and they need to know how feeding is 

going at the child care site and how much the 

baby is eating. One way to share this information 

with parents is through a daily activity chart. The 

chart could include things like what the baby ate, 

bowel movements, number of wet and dirty 

diapers, number and length of naps, and other 

See Appendix A: Sample Infant important notes.

Daily Activity Chart on page 139 for 

an example of a daily activity chart 

you can use to share information 

with parents. 

Tip: 

The CACFP does not require that you 

provide a daily activity chart, but it is a 

great way to communicate with parents! 

Be a Role Model at Mealtime 

You can model how to eat new foods for the 

baby! Mealtimes provide a chance to show how 

to use a spoon or fork to eat a small amount 

of food. Show your enjoyment of the food by 

smiling and using a positive tone of voice. If older 

children eat meals with the baby at the child care 

site, encourage them to also model good eating 

behaviors for the baby. This can help create a 

positive and encouraging eating environment. 

Keep parents updated on how feeding is going. 
Feeding Solid Foods • Chapter 6 | 87 

For Child Care Providers: Feeding Babies in Their First Year 

Baby’s age When baby can: Serve these foods in the CACFP: 

Birth through 

5 months 

• Only suck and swallow 

Liquids Only 

• Breastmilk 

• Iron-fortified infant formula 

Around 6 months 

through 8 months 

• Draw in upper or lower 

lip as spoon is removed 

from mouth 

• Move tongue up and down 

• Sit up with support 

• Swallow soft solid foods 

without choking 

• Open the mouth when 

they see food 

• Drink from a cup with 

help, with spilling 

Serve liquids above and add solid 

foods when babies are developmentally 

ready, including: 

• Cooked, plain pureed/mashed 

vegetables 

• Plain pureed/mashed fruit 

• Plain pureed/mashed meat and meat 

alternates (dairy and protein foods): 

meat, poultry, fish, whole eggs, cheese, 

yogurt, and cooked dry beans and peas 

• Iron-fortified infant cereals, bread, small 

pieces of crackers 

Around 8 months 

through 12 months 

• Move tongue from 

side to side 

• Begin spoon feeding 

themselves with help 

• Begin to chew and have 

some teeth 

• Begin to hold food and 

use their fingers to feed 

themselves 

• Drink from a cup with 

help, with less spilling 

Serve liquids and foods above, and add: 

A variety of new solid foods and textures 

such as: 

• Fortified ready-to-eat cereal, teething 

biscuits, crackers, and toasts 

• Finely chopped vegetables 

• Finely chopped fruit 

• Finely chopped meat and meat 

alternates (dairy and protein foods): 

meat, poultry, fish, whole eggs, cheese, 

yogurt, and cooked dry beans and peas 

.

A handout from Feeding Infants in the Child and Adult Care Food Program 

https://teamnutrition.usda.gov • FNS 786F • March 2019 

USDA is an equal opportunity provider, employer, and lender.

Food and Nutrition Service
88 | Chapter 6 • Feeding Solid Foods

Giving your baby a variety of vegetables is a great way to introduce different flavors 

and nutrients into your baby’s diet. You can start by giving your baby thinner pureed 

vegetables. Introduce thicker and lumpier vegetables as he or she gets older. This 

includes mashed, ground, and finely chopped foods. 

For Parents: Varying Your Baby’s Veggies 

What Face Does Your Baby Make When Trying These Foods? 

Circle the face that looks like the face your baby made when trying the new food. 

Age Around 6–8 Months Around 8–12 Months 

Texture 

of Food Pureed Mashed Ground/Finely Chopped 

Pureed sweet potato Mashed avocado Chopped green beans 

Pureed peas Mashed broccoli Chopped cooked zucchini 

What face did your 

baby make? 

What face did your 

baby make? 

What face did your 

baby make? 

What face did your 

baby make? 

What face did your 

baby make? 

What face did your 

baby make?

Food and Nutrition Service
Feeding Solid Foods • Chapter 6 | 89 

Pureed black beans Mashed carrots Chopped cooked bell pepper 

Pureed summer squash Mashed tomatoes Chopped cooked spinach 

Pureed butternut squash Mashed chickpeas Chopped squash 

What face did your 

baby make? 

What face did your 

baby make? 

What face did your 

baby make? 

What face did your 

baby make? 

What face did your 

baby make? 

What face did your 

baby make? 

What face did your 

baby make? 

What face did your 

baby make? 

What face did your 

baby make? 

It’s okay if your baby makes this face or this one after you let them try a new food! You may 

have to offer a food more than 10 times before your baby might like it. Don’t give up—keep offering 

these foods to your baby! One day your baby may like the food and will make this face . 

A handout from Feeding Infants in the Child and Adult Care Food Program 

https://teamnutrition.usda.gov • FNS 786G • March 2019 

USDA is an equal opportunity provider, employer, and lender.
90 | Chapter 6 • Feeding Solid Foods

A baby can learn as soon as he or she is born! 

Singing and reading to a baby are great ways to 

introduce new words to help him or her learn to 

talk and eventually write and read. Singing and 

reading about healthy foods provides a great 

opportunity to reinforce healthy eating habits in 

infants and children. 

Here is a list of books* about vegetables, fruits, 

and other healthy foods to get you started: 

• "Fruit" by Sara Anderson 

• "Vegetables" by Sara Anderson 

• "The Very Hungry Caterpillar" by Eric Carle 

• "My Very First Book of Food" by Eric Carle 

• "My Food / Mi Comida" by Rebecca Emberley 

• "Eating the Alphabet" by Lois Ehlert 

• "Farmer’s Market Book" by the Manhattan 

Toy Company

It’s Never Too Early To 

Sing and Read to Babies! 

In This Chapter 

In this chapter, you have learned about how to feed a baby solid foods. This information will be 

used in the next chapter when you learn about buying and preparing baby foods.

Child care provider reading to a baby. 

*Mention of these books is not an endorsement by the United States Department of Agriculture over other 

books that may be available on this subject. 
Feeding Solid Foods  Chapter 6 | 91 

Key Concepts

Communicate often with parents to find out about new solid 

foods that their baby is eating at home.

Encourage parents to introduce a variety of vegetables to 

their baby for healthy growth and development.

Textures of solid foods should be modified based on the 

baby's development. As babies develop, they need the 

opportunity to move from pureed foods to finely chopped 

soft foods.

It is normal for a baby to reject a new food. New foods may 

need to be offered more than 10 times before a baby might 

like it.

Iron-fortified infant cereals, meats, eggs, and poultry provide 

iron that babies need starting around 6 months for healthy 

development.

Feeding Solid Foods
92 | Chapter 6 • Feeding Solid Foods

: What Is Your Baby Eating? Let Us Know! For Parents 2. ● B and C 1. ANSWERS:

B, D, E. However, a pancake can be served at snack and 3. ● page 63 handout on 

be claimed for reimbursement since it is a bread-like item. Ready-to-eat cereals, bread, 

and crackers can be served at snack only. For more information, see "pancakes" in 

. page 170 : Infant Foods List on Appendix F

1. Which foods are creditable in the infant meal pattern and can be offered to 

infants around 6 through 11 months? Choose all that apply. 

Soy yogurt 

Pureed carrots 

Finely chopped baked chicken 

Granola bar 

2. You are talking to a father who wants you to start offering solid foods to his 

baby at your child care site. What tool can you use to help gather information 

on the types of food the baby has already been introduced to? 

3. You are serving older children fat-free (skim) milk, pancakes, and 

strawberries for breakfast. Which foods can you serve the 10-month-old in your 

program in order to claim reimbursement for the breakfast meal? Choose all 

that apply: 

Fat-free (skim) milk 

Breastmilk or iron-fortified infant formula 

Pancakes 

Finely chopped strawberries 

Iron-fortified infant cereal 

Check Your Knowledge 

B 

C 

D 

E 

A 

B 

C 

D 

A 
Buying and Preparing Baby Foods  Chapter 7 | 93 

Chapter 7

Buying and Preparing Baby Foods 

What’s In This Chapter? 

By the end of this chapter, child care 

providers will be able to:

Explain how to purchase and 

prepare creditable baby foods.

Identify equipment used to prepare 

baby foods.

Identify food safety tips for storing 

baby food. 

1

2

3

Both store-bought baby foods and foods 

prepared at a child care site may be part of a 

reimbursable meal or snack in the CACFP. 

Purchasing Baby Food

Many different store-bought baby foods are 

creditable. Water, broth, and vitamins (such as 

ascorbic acid) may be additional ingredients. 

These ingredients are added to make the food 

the right consistency for the baby and may be 

part of a creditable infant food. As a best 

practice, avoid choosing baby foods that have 

added sodium (salt), fat, and/or added sugars, 

like fruit juice concentrates or syrups. Foods high 

in added sodium, fat, and sugar are less healthful 

for the baby.

The following foods are creditable as part of a 

reimbursable infant meal or snack:

• Fruits (can include more than one kind of fruit)

• Vegetables (can include more than one 

kind of vegetable)

• Fruit and vegetable combinations

• Combination foods like meat or meat 

alternates with vegetable or fruit combinations

• Iron-fortified dry infant cereal

• Poultry (chicken or turkey)

• Meats (beef or pork)

• Meat alternates such as cheese and yogurt

• Fin fish and shellfish

• Ready-to-eat cereals (snack only)

• Breads (snack only)

• Crackers (snack only)

The following types of baby foods do not credit 

towards a reimbursable meal or snack:

• Grain-based desserts, such as cookies, 

puddings, brownies, etc.

• Fruit and yogurt products that do not meet 

the standard of identity for fat-free, low-fat, or 

whole milk yogurt6

,

7

,

8

• Freeze-dried fruit and yogurt combinations

6Food and Drug Administration. 21 CFR 131.200. 1999.

7Food and Drug Administration. 21 CFR 131.203. 1999.

8Food and Drug Administration. 21 CFR 131.206. 1999.
94 | Chapter 7  Buying and Preparing Baby Foods

Examples of Creditable Store-Bought Baby Foods

Ingredients: pears, zucchini, corn, water, 

vitamin c (ascorbic acid), citric acid 

Ingredients: beef, beef broth

Ingredients: vegetables (carrots, re-hydrated 

potatoes, peas), water, finely ground chicken

Ingredients: sweet potatoes, water

Ingredients: pears, pear puree (water, pear puree 

concentrate), ascorbic acid (vitamin c), citric acid

Ingredients: water, butternut squash, chicken, 

corn, whole grain brown rice (non-creditable)

 

 

 

 

 

 

 

 
Buying and Preparing Baby Foods • Chapter 7 | 95 

Ingredients: peach puree (water, peach puree 

concentrate), water, white grape juice 

concentrate, rice flour, ascorbic acid (vitamin c), 

cinnamon, citric acid 

Ingredients: cultured organic grade a milk, 

organic skim milk, organic sugar, organic 

strawberry puree, organic tapioca starch, organic 

strawberry flavor (organic strawberry flavor, 

organic sugar, organic lemon juice concentrate), 

contains 2% or less of the following: organic whey 

protein concentrate, pectin, organic inulin, organic 

beet juice concentrate (for color), mixed 

tocopherols (to preserve freshness), probiotics 

(s. thermophilus, l. bulgaricus, l. acidophilus, b. 

lactic, l. paracasel, l. rhamnosus), contains milk 

Examples of Non-Creditable Store-Bought Baby Foods 

Selecting Baby Foods From the Store 

When shopping for baby foods be sure to: 

• look at the “use by” date on the food package 

before buying it. If the date has passed, do not 

buy or use the food. 

• choose baby food containers that are clean. 

Do not buy or use dented, rusted, bulging, 

or leaking containers. The food in these 

containers may contain harmful bacteria or 

be unsafe. 

• check that the vacuum seal has not been 

broken before using. You should hear a pop 

when you open the lid of the jar, or a cracking 

sound when you break the seal of the pouch 

or container.

Look at the "use by" date before 

buying baby foods. 

 

 

 
96 | Chapter 7 • Buying and Preparing Baby Foods

Storing Opened Store-Bought Baby Food 

• Observe “use by” dates for storage of 

unopened baby food containers. If the date 

has passed, throw out the food. 

• After opening packaged baby food, label 

it with the date it was opened. Store any 

remaining food immediately in the refrigerator. 

Baby Food Packaging 

The CACFP allows store-bought baby foods that 

are packaged in a jar, plastic container, or pouch. 

The way the food is packaged does not impact 

whether a food is creditable or not. However, 

the American Academy of Pediatric Dentistry 

discourages the use of baby food pouches 

because if a baby sucks on the pouch for a long 

time, it may lead to tooth decay. If food pouches 

are used, squeeze the food onto a spoon to feed 

the baby or allow the baby to feed him or herself 

with the spoon. 

Tip: 

Baby foods and infant formulas served to 

infants containing healthy fats, such as 

docosahexaenoic (DHA), are creditable 

in the CACFP. “DHA” is usually written on 

the front of the food package if it is 

added. Some studies suggest that DHA 

may be good for a baby’s eye function 

and brain development.

The CACFP allows store-bought baby foods that are in a jar, container, or pouch. 
Buying and Preparing Baby Foods • Chapter 7 | 97 

You can prepare foods for babies at your child 

care site or purchase prepared foods from a 

vendor. There are many great reasons to prepare 

your own baby foods. Some are: 

• You may be able to offer locally grown and 

seasonal foods as part of infant meals. 

• It may be less expensive or easier for your 

child care site. 

• You may be able to offer a greater variety of 

foods to the babies at your site.te. 

Preparing Baby Food 

at Your Child Care Site 

Did you know? 

The American Academy of Pediatrics 

recommends that homegrown spinach, 

beets, turnips, carrots, and collard 

greens made at home should not be fed 

to infants less than 6 months of age 

because they may contain nitrates. This 

can cause a condition which can make it 

harder for a baby’s blood to carry oxygen 

throughout the body.

For more information on how to 

prepare foods to avoid choking, see 

Chapter 9: Choking Prevention on 

page 114. 

Tip: 

For safety reasons, foods that are canned 

by a child care site are not allowed as 

part of a reimbursable meal or snack under 

the CACFP. 

You can prepare foods for babies at your child care site. 
98 | Chapter 7 • Buying and Preparing Baby Foods

Common kitchen equipment is all that is needed to prepare baby food at your 

child care site. The following tools can help you puree, mash, grind, or finely 

chop foods for babies. 

Tools for Preparing Baby Food 

A blender can puree foods. 

A food processor can puree, mash, or finely 

chop foods. 

A fine mesh strainer changes the texture of 

the food when you push the food through the 

strainer with the back of a spoon. 

A baby food grinder or food mill grinds and 

strains soft food pieces, leaving most skins 

and seeds behind. 

A fork and knife can be used to mash or 

finely chop foods for babies. Foods should 

be no larger than 1⁄2 inch or cut into thin 

slices to reduce the risk of choking.
Buying and Preparing Baby Foods • Chapter 7 | 99 

Vegetables and fruits are great sources of 

nutrients, such as fiber and vitamin C, which 

promote healthy growth and development. 

Vegetables and fruits can be fresh, frozen, or 

canned, and prepared to the right texture for the 

baby. When possible, choose frozen vegetables 

and fruits without added salt, sauces, or fat; 

canned fruits without added sugar or syrup; and 

canned vegetables without added salt. Keep 

vegetables and fruits separate from raw meat, 

poultry, and fish in your shopping cart and in 

your refrigerator. Otherwise, the meat, poultry, 

and fish could drip juices and contaminate the 

other foods. 

• Rinse fresh vegetables and fruits very 

well with clean running water to remove dirt 

and bacteria. 

• Remove pits, seeds, skins, and tough peels 

from vegetables and fruits. Softer skins 

and peels can be removed either before or 

after cooking. 

• To make the food softer, cook the vegetables 

or fruits. You can steam them using a steamer 

basket in a covered saucepan or in a 

microwave with a small amount of water. 

• Vegetables and fruits can also be boiled in a 

small amount of water. 

• After cooking, puree or mash food with 

leftover cooking liquid or water until it reaches

the desired smoothness. If you are cooking 

for one baby, you can use breastmilk or infant

formula to change the texture of the food. 

If you are preparing a large amount of baby

food, it may be easier to use a blender or 

food processor.

Vegetables and Fruits 

Preparing and Cooking Food 

at Your Child Care Site 

Examples of pureed vegetable baby food. 
100 | Chapter 7 • Buying and Preparing Baby Foods

Tip: 

Home-caught fish is only creditable if it 

meets your State or local public health 

policies regarding food safety. 

Meat, Fish, Shellfish, and Poultry 

Babies can be fed well-cooked, pureed meat, 

fish, shellfish, and poultry, which are great sources 

of iron and zinc. 

• Purchase food from an approved source, such 

as a grocery store, food wholesaler, producer, 

or distributor. 

• Always use a food thermometer when cooking 

meat, poultry, or fish to ensure that the foods 

are cooked to a safe temperature (see “For 

Child Care Providers: Keeping Solid Foods 

Safe” handout on page 102). 

• Braising, stewing, or poaching works well for 

preparing soft meat. 

For food safety information, 

including information on using 

food thermometers, visit the USDA’s 

Food Safety and Inspection Service 

website https://www.fsis.usda.gov 

or call the Meat and Poultry Hotline, 

1-888-MPHOTLINE (1-888-674-6854). 

You can also contact your health 

department with questions. 

• After cooking, separate any remaining bone, 

skin, and pieces of fat. 

• Cut the meat, poultry, shellfish, or fish into 

small pieces and puree, mash, or finely chop 

until you get the right texture. Add cooking 

liquid or water until you get the desired 

thickness. If you are cooking for one baby, you 

can use breastmilk or infant formula to change 

the texture of the food. 

• Never deep-fat fry foods at your child care 

site. Deep-fat frying means cooking by fully 

covering (submerging) food in hot oil or other 

fat. Foods that are deep-fat fried on site 

cannot count toward a reimbursable meal in 

the CACFP. 

Eggs 

• Cook eggs well until the yolk and white are 

firm and not runny. Do not serve soft, runny 

eggs—these are undercooked and might 

contain bacteria that can make a baby sick. It 

is important to cook eggs fully to make sure 

they are safe to eat. 

• Try serving hard-boiled eggs to babies. Eggs 

can be mixed with a bit of liquid, such as 

water and mashed to the desired texture. If 

you are cooking for one baby, you can 

use breastmilk or infant formula to change 

the texture. 

Dry Beans or Dry Peas 

• To cook dry beans or peas, follow cooking 

instructions found on the package. It is not 

necessary to add seasonings, salt, or fat to 

the beans or peas. Make sure to cook the 

beans or peas until soft enough to puree or 

mash easily. 

• If canned beans are used, drain the liquid and 

rinse the beans with water before pureeing 

or mashing. This helps to rinse off some of 

the sodium (salt). Add liquid to the beans if 

needed to reach the right texture.
Buying and Preparing Baby Foods • Chapter 7 | 101 

Thawing and Reheating 

• Thoroughly reheat refrigerated or frozen baby 

foods to 165 °F before feeding to a baby. 

Reheating kills any bacteria that may be 

present. Stir the food and make sure it is not 

too hot before feeding to the baby. 

• Defrost frozen foods in the refrigerator or as part 

of the reheating process. Never defrost baby 

foods by leaving them at room temperature or in 

a bowl of standing water. 

• Label the food with the date and time you 

removed it from the freezer. Use thawed food 

within 48 hours from the time it was removed 

from the freezer. Throw it out if it has been 

stored longer than 48 hours in the refrigerator. 

Storing Solid Foods 

• Refrigerate hot foods in shallow containers. 

• Cover the container after the food has cooled. 

• Label the food with the date and time it was 

prepared. 

In This Chapter 

In this chapter, you have learned about how to safely buy and prepare foods for babies in your 

care. In the next chapter, you will learn about how to safely prepare food at your child care site.

Cooked, pureed, or mashed food can be 

frozen using a clean ice cube tray. 

How To Freeze Foods 

You can freeze prepared baby foods in a freezer 

with a temperature of 0 °F or colder. Here are 

some tips for freezing baby foods: 

• Pour cooked, pureed, or mashed food into 

sections of a clean ice cube tray. Cover with 

plastic wrap, a lid, or aluminum foil. Place in 

the freezer. Once frozen, cubes can be stored 

in a container or plastic freezer bags. Each 

section of the tray holds about 2 tablespoons 

of food. 

• Place 1–2 tablespoons of cooked, pureed 

food in separate spots on a clean baking 

sheet. Cover with plastic wrap or aluminum 

foil. Place in the freezer. Once frozen, food 

pieces can be stored in a freezer container or 

plastic freezer bag. 

• Label and date bags or containers of frozen 

food. Use them within 1–2 months. When 

ready to use, remove the desired number of 

cubes or pieces with clean hands. Reheat 

thoroughly. 
102 | Chapter 7 • Buying and Preparing Baby Foods

Food Temperature (using a food thermometer) 

Fresh beef, pork, 

veal, lamb (steaks, 

roasts, chops) 

145 oF or 63 oC (with a 3-minute rest time) 

Ground beef, pork, 

veal, lamb 160 oF or 71 oC 

Ground turkey, 

chicken 165 oF or 74 oC 

Fresh chicken, turkey 

(whole, breasts, thighs, 

legs, wings) 

165 oF or 74 oC 

Fresh ham 145 oF or 63 oC 

Fish 145 oF or 63 oC 

Eggs and egg dishes 160 oF or 71 oC 

Cook until yolk and white parts of the egg are firm.

For Child Care Providers: Keeping Solid Foods Safe 

Cooking Solid Foods: Refer to the chart below for minimum cooking temperatures for each food. 

Food and Nutrition Service
Buying and Preparing Baby Foods • Chapter 7 | 103 

When taking the temperature of beef, pork, or lamb roasts, the food thermometer 

should be placed midway in the roast, avoiding the bone. When cooking 

hamburgers, steaks, or chops, insert a thermometer in the thickest part, away 

from bone, fat, or gristle. 

To avoid spreading harmful bacteria to other foods: 

• Do not allow raw or partially cooked meat, 

poultry, or fish, or their juices, to touch 

other foods. They should also not touch the 

surfaces, serving plates, or utensils used to 

serve or prepare other foods. For example, do 

not use a fork to test a piece of meat, poultry, 

or fish while cooking and then use the same 

fork to mix a cold vegetable dish. 

Avoid Spreading Harmful 

Bacteria to Other Food 

Solid Foods 

(store-bought or freshly made) Refrigerator Freezer 

Vegetables and fruits 2–3 days 6–8 months 

Meats and eggs 1 day 1–2 months 

Meat/vegetable combinations 1–2 days 1–2 months 

Freshly made baby foods 1–2 days 1–2 months 

Storing Solid Foods: Refer to the chart below for storing methods 

of different foods and the length of time they can be stored. 

• Use separate utensils and cutting boards 

for animal foods (such as meat, poultry, fish, 

and shellfish) and non-animal foods (such as 

vegetables, fruits, breads). 

• Do not use cutting boards with crevices and cuts. 

• Wash and sanitize utensils and boards after each 

use. Non-porous plastic cutting boards are best 

as they are easiest to clean. 

• In the refrigerator, store raw or cooked meat, 

poultry, and fish below cooked or ready-to-eat 

foods so that no juices from those foods drip on 

other foods. 

A handout from Feeding Infants in the Child and Adult Care Food Program 

https://teamnutrition.usda.gov • FNS 786H • March 2019 

USDA is an equal opportunity provider, employer, and lender.
104 | Chapter 7  Buying and Preparing Baby Foods

Key Concepts

If purchasing baby foods from the store, be sure to avoid 

dented, rusted, bulging, or leaking containers.

Both store-bought foods and foods prepared at the child 

care site or through a vendor can be part of a reimbursable 

meal in the CACFP. However, foods canned at home are not 

creditable and may not be offered.

Choose baby foods that do not contain added sugars, 

sodium (salt), and fat.

Never give honey to a baby under the age of 1 year or include 

it in a recipe when cooking.

Buying and Preparing Baby Foods
Buying and Preparing Baby Foods  Chapter 7 | 105 

True 3. ● B 2. ● D 1. ANSWERS:

1. A parent asks what to look for when buying store-bought baby food. 

You recommend: 

Look at “use by” dates. 

Find foods with unbroken seals.

Do not buy baby food containers with dents, rust, or that are 

bulging or leaking.

All of the above.

2. All of the following should be done while preparing food, except: 

Remove pits, seeds, skins, and tough peels from fruits 

and vegetables.

Deep-fat fry chicken at your child care site.

Remove all bones from fish.

Cook eggs until the yolk and white are firm and not runny.

3. True or False? Blenders, food processors, fine mesh strainers, baby food 

grinders or mills, and a fork and knife are all good tools to use to change the 

texture of the food that you serve to a baby.

Check Your Knowledge

B

C

D

A

B

C

D

A
106 | Chapter 8 • Safe Food Preparation

Chapter 8 

Safe Food Preparation 

What’s In This Chapter? 

By the end of this chapter, child care 

providers will be able to: 

Describe the correct way to wash 

their hands. 

List the proper refrigerator and 

freezer temperatures for storing 

foods safely. 

Describe how to reduce lead 

exposure from foods. 

1 

2 

3 

Babies and children under 5 years old are at a 

higher risk for getting sick from foodborne 

illnesses (food poisoning). They have a harder 

time fighting off infections compared to older 

children and adults. Take extra care when 

handling babies’ food, bottles, and utensils to 

make sure they are safe and clean. 

Hand Washing 

Washing your hands with soap and water for at 

least 20 seconds is one of the best ways to keep 

germs and disease from spreading. Be sure to 

lather the backs of your hands, between your 

fingers, and under your nails. 

State and local requirements regarding safe food 

preparation in child care sites may vary. Contact 

your local health department to get a copy of your 

local food safety requirements for child care sites. 

See the “Hand Washing” handout 

on page 111. It can be a helpful 

reminder if you post this page next 

to the sink and refrigerator at your 

child care site.

Child care provider washing her hands. 

Washing a bottle to make it safe and clean. 
Safe Food Preparation • Chapter 8 | 107 

Wash your hands thoroughly before you: 

feed a baby 

handle, prepare, serve, or 

touch food or bottles 

handle spoons, forks, bowls, and plates prepare bottles 

put away clean dishes give medication to a child 

treat a cut or wound care for a sick baby or child

When Should Your Hands Be Washed? 
108 | Chapter 8  Safe Food Preparation

Wash your hands thoroughly after you:

arrive at the 

site for the day

handle raw meat, chicken, 

turkey, pork, fish, or eggs

change a baby’s or child’s 

diaper or clothing

use the bathroom or 

assist a child in the 

bathroom

handle a baby or 

child who is ill or give 

medication

come in contact with 

runny noses, drool, vomit, 

urine, poop, or blood

blow your nose, 

sneeze, or cough into 

tissues or hands

get your hands dirty, or 

have been cleaning or 

working outside

wipe noses, mouths, 

bottoms, sores, or cuts

touch pets or other animals take out the garbage shake hands with a 

parent or child
Safe Food Preparation  Chapter 8 | 109 

Make sure to wash a baby or child’s hands 

before and after meals and snacks. Also, wash 

babies' hands after changing their diaper. 

Many babies place their hands in their diaper 

area during changing.

Did you know?

Children watch and learn from you! When 

you wash your hands often you are 

keeping children safe and teaching them 

healthy habits.

If You or Another Staff Member 

Has an Illness 

People who are sick and handle food can 

spread their illness to others, including babies 

and children. Check with your State agency 

or local health department for guidelines on 

handling food if you or your employees are sick.

Cleaning Food Preparation 

and Eating Areas

Clean all food preparation areas before and 

after each meal. Items should be washed with 

soap and hot water and then rinsed with hot 

water. This includes:

• all surfaces used to prepare food, including 

cutting boards, countertops, and tables.

• cooking equipment and utensils.

• food service and dining areas, including 

high chairs. 

Cleaning Dishes and Utensils

Dishes, feeding utensils, and high chair trays 

should be free of chips, cracks, or sharp edges. 

They should also be washed after each use.

Washable items such as bibs or placemats should 

be washed after each meal. 

Prevent Spreading Illness to Others

Protective Clothing 

Wear clean clothing when working with 

breastmilk, infant formula, or food. Check with 

your State agency or local health department 

about specific requirements regarding the use 

of gloves or other types of protective 

equipment during food preparation.

Cleaning dishes after a meal.
110 | Chapter 8 • Safe Food Preparation

Refrigerator and 

Freezer Temperature 

Make sure the refrigerator at your child care site 

is set at a temperature of 40 °F (4 °C). The 

temperature in a freezer should be 0 °F (-18 °C) 

or colder. Check the refrigerator and freezer 

regularly with an appliance thermometer. If the 

temperatures are above these levels, have the 

appliances checked immediately by a qualified 

repair person. 

Water can contain substances that are harmful 

to babies, such as lead. It is important to make 

sure the water in your child care site is approved 

by the local health department and safe to use. 

Exposure to lead can affect children’s attention 

span and IQ, and can negatively impact their 

ability to do well in school. The effects of lead 

exposure are permanent. 

To reduce the chances that a baby will be 

exposed to lead from food or water: 

• ask your local health department how often 

your water should be checked for lead. 

• do not feed babies any foods or beverages 

that were canned in another country (outside 

of the United States). These cans may 

contain lead which can leak into the food.

• avoid using imported dishware, as it may 

contain high levels of lead. 

• do not cook, store, or serve foods or 

beverages in containers that may contain 

toxic levels of lead, such as: 

• decorative ceramic ware or pottery that 

has been imported. 

• antique ceramic or pewter containers, 

dishes, or utensils. 

• wash each baby and child's hands with soap 

and water before feeding. This will wash away 

dirt and dust that could contain lead. Dust and 

dirt containing lead can come from outside or 

inside a building. For this same reason, it is 

important to regularly wash toys. 

In This Chapter 

In this chapter, you have learned about how to safely prepare foods and surfaces before and after 

meal and snack time. In the next chapter, you will learn how to prepare foods to prevent a baby 

from choking. 

Reducing Lead Exposure From Food or Water 

Appliance thermometer showing the freezer 

temperature is at 0 °F (-18 °C). 
Safe Food Preparation  Chapter 8 | 111 

Food and Nutrition Service

.

A handout from Feeding Infants in the Child and Adult Care Food Program

https://teamnutrition.usda.gov  FNS 786I  March 2019

USDA is an equal opportunity provider, employer, and lender.

For Child Care Providers: 

Hand Washing 

Hand washing is one of the best ways to stop 

the spread of germs that cause illness. Make 

sure to wash your hands thoroughly by following 

these steps:

Wet your hands with 

running water. Add soap.

Wash all surfaces on hands. Wash 

carefully between your fingers, 

around the tops and palms, over 

wrists, and under fingernails.

Rinse your hands well 

under running water.

Dry your hands with a clean, 

disposable paper towel.

Turn off the faucet using the 

disposable paper towel instead 

of your clean, bare hands.

Rub your hands together 

for at least 20 seconds.

Child care provider washing her hands.
112 | Chapter 8  Safe Food Preparation

Key Concepts

Hand washing is one of the best ways to prevent 

the spread of foodborne illness.

Wash all surfaces used to prepare food, including 

cutting boards, countertops, and tables; food 

preparation equipment and utensils; and food 

service and eating areas, including high chairs, 

with hot water and soap before serving food.

Set the refrigerator at your child care site at a 

temperature of 40 °F (4 °C). Set the temperature 

in a freezer at 0 °F (-18 °C) or colder.

To reduce exposure to lead, only use water that is 

approved by your local health department.

Safe Food Preparation
Safe Food Preparation • Chapter 8 | 113 

1. Fill in the blanks to complete this description of proper hand washing: 

Wet your hands with running water. Add ______. Wash all surfaces on hands. 

Rub your hands together for at least _______ seconds. Wash carefully 

between ________, around the tops and palms of hands, over wrists, and 

under ________. Rinse your hands well under running water and dry them 

with a clean, disposable paper towel. Turn off the faucet, using ____________, 

instead of __________. 

2. To reduce a baby’s exposure to lead, you can: 

A Make sure the water is considered safe by the local health department. 

B Store foods in covered plastic or glass food storage containers. 

C Cook foods in ceramic ware or pottery made outside of 

the United States. 

D A and B 

3. True or False? Properly storing food is important for food safety. The 

recommended temperature settings are 40 °F (4 °C) for the refrigerator and 

0 °F (-18 °C) or colder for the freezer. 

soap, 20, fingers, fingernails, the disposable paper towel, your clean, 1. ANSWERS: 

True 3. • D 2. • bare hands 

Check Your Knowledge 
114 | Chapter 9 • Choking Prevention

Chapter 9 

Choking Prevention 

Babies are at a higher risk of choking than 

older children since they do not chew well and 

have small airways. It is very important to be 

careful about the types of food you feed a 

baby. Serve foods that are the right size, shape, 

and texture for a baby. 

What’s In This Chapter? 

By the end of this chapter, child care 

providers will be able to: 

Identify ways to reduce a baby’s 

risk of choking during mealtime. 

Name at least three finger foods 

that are safe for older babies. 

Explain how to prepare foods to 

lower choking risk. 

1 

2 

3 

Preventing Choking During 

Mealtime 

At mealtime, make sure to: 

• Sit and watch babies. Do not leave babies or 

young children under the age of 4 alone when 

they are eating. 

• Keep mealtimes calm and not rushed. 

Avoid disruptions and distractions when eating. 

• Make sure the hole in the nipple of the 

baby’s bottle is not too large. If the bottle 

is held upside down, the falling drops 

should follow each other closely and not 

make a stream. 

• Have babies sit in an upright position when 

eating. Laying babies down or letting them 

crawl or walk while eating increases their risk 

of choking. Make sure babies are in a high 

chair or feeding seat while eating solid foods. 

For more information on the right 

texture for a baby’s development, 

see page 59 in Chapter 6: Feeding 

Solid Foods. 

Foods To Avoid That Can Cause Choking 

Some foods are harder for babies to eat. Do 

not feed foods or pieces of food that are the size 

or shape of a small marble to babies or young 

children. Foods this size can be swallowed 

whole and could get caught in a baby’s throat and 

cause choking.

Upside down bottle with falling drops of 

milk, not a stream. 
Choking Prevention • Chapter 9 | 115 

When preparing foods for babies, make sure they 

are in a form that a baby can easily chew. Think 

of the shape, size, and texture, when choosing 

foods. To prevent choking, it is recommended to: 

• cook or steam foods until they are soft enough 

to easily pierce with a fork. 

• cut soft foods into small pieces (no larger 

than 1⁄2 inch) or thin slices that can easily be 

chewed. 

• cut round foods, such as hot dogs, 

into short strips (lengthwise) rather than 

round pieces. 

• remove all bones from poultry, meat, and fish. 

• cut grapes and cherry tomatoes into quarters. 

• remove pits, seeds, and tough skins or peels 

from ripe fruit and cut the fruit into small pieces. 

• modify the texture of foods by pureeing, 

mashing, grinding, or finely chopping. 

Preparing Foods To Lower Choking Risk 

In This Chapter 

In this chapter, you learned about how to prevent choking by preparing foods to the 

right size, shape, and texture for meals and snacks. In the next chapter, you will learn 

about food allergies and intolerances and the signs of an allergic reaction.

Small pieces of ground beef no larger than 1⁄2 inch. 
116 | Chapter 9 • Choking Prevention

Prepare Foods So They Are Easy To Chew 

• Grind up tough meats. 

• Cook or steam food until it is soft. 

• Puree, mash, or finely chop foods into small 

pieces (no larger than 1⁄2 inch) or thin slices or 

strips (lengthwise). 

• Remove all bones from fish, chicken, and 

meat before cooking or serving. 

• Remove seeds, pits, tough skins, and peels 

from fruits and vegetables. 

For Child Care Providers: 

Making Foods Safer for Baby 

Babies and young children are at the highest risk of choking on food. They remain at high risk until they 

have more teeth and are better able to chew and swallow. Young children die from choking more than 

any other home accident. You can help make eating safer for babies and young children. 

Avoid serving small, sticky, or hard foods 

that are difficult to chew and easy to swallow 

whole. These foods are not creditable for 

infants in the CACFP. 

• Popcorn 

• Nuts and seeds (including breads, crackers, 

and ready-to-eat cereals that contain nuts 

and seeds) 

• Hard candy 

• Chunks of peanut butter and other nut butters 

• Marshmallows 

• Chewing gum 

.

A handout from Feeding Infants in the Child and Adult Care Food Program

https://teamnutrition.usda.gov • FNS 786J • March 2019 

USDA is an equal opportunity provider, employer, and lender.

Food and Nutrition Service

Always prepare foods so they are easy to chew. Older baby eating small pieces of bread at snack. 
Choking Prevention  Chapter 9 | 117 

Key Concepts

Always sit and watch babies and young children at 

mealtime to make sure they do not choke.

Prepare foods to the right shape, size, and texture to 

lower the risk of the baby choking.

Cut foods into small pieces no larger than 1⁄2 inch 

or in short thin slices or strips to lower the risk of the 

baby choking.

Avoid serving small, sticky, or hard foods that are 

difficult to chew.

Choking Prevention
118 | Chapter 9  Choking Prevention

1. Fill in the blanks: 

Cut soft foods into small pieces (no larger than _____ inch) or thin _____ or 

_____ that can easily be chewed. 

2. All of the following finger foods are creditable in the CACFP infant meal 

pattern and can be prepared the right way to avoid choking, except: 

A Small strips of bread

Grapes cut into quarters

C Chunks of peanut butter or other nut butters

D Soft cooked, chopped vegetables

3. A parent brings in a container of whole grapes for her 11-month-old. 

To build a good partnership with the family, which of the responses may be 

better to say?

A I will be happy to serve these to your child at the next meal, 

just as they are.

B Fruits are always an excellent choice. To make these safer and 

reduce choking risk, I will cut these grapes in quarters before I serve 

them to your child.

C Grapes are not creditable in the CACFP infant meal pattern.

D None of the above.

B 3. ● C 2. ● 1⁄2; slices or strips 1. ANSWER: 

Check Your Knowledge

B
Food Allergies and Intolerances • Chapter 10 | 119 

Chapter 10 

Food Allergies and Intolerances 

What’s In This Chapter? 

By the end of this chapter, child care 

providers will be able to: 

Define “food allergy” and 

“food intolerance.” 

Identify signs and symptoms that a 

baby is having an allergic reaction. 

Use a tool to help gather information 

on a baby’s food allergies and 

intolerances from the parents. 

1 

2 

3 

What Is a Food Allergy? 

A food allergy is a body’s reaction to a protein in 

a food called an allergen. Milk, eggs, fish, shellfish, 

tree nuts, peanuts, wheat, and soybeans are 

the most common allergens. These used to be 

thought of as foods that should be avoided when 

feeding babies. However, recent research shows 

that there is no need to delay the introduction of 

these foods. 

Handling food allergies and food 

intolerances in a child care setting 

can be a challenge. Speaking to 

parents often about any food allergies or food 

intolerances their child may have, and steps 

to take if they have a reaction, is key to 

ensuring a safe feeding environment in your 

child care site. 

What Is a Food Intolerance? 

A food intolerance is a sensitivity to a certain food 

that makes it hard to digest. The most common 

intolerances are lactose and gluten. Lactose 

intolerance is the sensitivity to the sugar found 

in milk, called lactose, and foods made with milk. 

A gluten intolerance is the sensitivity to a 

protein called “gluten” that is part of wheat, 

barley, and rye. 

To help gather information on a 

baby’s food allergies and 

intolerances from parents, you can 

use the “For Parents: Is Your Baby 

Ready for Solid Foods?” handout 

on page 12. 

Child care provider discussing food allergies and 

intolerances with parents.
120 | Chapter 10 • Food Allergies and Intolerances

Food allergies and intolerances occur in 2 to 8 

percent of babies and children. 

Ask each parent for a list of foods, 

if any, that their baby has reactions 

to, or that should not be fed to the 

baby. Remember to always talk to 

parents before giving a baby solid foods. Never 

serve a food that the baby has had a reaction to 

until the baby’s parents say it’s okay to serve. 

Encourage parents to follow these steps to 

make it easier to identify a possible food allergy 

or intolerance: 

• Introduce new foods gradually, one at a time, 

over the course of a few days. 

• Introduce a small amount, such as 1 to 2 

tablespoons, of a new food at first. 

• Use store-bought baby foods that contain 

only one food item with few added ingredients 

or home-prepared baby food made with one 

pureed ingredient to see how the baby reacts 

to each new food. 

Talk to Parents About Food Allergies and Intolerances 

See the “For Parents: Is Your Baby 

Ready for Solid Foods?” handout 

on page 12 to help discuss a 

baby's food allergies and intolerances 

with parents. 

Remember to always talk to parents before giving a baby solid foods. 

Store-bought baby food that contains only 

one food item.
Food Allergies and Intolerances • Chapter 10 | 121 

Signs of an Allergic Reaction 

Observe closely for reactions when feeding a 

baby, especially when you start to serve solid 

foods. Watch for signs such as: 

• diarrhea, vomiting, constipation 

• stomach pain 

• gas 

• mouth sores 

• coughing and wheezing 

• congestion or stuffiness 

• hives and skin rash 

• a lot of fussiness 

• more severe reactions, like 

shock or difficulty breathing 

Did you know? 

Anaphylaxis is a severe allergic reaction 

that can happen quickly and may cause 

death. If a baby with a known food allergy 

is having a hard time breathing or stops 

breathing, give medication and call 911. 

What To Do When a Baby Has 

a Reaction to a Food 

It is recommended to have a written care plan 

developed by the parents and the baby’s health 

care provider if the baby has a known food 

allergy or intolerance. The written care plan 

should include the steps you should follow if the 

baby has a reaction at meal or snack time. 

Always watch a baby closely during and after a 

feeding. A reaction due to a food allergy or 

intolerance can happen within a few minutes or 

hours after the baby eats. When you are feeding a 

baby and you notice that he or she is showing 

signs of an allergic reaction, follow the steps in 

their written care plan. 

If you see that the baby is having a very bad 

reaction and is having a hard time breathing, 

but does not have a written care plan, follow 

these steps: 

1. Stop feeding the baby immediately. 

2. Call 911. 

3. Ask another adult nearby to call the baby’s 

parents to let them know what is happening. 

4. Stay with the baby even when the medical 

staff is at your child care site to help. 

Preventing an 

Allergic Reaction 

The best way to stop an allergic reaction from 

happening is to avoid giving the baby the food 

that causes the reaction. If the baby is having a 

very bad reaction follow the steps above. 

In This Chapter 

In this chapter, you have learned about the common food allergens and the steps to 

follow if a child in your care has an allergic reaction. In the next chapter, you will learn 

about caring for babies’ teeth and gums. 
122 | Chapter 10 • Food Allergies and Intolerances

Key Concepts Food Allergies and Intolerances 

Always talk to parents before giving a baby solid foods. 

Encourage parents to introduce new foods gradually, one at a 

time, over a period of a few days. 

A written care plan developed by the parents and the baby’s 

health care provider can tell you what to do if the baby has a 

reaction to a food at meal or snack time. 

If a baby is having a very bad reaction and is having a hard time 

breathing, but does not have a written care plan, you should: 

1. Stop feeding the baby immediately. 

2. Call 911. 

3. Ask another adult nearby to call the baby’s parents to let 

them know what is happening. 

4. Stay with the baby even when the medical staff are at your 

child care site to help.
Food Allergies and Intolerances • Chapter 10 | 123 

1. All of the following are true about food allergies, except:

A A food allergy is a body’s reaction to a protein in a food called an allergen. 

B A sensitivity to a certain food makes that food hard to digest.

C Milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soybeans are 

the most common allergens. 

D All of the above. 

2. True or False? 

If a baby is having a severe reaction to a food you just fed to him or her, 

and he or she does not have a written care plan, then you should stop 

feeding the baby immediately, call 911, ask another adult nearby to call his 

or her parents to let them know what is happening, and stay with the baby 

even after the medical staff arrives. 

3. A baby is enrolling in your program or is starting solid foods, and you 

want to know if the baby has any food allergies and intolerances. To help 

guide the discussion with the parents on allergies and intolerances, you use 

which parent handout in Chapter 1: Giving Babies a Healthy Start With the 

CACFP to gather the information? 

B. A food intolerance is a sensitivity to a certain food, making that food 1. ANSWERS: 

: Is Your Baby Ready for Solid Foods?” For Parents “ 3. ● rue T 2. ● hard to digest. 

. page 12 handout on 

Check Your Knowledge 
124 | Chapter 11 • Caring for Babies' Gums and Teeth

Chapter 11

Caring for Babies’ Gums 

and Teeth 

What’s In This Chapter? 

By the end of this chapter, child care 

providers will be able to: 

Describe why it is important to 

keep a baby’s gums and teeth clean 

and healthy. 

Identify signs of tooth decay. 

List at least three ways to keep a 

young child’s gums and teeth clean 

and healthy. 

1 

2 

3 

As a child care provider, you play an important 

role in maintaining the health of the babies in your 

care. Keeping a baby’s gums and teeth clean 

helps to contribute to the baby’s overall health. 

What Is Tooth Decay? 

Tooth decay (cavities) is common in young 

children. About one out of every five children 

(ages 5 to 11 years) has at least one cavity that 

has not been treated by a dentist. Tooth decay 

in babies is sometimes called “early childhood 

caries” or “baby bottle tooth decay.” 

What Causes Tooth Decay? 

The sugar from foods and beverages is used by 

bacteria in the mouth to make acids that can 

cause damage to teeth. When a baby sleeps 

with a bottle in his or her mouth, the sugary liquid 

from the bottle can pool around the teeth and 

gums. Bacteria use the sugars in the liquid to 

Parent helping a young child brush his teeth. grow, which can lead to tooth decay. 

A young child brushing her teeth. 
Caring for Babies' Gums and Teeth • Chapter 11 | 125 

Why Should Tooth Decay Be Prevented? 

Tooth decay can be painful for babies and can cause infections and early tooth 

loss. This can affect a child’s ability to eat and speak, which can affect his or her 

overall health and development. If a child’s baby teeth are healthy, it is more likely 

his or her adult teeth will be healthy too. 

Moderate to Severe Tooth 

Decay of Baby Teeth 

Moderate to Severe Tooth 

Healthy Baby Teeth Decay of Baby Teeth 

Copyright © 2016 American Dental Association. All rights reserved. Reprinted with permission. 

How Can I Help Prevent Tooth Decay? 

You can help babies have healthy teeth. 

Remember to: 

• only put breastmilk or formula in bottles 

and no other liquids unless the health care 

provider indicates otherwise. 

• never put a baby to bed with a bottle. 

• avoid propping bottles in cribs, swings, 

or car seats. 

• never dip a baby’s pacifier in honey, syrup, 

or sugar. 

• offer foods and beverages only when the baby 

is hungry. Do not let the child sip from a bottle 

or cup or snack constantly throughout the day. 

• avoid letting children share pacifiers, bottles, 

cups, and utensils. 

• choose foods that have no added sugars 

once the baby is developmentally ready 

for solid foods. 

• once a baby is developmentally ready, start 

helping the baby transition from a bottle to a 

cup before 18 months of age. 

• encourage parents to plan the child’s first 

dentist visit. A child’s first dental visit should 

take place after his or her first tooth comes in, 

but no later than his or her first birthday. 
126 | Chapter 11 • Caring for Babies' Gums and Teeth

How Do I Take Care of a 

Baby's Gums and Teeth? 

Taking care of a baby’s gums and teeth should 

start as soon as the baby is born. Encourage 

parents to use a clean, soft washcloth to wipe 

the baby’s gums after each feeding. Once the 

baby has one or more teeth, a soft toothbrush 

with a small amount of toothpaste that contains 

fluoride (about the size of a grain of rice) can be 

used to gently brush the baby’s teeth. 

The American Academy of Pediatric Dentistry 

recommends that child care providers brush 

babies’ teeth at least once daily after a meal or 

snack. Some child care sites help children learn 

about healthy habits by building in tooth brushing 

as part of their daily activities. 

In This Chapter 

In this chapter, you have learned about how to care for babies’ teeth and gums. In the 

next chapter, you will learn about strategies for communicating and partnering with families 

to provide babies the best care possible. 

Teething 

When teeth start to come in and push through 

the gums, it is called teething. Teething is normal, 

but may cause the baby to be uncomfortable. It 

is important to make sure any items that a baby 

puts in his or her mouth to help with teething are 

clean and that there is no risk of choking. Never 

dip a pacifier or other item in honey, sugar, or 

syrup. The sharing of utensils, cups, pacifiers, or 

teething toys should be avoided as well. 

Child care provider helping a baby brush his teeth. 
Caring for Babies' Gums and Teeth  Chapter 11 | 127 

Key Concepts

Following good feeding practices can help children have 

healthy teeth. Transitioning babies from a bottle to a cup 

before 18 months of age is one example.

A child’s first dental visit should take place after his or her 

first tooth comes in, but no later than his or her first birthday.

Before the baby has teeth, wipe his or her gums using a 

clean, soft washcloth after each feeding.

The practice of propping a bottle up in a car seat or swing 

can lead to tooth decay and possibly cause choking.

Once the baby has one or more teeth, a soft toothbrush 

with a small amount of toothpaste that contains fluoride 

(about the size of a grain of rice) can be used to gently 

brush the baby’s teeth.

Caring for Babies’ Gums and Teeth
128 | Chapter 11 • Caring for Babies' Gums and Teeth

A mother brings her baby to your child care center with a bottle of juice. 

What are some things you can tell the mother about juice and tooth decay? 

A Tooth decay is a common infection in babies and can cause them to 

lose their teeth too early. 

B Juice can be served to babies of any age and won’t cause tooth decay 

because the baby’s teeth have not all come in yet. 

C Tooth decay can cause pain and serious infections. 

D A and C. 

E All of the above. 

2. Which of the following can cause tooth decay? 

A The sugar from foods and beverages. 

B The liquid that pools around the teeth and gums when a baby falls 

asleep with a bottle in his or her mouth. 

C Children and adults sharing utensils. 

D All of the above. 

 D 2. ● D1. : ANSWERS 

Check Your Knowledge 
Partnering With Families • Chapter 12 | 129 

Chapter 12 

Partnering With Families 

What’s In This Chapter? 

By the end of this chapter, child care 

providers will be able to: 

Connect with families. 

Create a comfortable environment 

for families. 

Talk to parents about 

solid foods when the child is 

developmentally ready. 

1 

2 

3 

Provider talking to a parent about their baby. 

Think of parents as partners in the work you 

do. Communicating regularly with parents and 

forming a strong relationship with families benefits 

everyone—the baby, the family, and you. 

When building partnerships with parents, keep 

in mind that people come from a variety of 

backgrounds, cultures, and experiences. These 

differences can influence communication styles, 

languages spoken, food beliefs and preferences, 

and parenting practices. The best way to learn 

about these differences is through regular 

communication with parents. 

To Help Build a Successful Partnership 

With Parents, You Can: 

Make parents feel welcome at your 

child care site. 

• Have a “Welcome” sign at the front of your 

child care site in all of the languages spoken 

by the parents. 

• Post images and pictures around 

your child care site of mothers from 

diverse backgrounds. 

• Display posters or pictures of foods 

from various cultures throughout your child 

care site. 

Get to know the baby’s family. 

• Ask parents to bring in family pictures to 

display throughout your child care site. 

• Show interest in different holidays celebrated 

by families, and ask about family members 

near and far. 

Communicate with and engage families. 

• Ask regularly and often about the baby’s 

eating habits at home. Consider using some of 

the parent handouts provided in this guide as 

part of the conversation. 

• Keep a daily activity chart of the baby’s 

activities and share it with parents. 

• Use a phone app, email, or text message, with 

the parent’s permission, to provide an update 

on what the baby is enjoying that day or week 

at your child care site. 

Successful partnerships must include two-way 

communication. This means that both the child 

care provider and the parent(s) feel comfortable 

sharing and receiving information. This exchange 

of information allows both parties to talk about 

important topics such as breastfeeding after 

returning to work or school and introducing solid 

foods when the child is developmentally ready. 
130 | Chapter 12 • Partnering With Families

A child care provider talking to a parent in the morning at drop off.

• Encourage parents to talk. 

Some people are more 

comfortable sharing than others. 

Ask open-ended questions such as, “Tell 

me what you think about...?”, “Can you tell 

me one or two things I can do to...” 

• Observe body language. Body language is 

a form of nonverbal communication. It tells 

people how you feel without using words. 

It may include facial expressions, body 

movements such as crossing arms, or the 

way a person sits or stands. However, keep 

in mind that this may vary based upon cultural 

backgrounds. For example, many people are 

taught to make eye contact when speaking 

with people. However, for some cultures it is 

viewed as an insult or a sign of disrespect. 

• Be patient and open minded. Some people 

may need additional time to respond to or ask 

questions. Always try to understand the other 

person’s point of view or opinion, even if you 

do not agree. 

When Communicating With Parents It Is Important To: 

• Practice active listening. Give the person 

talking your full attention. Repeat what you 

heard to make sure you understand what the 

parent is saying. 

• Provide praise. Share what is going well for 

the child. Highlight what the parents are doing 

well to support their child. 

Infant feeding behaviors are often influenced 

by culture and family tradition. Communicating 

regularly with parents about what their baby is 

eating at home will help you learn what you can 

offer the baby in child care. 
Partnering With Families • Chapter 12 | 131 

Talk to Parents About Feeding Their Baby 

[FPO PHOTO]

Child care provider distributing "Breastfed Babies Welcome Here! A Mother's Guide" to a visiting mother. 

• Let them know that babies are great at 

knowing how much they need to eat to be 

full. Parents as well as child care providers 

can provide the food. However, the baby 

will decide when, if, and how much he or she 

wants to eat. 

• Post the food menu in the main areas in the 

child care site where parents can easily see it 

when they drop off or pick up their baby. 

• Allow parents to give feedback on the food 

menu. This can be done by asking them at 

pick up or drop off times what they would like 

to see on the food menu. 

Ask what foods they typically eat 

at home. You can also consider 

adding a suggestion box in your 

child care site so that parents can 

provide feedback anonymously. 

• Use the handouts parents may have filled 

out on their baby’s eating habits such as the 

"For Parents: What Is Your Baby Eating? Let 

Us Know!" handout on page 63 and ask the 

parents questions to get a good understanding 

of any foods the baby cannot eat. This may be 

due to food allergies or intolerances or for 

religious reasons. 

• Share the "For Parents" handouts in this 

guide with parents (see Handouts and 

Tables in the front of this guide for a full list). 

Consider ordering them from the USDA Team 

Nutrition website at https://teamnutrition. 

usda.gov. Or, you can print them and have 

them out in common areas for parents to 

look at when they are in the child care site. 

• Review the daily activity chart with the baby’s 

parents at pick up to talk about what foods 

and how much their baby ate that day.
132 | Chapter 12 • Partnering With Families

Hear From Mothers and Other Providers 

Talking with parents often can make it easier 

to care for the babies at your child care site. 

But sometimes it can be hard to start those 

conversations. You may be thinking, “Do 

parents even want information about feeding their baby?” 

We spoke to child care providers, current mothers, and 

pregnant mothers about meals and snacks at child care. 

Below are some quotes from these interviews: 

When asked how they feel about a poster of a 

breastfeeding mom displayed at a child care site, 

child care providers and mothers said: 

“Many times, and I've heard it with my sisters, my aunts, 

my cousins, it's something we do not often talk about, 

and sometimes we're ashamed to ask. If you have 

something that says, ‘Tell us how we can help you,’ 

you already get that invitation, maybe if you have any 

questions. Because with our daycare providers you start 

having that relationship and that trust.” – Mother 

“It’s like we’re here for you, not just you can come here 

and chill. We’re here for you.” – Mother 

“It gives moms comfort to know that the teachers will use 

the mom’s breastmilk.” – Director of a Child Care Center 

“I like it, it lets moms know that we have a space for 

them to breastfeed. We support moms here who want to 

breastfeed.” – Director of a Child Care Center 

“Moms would want to know about whether it was ok to 

breastfeed but might be afraid to ask. The poster would 

break the ice, get moms asking questions about it. Plain 

and simple.” – Director of a Family Child Care Home 

When asked about a handout to provide information 

to their child care provider or receive information 

from mothers on their baby’s eating, child care 

providers and mothers said: 

“It’s things that you may overlook when you’re dropping 

your child off with somebody. You already have anxiety 

about leaving your baby in the care of somebody else, 

and you don’t think to share all of these things that you’re 

doing with them.” – Pregnant Mother 

Display this poster to show moms 

that you support breastfeeding. 

Handout: Breastfeeding? Tell Us 

About Your Breastfed Baby!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

https://teamnutrition.usda.gov 

 

 

 

https://teamnutrition.usda.gov • 

 

 
Partnering With Families  Chapter 12 | 133 

“I liked [this handout] because I was already doing 

some things that they mentioned there. But sometimes 

there is not communication, and that is very important 

between the mother and the provider.” – Mother

“This facilitates communication between parents 

and staff to avoid health issues.” – Director of a Child 

Care Center 

When asked about a handout to provide information 

to parents on how to know when a baby is ready for 

solid foods, a child care provider said: 

“A lot of parents may not know what developmental 

readiness is, but this breaks it down. Just because 

they are 4 months old, it does not mean that they are 

ready to eat.” – Director of a Child Care Center 

Handout: For Parents: Is Your Baby 

Ready for Solid Foods?

Eli Is Ready for Solid Foods!

Eli began to sit up on his own with little support 

and with good head control. He even started 

reaching for food when it was near him. His 

child care provider, Betty, noticed this and 

decided she should talk to his parents about 

starting solid foods but she did not know how. 

She used the “For Parents: Is Your Baby Ready 

for Solid Foods?” handout on page 12 to start 

the conversation. The parents read the handout, 

checked in with their baby’s health care provider, 

and ended up starting Eli on solid foods. As Eli 

tried new foods and textures, Betty checked in 

with his parents using the “For Parents: What 

Is Your Baby Eating? Let Us Know!" handout 

on page 63 to gather information on all of the 

foods Eli had eaten. This helped Betty plan her 

menu and offer foods in child care that Eli had 

already tried at home. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

https://teamnutrition.usda.gov 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Handout: Dear Child Care Provider: 

Here Is Information About My Breastfed 

Baby! from “Breastfed Babies Welcome 

Here! A Mother’s Guide.”
134 | Chapter 12 • Partnering With Families

Scenario Communication Tools 

Jana is pregnant with her first baby and is 

visiting a few child care sites. She plans on 

breastfeeding her baby and wants to find a 

child care site that will support her. Jana felt 

welcomed at your child care site when she 

saw a poster on the front door that said, 

“Breastfed Babies Welcome Here! Ask Us 

How We Can Support You!” How else can 

you support Jana's breastfeeding? 

You could give Jana a copy of “Breastfed 

Babies Welcome Here! A Mother’s Guide.” 

It will help Jana get started in learning who 

can support her in the hospital and in the 

community. You can let her know that your child 

care site can store her bottles of breastmilk. 

Also, you can make sure she has a quiet, 

private space to breastfeed her baby at the 

child care site. With all of this support, Jana 

is more likely to breastfeed her child longer. 

She may also be more likely to choose your 

child care site since it supports her desire to 

breastfeed. 

Baby Kim still needs help holding her head 

up and cannot sit on her own. She doesn’t 

seem interested when food is around her. 

Her parents want her to start solid foods, 

but you do not think Baby Kim is ready. 

What can you do? 

You can use the “For Parents: Is Your Baby 

Ready for Solid Foods?” handout on page 12

to talk to Baby Kim’s parents. The handout 

offers information on how Baby Kim’s parents 

can tell when she is developmentally ready for 

solid foods. If the parents still decide to start 

solid foods, you should offer solid foods to the 

baby at your child care site. 

Baby Talia is 2 months old and is new to your 

family child care home. You want to get to 

know Baby Talia and what her usual eating 

habits are throughout the day. You want to 

gather information from Baby Talia’s parents, 

but are worried you will not remember 

everything you need to ask them. What 

can you use? 

You can use the “For Parents: Breastfeeding? 

Tell Us About Your Breastfed Baby!” handout 

on page 26. Baby Talia’s parents can share 

information on the handout, like how they know 

when their baby is hungry and how much 

breastmilk Baby Talia usually drinks during each 

feeding. This handout also lets Baby Talia’s mom 

know there is a space where she can breastfeed 

her baby at your child care site. It includes a 

reminder to label bottles of breastmilk with Baby 

Talia’s full name and the date mom pumped the 

breastmilk for safe storage.

Table 12 Sharing Information With Parents 
Partnering With Families  Chapter 12 | 135 

Baby Michael drinks infant formula at home 

and his mom brought it in on his first day at 

child care. You are happy to give Baby 

Michael the infant formula his mom brought 

in, but you also want to let her know you 

have some at the center. How can you have 

this conversation with Baby Michael’s mom?

You can use the “For Parents: Feeding Your 

Baby Infant Formula? Tell Us More!” handout 

on page 34. Baby Michael’s mom can fill out 

the handout to let you know if she would like to 

provide her own infant formula, breastmilk and 

infant formula, or if she would like you to give 

Baby Michael the iron-fortified infant formula

you have at the child care center. The handout 

also helps you share that if mom brings in infant 

formula for Baby Michael, it must contain iron.

Baby Mia was just enrolled at your child care 

center. You know Baby Mia is eating solid 

foods, but aren’t sure what her parents have 

given to her at home. How can you gather 

this information?

You can use the “For Parents: What Is Your 

Baby Eating? Let Us Know!” handout on page 

63. The handout allows Baby Mia’s mom to 

share that her baby is eating mashed foods

and has eaten many different iron-fortified 

infant cereals, meats, vegetables, and fruits.

Baby Joey’s mom breastfeeds him in the 

morning and at night and gives you bottles 

of breastmilk to feed him throughout the day. 

Baby Joey has only had breastmilk but is 

eating solid foods as well. You know that 

breastfed babies around 4–6 months of age 

need iron. You want to make sure Baby 

Joey is getting enough iron from solid foods. 

What can you do?

You can share the “For Parents: Making Sure 

Your Baby Gets Enough Iron” handout on page 

76. The handout gives Joey’s mom a list of 

foods that are good sources of iron. She can 

also see that foods that have vitamin C in them 

can help Baby Joey’s body better absorb the 

iron. You can even circle foods on the menu 

to show Joey’s mom that Joey is getting good 

sources of iron while in child care.

Baby Ella’s parents let you know that Baby 

Ella does not like vegetables. Baby Ella’s 

parents tell you not to give her any vegetables 

during the day. You know Baby Ella may be 

making faces because she is just learning new 

tastes and textures. What can you do 

to encourage Baby Ella’s parents to not give 

up on feeding her vegetables?

You can share the “For Parents: Varying Your 

Baby’s Veggies” handout on page 88 with 

Baby Ella’s parents. The handout lets Baby 

Ella’s parents know that they may need to 

offer Ella a food more than 10 times before 

she might like it. They can track all of Baby 

Ella’s happy and sad faces after trying different 

vegetables on the handout. They can keep 

offering her different vegetables until that sad 

face becomes a happy one.
136 | Chapter 12 • Partnering With Families

As a busy child care provider, sometimes you 

want to make sure you are getting the same 

message out to parents at the same time. Short 

nutrition messages can be used to engage 

parents using bite-size information. Connect with 

parents through your child care site’s social media 

posts, tweets, emails, or even on your food menu! 

Give these a try: 

In This Chapter 

In this chapter, you have learned about ways to regularly communicate with parents. Partnering 

with families can be a great resource for you in providing the best care possible to the babies in 

your care!

• “Feeding your baby breastmilk? Ask us how 

we can support you!” 

• “Is your baby sitting up with good head 

control? Does he or she reach for food? If so, 

it might be time for solid foods! When your 

baby is ready, we can offer foods at meals and 

snacks!” 

• “Does your baby eat solid foods? Let us know 

what he or she eats at home—we may be 

able to offer the same at child care!” 

Bite-Size Nutrition Messages 

Talking with parents can often make it easier to 

care for babies at your child care site. 

• Babies can’t say, “I am hungry!”, but they do 

let us know in other ways when they are ready 

to eat. Tell us how you know when your baby 

is hungry and we will watch for those signs at 

child care!” 

• "Breastfeeding? We have room in our fridge 

for your breastmilk. Bring in bottles labeled 

with your baby’s first and last name and the 

date you pumped the breastmilk. We will take 

care of the rest!” 

• “We know we may need to offer a food more 

than 10 times before a baby might like it. 

That’s why we offer many different types of 

vegetables, fruits, meats, beans, grains, and 

more at mealtime in child care. Ask us what’s 

on the menu this week! 

Communicate regularly with parents about what 

their baby is eating at home. 
Partnering With Families  Chapter 12 | 137 

Key Concepts

Parents can be your partner in providing the best care 

possible at your child care site.

People come from a variety of backgrounds, cultures, and 

experiences. These differences can influence things like 

communication styles and food beliefs and preferences.

Display the "Breastfed Babies Welcome Here!" poster and 

message graphic and distribute the guide to let parents know 

that you support breastfeeding. The "Breastfed Babies 

Welcome Here" guide, poster, and message graphic can be 

found online at https://www.fns.usda.gov/tn/breastfedbabies-welcome-here.

Use handouts within this guide to share and gather 

information from parents. Parent handouts from this guide can 

be found here: https://www.fns.usda.gov/tn/feeding-infantschild-and-adult-care-food-program.

Encourage parents to share their ideas and ask questions.

Partnering With Families
138 | Chapter 12 • Partnering With Families

1. Select which items are important for parents and child care providers 

to share with each other: 

A Baby’s food allergies or intolerances. 

B If the baby has eaten solid foods and if so, which ones. 

C Baby’s usual eating habits when fed breastmilk, iron-fortified infant 

formula, and solid foods when developmentally appropriate. 

D Food preferences (cultural or other) that are important to the family. 

E All of the above. 

2. True or False? Using phone apps, email, or text messages are great 

ways to update parents about their baby throughout the day or week, if you 

have their permission. 

3. You can communicate your support of breastfeeding to mothers by: 

A Distributing the “Breastfed Babies Welcome Here! A Mother’s Guide” to 

parents who visit your site. 

B Displaying the “Breastfed Babies Welcome Here!” poster and message 

graphic to let parents know you support breastfeeding at your child 

care site. 

C Using the “For Parents: Breastfeeding? Tell Us About Your 

Breastfed Baby!” handout on page 26 to gather information on 

their breastfed baby. 

D All of the above. 

Check Your Knowledge 

D 3. ● True 2. ● E 1. ANSWERS: 
Appendixes | 139 

Appendixes

Appendix A: Sample Infant Daily Activity Chart

Appendix B: Sample Infant Menu 

(6 Through 11 Months)

Appendix C: Infant Meal Pattern

Appendix D: Choose Breakfast Cereals That Are 

Lower in Added Sugars

Appendix E: Choose Yogurts That Are Lower in 

Added Sugars

Appendix F: Infant Foods List 

Appendix G: CACFP Questions and Answers 

Appendix H: Feeding Infants Pre- and Post-Test

Appendix A: Sample Infant 

Daily Activity Chart

What time did my baby eat? How much did my baby drink (fluid ounces)?

What did my baby eat? How much did my 

baby eat (tablespoons)? What time did my baby eat?

What time was my baby’s diaper changed? Was it wet (W), dirty (D), or both (B)?

Baby’s Name: 

Date: 

Fluids: Breastmilk  Infant Formula 

Type of Formula: 

Solid Foods: 

Fluids:

Diaper Changing:

Did my baby sleep today? When and for how long?

What activities did my baby do today?

Notes: 

Adapted from the Arizona Department of Health Licensing Department Infant Daily Log
140 | Appendixes

Appendix B: Sample Infant Menu (6 Through 11 Months) 

Baby’s Name: Week of: 

Food 

Component 

Serving 

Size Day of Week 

6 through 

11 months Mon Tues Wed Thurs Fri 

Breakfast 

breastmilk1 or 

formula2 6–8 fl. oz. 

Breastmilk 

or infant 

formula 

Breastmilk 

or infant 

formula 

Breastmilk 

or infant 

formula 

Breastmilk 

or infant 

formula 

Breastmilk 

or infant 

formula 

infant 

cereal,2 meat, 

fish, poultry, 

whole eggs, 

cooked dry 

beans or 

peas; or 

0–4 tbsp. 

Ironfortified 

infant 

cereal 

Scrambled 

eggs 

Ironfortified 

infant 

cereal 

cheese; or 0–2 oz. 

cottage 

cheese; or 

0–4 oz. 

(volume) 

Cottage 

cheese 

yogurt3; or a 

combination4 

0–4 oz. 

(1⁄2 cup) 

Yogurt 

vegetable, fruit 

or both4,5 0–2 tbsp. 

Finely 

chopped 

peaches 

Cooked 

spinach 

Finely 

chopped 

pears 

Mashed 

avocado Applesauce
Appendixes | 141 

Lunch or Supper 

breastmilk1 or 

formula2 6–8 fl. oz. 

Breastmilk 

or infant 

formula 

Breastmilk 

or infant 

formula 

Breastmilk 

or infant 

formula 

Breastmilk 

or infant 

formula 

Breastmilk 

or infant 

formula 

infant 

cereal,2 meat, 

fish, poultry, 

whole eggs, 

cooked dry 

beans or 

peas; or 

0–4 tbsp. Beef 

(strained) 

Mashed 

kidney 

beans 

Ground 

turkey 

Baked cod 

(white fish) 

Finely 

chopped 

baked 

chicken 

cheese; or 0–2 oz. 

cottage 

cheese; or 

0–4 oz. 

(volume) 

yogurt3; or a 

combination4 

0–4 oz. 

(1⁄2 cup) 

vegetable, fruit, 

or both4,

5 0–2 tbsp. 

Mashed 

butternut 

squash 

Finely 

chopped 

zucchini 

Mashed 

carrots 

Mashed 

broccoli 

Mashed 

sweet 

potato
142 | Appendixes

1 Breastmilk or formula, or portions of both, must be served; however, it is recommended that breastmilk 

be served in place of formula from birth through 11 months. For some breastfed infants who regularly 

consume less than the minimum amount of breastmilk per feeding, a serving of less than the minimum 

amount of breastmilk may be offered, with additional breastmilk offered at a later time if the infant will 

consume more. 

2 Infant formula and dry infant cereal must be iron-fortified. 

3 Yogurt must contain no more than 23 grams of total sugars per 6 ounces. 

4 A serving of this component is required when the infant is developmentally ready to accept it. 

5 Fruit and vegetable juices must not be served. 

6 All grains served must be made with enriched or whole grain meal or flour. Ready-to-eat breakfast 

cereals and infant cereals that are fortified are also creditable. 

7 Ready-to-eat breakfast cereals must contain no more than 6 grams of sugar per dry ounce (no more 

than 21.2 grams sucrose and other sugars per 100 grams of dry cereal).

Food 

Component

Min. 

Serving 

Size

Day of Week

6 through 

11 months Mon Tues Wed Thurs Fri

Snack 

breastmilk1 or 

formula2 2–4 fl. oz. 

Breastmilk 

or infant 

formula 

Breastmilk 

or infant 

formula 

Breastmilk 

or infant 

formula 

Breastmilk 

or infant 

formula 

Breastmilk 

or infant 

formula 

bread slice6; or 0–1⁄2 slice Bread Tortillas 

crackers6; or 0–2 Crackers 

infant cereal2,6 

or ready-to-eat 

cereal4,6,7 

0–4 tbsp. O-shaped 

cereal 

Ironfortified 

infant

 cereal 

vegetable, fruit, 

or both4,5 0–2 tbsp. Pureed 

peas 

Mashed 

banana 

Finely 

chopped 

pears 

Mashed 

black 

beans 

Mashed 

carrots 
Appendixes | 143 

Appendix C: Infant Meal Pattern 

Breakfast 

Birth through 5 months 6 through 11 months 

4–6 fluid ounces breastmilk1 or formula2 6–8 fluid ounces breastmilk1 or formula2; and 

0–4 tablespoons infant cereal,2 meat, fish, 

poultry, whole egg, cooked dry beans, or cooked 

dry peas; or 

0–2 ounces of cheese; or 

0–4 ounces (volume) of cottage cheese; or 0–4 

ounces or 1⁄2 cup of yogurt3; or a combination of 

the above4; and 

0–2 tablespoons vegetable or fruit or a 

combination of both4

,

5 

Lunch and Supper 

Birth through 5 months 6 through 11 months

4–6 fluid ounces breastmilk1 or formula2 6–8 fluid ounces breastmilk1 or formula2; and 

0–4 tablespoons infant cereal,2 meat, fish, 

poultry, whole egg, cooked dry beans, or cooked 

dry peas; or 

0–2 ounces of cheese; or 

0–4 ounces (volume) of cottage cheese; or 0–4 

ounces or 1⁄2 cup of yogurt3; or a combination of 

the above4; and 

0–2 tablespoons vegetable or fruit or a 

combination of both4

,

5
144 | Appendixes

Snack 

Birth through 5 months 6 through 11 months

4–6 fluid ounces breastmilk1 or formula2 2–4 fluid ounces breastmilk1 or formula2; and 

0–1⁄2 slice bread6; or 0–2 crackers6; or 

0–4 tablespoons infant cereal2

,

6 or ready-to-eat 

breakfast cereal4

,

6

,

7; and 

0–2 tablespoons vegetable or fruit, or a 

combination of both4

,

5 

1 Breastmilk or formula, or portions of both, must be served; however, it is recommended that breastmilk 

be served in place of formula from birth through 11 months. For some breastfed infants who regularly 

consume less than the minimum amount of breastmilk per feeding, a serving of less than the minimum 

amount of breastmilk may be offered, with additional breastmilk offered at a later time if the infant will 

consume more. 

2 Infant formula and dry infant cereal must be iron-fortified. 

3 Yogurt must contain no more than 23 grams of total sugars per 6 ounces. 

4 A serving of this component is required when the infant is developmentally ready to accept it. 

5 Fruit and vegetable juices must not be served. 

6 All grains served must be made with enriched or whole grain meal or flour. Ready-to-eat breakfast 

cereals and infant cereals that are fortified are also creditable. 

7 Ready-to-eat breakfast cereals must contain no more than 6 grams of sugar per dry ounce (no more 

than 21.2 grams sucrose and other sugars per 100 grams of dry cereal).
Appendixes | 145 

Appendix D: Choose Breakfast Cereals 

That Are Lower in Added Sugars 

Serving Size* Sugars 

If the serving size is: Sugars cannot be more than: 

12-16 grams 3 grams 

26-30 grams 6 grams 

31-35 grams 7 grams 

45-49 grams 10 grams 

55-58 grams 12 grams 

59-63 grams 13 grams 

74-77 grams 16 grams 

2 

4 

3 

Find the Sugars line. Look at the number of 

grams (g) next to Sugars. 

1 Use the Nutrition Facts label to find the Serving 

Size, in grams (g), of the cereal. 

Use the serving size identified in Step 1 to find 

the serving size of your cereal in the table below. 

In the table, look at the number to the right of the 

serving size amount, under the “Sugars” column. 

If your cereal has that amount of sugar or 

less, your cereal meets the sugar requirement. 

Test Yourself: 

Does the cereal above meet the 

sugar requirement? 

(Check your answer on the next page)

Serving Size: ___________

Sugars: _______________

 Yes No 

Yummy Brand Cereal 

*Serving sizes here refer to those commonly found for breakfast 

cereals. For serving size requirements in the CACFP, please visit 

https://www.fns.usda.gov/cacfp/meals-and-snacks. 

More training, menu planning, and nutrition education materials for 

the CACFP can be found at https://teamnutrition.usda.gov.

Choose Breakfast Cereals That Are Lower in Added Sugars 

As of October 1, 2017, breakfast cereal served in the Child and Adult Care Food Program (CACFP) must contain 

no more than 6 grams of sugar per dry ounce. 

There are many types of cereal that meet this requirement. You can use any cereal that is listed on any State 

agency’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-approved cereal list, 

found as part of the State’s approved food lists at: https://www.fns.usda.gov/wic/links-state-agency-wicapproved-food-lists. You can also find cereals that meet the requirement using the Nutrition Facts label and by 

following the steps below: 
146 | Appendixes

Use the “Sugar Limits in Cereal” table below to help find cereals you can serve at your site. 

rite down your favorite brands and other information in the “Cereals To Serve in the CACFP” 

list. You can use this as a shopping list when buying cereals to serve in your program. 

Try It Out!

Cereal Brand Cereal Name Serving Size Sugars (g) 

Healthy Food Company Nutty Oats 28 grams 5 grams 

Answer to “Test Yourself” activity on page 1: The cereal has 5 grams of sugar per 30 grams. 

The maximum amount of sugar allowed for 30 grams of cereal is 6 grams. 

5 is less than 6, so this cereal meets the sugar requirement. 

FNS-653 June 2017 

USDA is an equal opportunity provider, employer, and lender.

Cereals To Serve in the CACFP* 

Serving Size Sugars 

If the serving size is: Sugars cannot be more than: 

0-2 grams 0 grams 

3-7 grams 1 gram 

8-11 grams 2 grams 

12-16 grams 3 grams 

17-21 grams 4 grams 

22-25 grams 5 grams 

26-30 grams 6 grams 

31-35 grams 7 grams 

36-40 grams 8 grams 

41-44 grams 9 grams 

45-49 grams 10 grams 

Serving Size Sugars

If the serving size is: Sugars cannot be more than:

50-54 grams 11 grams 

55-58 grams 12 grams 

59-63 grams 13 grams 

64-68 grams 14 grams 

69-73 grams 15 grams 

74-77 grams 16 grams 

78-82 grams 17 grams 

83-87 grams 18 grams 

88-91 grams 19 grams 

92-96 grams 20 grams 

97-100 grams 21 grams 

Sugar Limits in Cereal 

*

The amount of sugar in a cereal might change. Even if you always buy the same brands and types of cereal, be sure to check the serving size and

amount of sugars on the Nutrition Facts label to make sure they match what you have written in the list above. All cereals served must be whole 

grain-rich, enriched, or fortified. 
Appendixes | 147 

Appendix E: Choose Yogurts That 

Are Lower in Added Sugars 

Choose Yogurts That Are Lower in Added Sugars 

As of October 1, 2017, yogurt served in the Child and Adult Care Food Program 

(CACFP) must not have more than 23 grams of sugar per 6 ounces. 

There are many types of yogurt that meet this requirement. It is easy to find them by 

using the Nutrition Facts label and following the steps below. 

Serving 

Size* 

Ounces (oz) 

Serving Size 

Grams (g) 

(Use when the serving size 

is not listed in ounces) 

Sugars 

Grams (g) 

If the serving size is: 

Sugars 

must not be 

more than: 

2.25 oz 64 g 9 g 

3.5 oz 99 g 13 g 

4 oz 113 g 15 g 

5.3 oz 150 g 20 g 

6 oz 170 g 23 g 

8 oz 227 g 31 g 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Test Yourself: 

Does the yogurt above meet the 

sugar requirement? 

(Check your answer on the next page) 

Serving Size: ___________

Sugars : 

 

_______________

Yes No 

 

*Serving sizes here refer to those commonly found for store-bought yogurts. Homemade yogurt is 

not creditable in the CACFP. For serving size requirements of yogurt in the CACFP, please visit 

https://www.fns.usda.gov/cacfp/meals-and-snacks. 

2 

4 

3 

Find the Sugars line. Look at the number 

of grams (g) next to Sugars. 

1 Use the Nutrition Facts Label to find the 

Serving Size, in ounces (oz) or grams (g), 

of the yogurt. 

TIP: If the serving 

size says “one 

container,” check the 

front of the package 

to see how many 

ounces or grams are 

in the container. 

Use the serving size identified in Step 1 

to find the serving size of your yogurt in 

the table below. 

In the table, look at the number to the 

right of the serving size amount, under 

the “Sugars” column. 

If your yogurt has that amount of 

sugar, or less, the yogurt meets the 

sugar requirement. 

More training, menu planning, and nutrition education materials for 

the CACFP can be found at https://teamnutrition.usda.gov.
148 | Appendixes

Serving Size 

Ounces (oz) 

Serving Size 

Grams (g) 

(Use when the serving size 

is not listed in ounces) 

Sugars 

If the serving size is: Sugars must not be more than: 

1 oz 28 g 4 g 

1.25 oz 35 g 5 g 

1.5 oz 43 g 6 g 

1.75 oz 50 g 7 g 

2 oz 57 g 8 g 

2.25 oz 64 g 9 g 

2.5 oz 71 g 10 g 

2.75 oz 78 g 11 g 

3 oz 85 g 11 g 

3.25 oz 92 g 12 g 

3.5 oz 99 g 13 g 

3.75 oz 106 g 14 g 

4 oz 113 g 15 g 

4.25 oz 120 g 16 g 

4.5 oz 128 g 17 g 

Serving Size 

Ounces (oz)

Serving Size

Grams (g)

(Use when the serving size 

is not listed in ounces)

Sugars

If the serving size is: Sugars must not be more than:

4.75 oz 135 g 18 g 

5 oz 142 g 19 g 

5.25 oz 149 g 20 g 

5.3 oz 150 g 20 g 

5.5 oz 156 g 21 g 

5.75 oz 163 g 22 g 

6 oz 170 g 23 g 

6.25 oz 177 g 24 g 

6.5 oz 184 g 25 g 

6.75 oz 191 g 26 g 

7 oz 198 g 27 g 

7.25 oz 206 g 28 g 

7.5 oz 213 g 29 g 

7.75 oz 220 g 30 g 

8 oz 227 g 31 g 

Yogurt Brand Flavor Serving Size (oz or g) Sugars (g): 

Yummy Yogurt Vanilla 6 oz 13 

Use the “Sugar Limits in Yogurt” table below to help find yogurts you can serve at your site. 

Write down your favorite brands and other information in the “Yogurts To Serve in the CACFP” list. 

You can use this as a shopping list when buying yogurts to serve in your program. 

Answer to “Test Yourself” activity on page 1: This yogurt has 9 grams of sugar per 8 ounces (227 grams). 

The maximum amount of sugar allowed in 8 ounces of yogurt is 31 grams. 9 is less than 31, so this yogurt is creditable. 

*

The amount of sugar in a yogurt might change. Even if you always buy the same brands and flavors of yogurt, be sure to check the serving size and 

amount of sugars on the Nutrition Facts label to make sure they match what you have written in the list above. 

FNS-652 June 2017 

USDA is an equal opportunity provider, employer, and lender.

Try It Out!

Sugar Limits in Yogurt 

Yogurts To Serve in the CACFP* 
Appendixes | 149 

Appendix F: Infant Foods List

This list of creditable and non-creditable foods in 

this publication is not all-inclusive. This publication 

includes only those foods that are most commonly 

served to infants in child care programs. For 

more information on determining which foods are 

creditable in the CACFP and contribute toward the 

meal pattern requirements, see the Food Buying 

Guide for Child Nutrition Programs. Some food 

products may require additional documentation, 

such as a Child Nutrition (CN) label or Product 

Formulation Statement, to determine if they are 

creditable in the CACFP.

Allergies 

A food allergy is a body’s reaction to a protein in a 

food called an allergen. Milk, eggs, fish, shellfish, 

tree nuts, peanuts, wheat, and soybeans are 

the most common allergens. These used to be 

thought of as foods that should be avoided when 

feeding babies. However, recent research shows 

that there is no need to delay the introduction of 

these foods. Serve foods to a baby at your child 

care site only after they have been introduced to 

the baby at home with no problems.

Vegetables and Fruits 

Vegetables and fruits that have been pureed, 

mashed, or finely chopped credit toward the 

meal pattern based upon the amount served. 

For instance, 1⁄8 cup (or 2 tablespoons) of pureed 

peaches counts as 1⁄8 cup of fruit. A 1⁄8 cup of 

puree credits at 1⁄8 cup, even if you made this 

amount of puree using 1⁄4 of a fresh peach.

Grains

Grain products, such as bread, crackers, and 

ready-to-eat cereals, must be made with enriched 

or whole grain meal or flour or be fortified. 

All cereals must contain no more than 6 grams of 

sugar per dry ounce.

Prevent Choking 

Infants and young children are at a high risk for 

choking on foods. All foods given to infants and 

young children must be of a size, shape, and 

texture appropriate for the age and development 

of the infant or young child. Foods must be cut 

into small pieces no larger than 1⁄2 inch or cut 

lengthwise into thin slices. Adults should always 

supervise participants, especially infants, during 

meals and snacks.

Tip:

The Food Buying Guide for Child Nutrition 

Programs is available online and as a 

mobile app at: https://www.fns.usda.gov/

tn/food-buying-guide-for-child-nutritionprograms.
150 | Appendixes

Food

Creditable

Comments

Yes Maybe No

Baby foods, desserts 

(such as baby puddings, 

custards, cobblers, fruit 

desserts)

X

Baby food desserts often contain insufficient 

amounts of creditable ingredients. They are 

not 100% fruit and are often high in added 

sugars and fat and low in nutrients.

Baby foods, store-bought 

(commercial), combination 

foods (such as chicken 

and vegetables)

X

The American Academy of Pediatrics 

recommends introducing single-ingredient 

foods to babies first before giving a mix of 

foods, or combination foods. It is encouraged 

that once the baby is developmentally ready 

and has eaten each ingredient within a 

combination food individually without having 

an allergic reaction, then combination foods 

can be served. For example, a baby should try 

chicken separate from vegetables first before 

trying a mixed chicken and vegetables baby 

food. Some mixed dishes may contain foods 

that do not credit towards the infant meal 

pattern, such as rice or pasta.

Baby food, store-bought 

(commercial), mixed fruit X

See Baby foods, store-bought 

(commercial), single-component (such 

as plain fruits, mixed fruits and vegetables, 

vegetables, or meats).

Baby food, store-bought 

(commercial), mixed 

vegetables

X

See Baby foods, store-bought 

(commercial), single-component (such 

as plain fruits, mixed fruits and vegetables, 

vegetables, or meats).

Baby foods,

store-bought (commercial), 

single-component (such 

as plain fruits, mixed 

fruits and vegetables, 

vegetables, or meats)

X

Store-bought baby foods that contain one food 

component and are packaged in a jar, plastic 

container, pouch, or any other packaging are 

creditable in the Child and Adult Care Food 

Program. The way a food is packaged does not 

impact whether a food is creditable or not.

All Food Components
Appendixes | 151 

Canned foods, homemade X

Home-canned foods are not creditable due 

to food safety issues that can arise during the 

home canning process.

Combination foods,

commercial baby food X

See Baby foods, store-bought 

(commercial), combination foods

(such as chicken and vegetables).

Desserts, baby food X See Baby foods, desserts.

Home-canned baby foods X See Canned foods, homemade.

Homemade baby foods X

Foods should be cooked, if necessary, and 

pureed, mashed, ground, or finely chopped. 

Parents may only provide one component of a 

reimbursable meal.

Honey X

Honey (including products that have honey 

cooked or baked into them, such as honey 

graham crackers) should not be served to 

infants younger than 1 year of age. Honey is 

sometimes contaminated with Clostridium 

botulinum spores. If an infant ingests these 

spores, the spores can produce a toxin that 

may cause a severe foodborne illness called 

infant botulism. Be sure to read the ingredients 

list on the back of food packages.

Single-component 

baby foods, store-bought 

(commercial)

X

See Baby foods, store-bought 

(commercial), single-component (such 

as plain fruits, mixed fruits and vegetables, 

vegetables, or meats).
152 | Appendixes

Food

Creditable

Comments

Yes Maybe No

Almond milk

X Only breastmilk and iron-fortified infant 

formula are creditable unless the substitution 

is supported by a medical statement from a 

State-recognized medical authority.

Breastmilk

X

Breastmilk is the best food for infants and is 

recommended from birth through the first year 

of life. Infants should be fed only breastmilk, 

iron-fortified infant formula, or both until they 

are around 6 months of age.

Buttermilk X

Only breastmilk and iron-fortified infant 

formula are creditable unless the substitution 

is supported by a medical statement from a 

State-recognized medical authority.

Cream

X

Only breastmilk and iron-fortified infant 

formula are creditable unless the substitution 

is supported by a medical statement from a 

State-recognized medical authority.

Dry milk, reconstituted X

Only breastmilk and iron-fortified infant 

formula are creditable unless the substitution 

is supported by a medical statement from a 

State-recognized medical authority.

Evaporated milk X

Only breastmilk and iron-fortified infant 

formula are creditable unless the substitution 

is supported by a medical statement from a 

State-recognized medical authority.

Milk
Appendixes | 153 

Formula, follow-up X

Only breastmilk and iron-fortified infant formula 

are creditable unless the substitution is 

supported by a medical statement signed by a 

State-recognized medical authority.

Formula, infant, FDA 

Exempt X

Formulas classified as Exempt Infant Formulas 

by the U.S. Food and Drug Administration (FDA) 

may be served as a part of a reimbursable meal 

if the substitution is due to a disability and is 

supported by a medical statement signed by the 

baby’s health care provider.

Formula, infant, 

iron-fortified (includes 

soy-based)

X

The only acceptable alternative to breastmilk 

is iron-fortified infant formula. The American 

Academy of Pediatrics recommends only 

serving breastmilk, iron-fortified infant 

formula, or both during the first year of life. 

Formula must be served as a beverage to 

be creditable. The infant formula must be 

FDA approved (i.e., not bought from another 

country), should not be on the FDA Exempt 

Infant Formula list, and must be iron-fortified.

Formula, infant, low-iron 

(includes soy-based) X

Only breastmilk and iron-fortified infant formula 

are creditable unless the substitution is 

supported by a medical statement signed by a 

State-recognized medical authority.

Formula, infant, low 

lactose or lactose free X

Must be iron-fortified. A medical statement is 

not required to serve this formula and have it 

count as part of a reimbursable meal or snack.

Goat’s milk X

Only breastmilk and iron-fortified infant 

formula are creditable through 11 months of 

age unless the substitution supported by a 

medical statement from a State-recognized 

medical authority. Must meet State standards 

for fluid milk.
154 | Appendixes

Half and half X

Only breastmilk and iron-fortified infant 

formula are creditable through 11 months of 

age unless the substitution is supported by a 

medical statement from a State-recognized 

medical authority.

Hemp milk X

Only breastmilk and iron-fortified infant 

formula are creditable through 11 months of 

age unless the substitution is supported by a 

medical statement from a State-recognized 

medical authority.

Milk, raw X

Raw milk is unpasteurized and can be harmful 

to an infant’s health. Only breastmilk and 

iron-fortified infant formula are creditable 

through 11 months of age.

Milk, whole, reduced-fat 

(2%), low-fat (1%) or 

fat-free (skim)

X

Only breastmilk and iron-fortified infant 

formula are creditable through 11 months of 

age unless the substitution is supported by a 

medical statement from a State-recognized 

medical authority.

Soy-based formula X See Formula, infant, iron-fortified 

(includes soy-based).

Sweetened 

condensed milk X

Only breastmilk and iron-fortified infant formula 

are creditable unless the substitution is 

supported by a medical statement signed by a 

State-recognized medical authority.

Milk continued from pg 153
Appendixes | 155 

Food

Creditable

Comments

Yes Maybe No

Baby foods, store-bought 

(commercial), combination 

foods (such as chicken and 

vegetables)

X

The American Academy of Pediatrics 

recommends introducing single-ingredient 

foods to babies first before giving a mix of 

foods, or combination foods. It is encouraged 

that once the baby is developmentally 

ready, and has eaten all ingredients within a 

combination food individually without having 

an allergic reaction, then combination foods 

can be served. For example, a baby should try 

chicken separate from vegetables first before 

trying a mixed chicken and vegetables baby 

food. Some mixed dishes may contain foods 

that do not credit towards the infant meal 

pattern, such as rice or pasta.

Baby foods, 

store-bought (commercial), 

single-component

X

Store-bought baby foods that contain one food 

component packaged in a jar, plastic container, 

pouch, or any other packaging are creditable 

in the Child and Adult Care Food Program. 

The way a food is packaged does not impact 

whether a food is creditable or not.

Beans and peas, dry or 

canned X

Beans or peas can be credited either as a 

vegetable or a meat alternate, but not both 

in the same meal or snack. They should be 

cooked and prepared to the appropriate 

texture for infants (pureed or mashed). Do 

not serve whole beans or peas because they 

may cause infants to choke. If serving canned 

beans or peas, drain them first and rinse with 

clean, safe water before using to reduce the 

amount of salt.

Canned foods, homemade X

Home-canned foods are not creditable due 

to food safety issues that can arise during the 

home canning process.

Meat and Meat Alternates
156 | Appendixes

Food

Creditable

Comments

Yes Maybe No

Cheese, cottage cheese X

Cottage cheese is creditable at all meals and 

snacks for infants who are developmentally 

ready to accept them. See the Food Buying 

Guide for Child Nutrition Programs for more 

information.

Cheese foods, cheese 

food substitutes, 

cheese spreads, and 

cheese spread substitutes

X

Cheeses labeled as “cheese food,” “cheese 

spread,” and “imitation cheese” are not 

creditable for infants because they are 

generally higher in sodium than other cheeses. 

Cheese foods do not meet the Food and Drug 

Administration’s standard of identity.

Cheese, imitation X

Cheeses labeled “imitation” are not creditable. 

Imitation cheese does not meet the Food and 

Drug Administration’s standard of identity.

Cheese, natural and

processed cheese X

Natural and processed cheeses such as 

American cheese, cheddar, Monterey Jack, 

and Swiss are creditable at all meals and 

snacks for infants who are developmentally 

ready to accept them. Cut cheese into small 

thin slices or strips no larger than 1⁄2 inch to 

reduce the risk of choking.

Cheese products X

Cheeses labeled “product” are not creditable for 

infants. Cheese product does not meet the Food 

and Drug Administration’s standard of identity.

Chicken nuggets X

Only the edible chicken portion credits toward 

the meat/meat alternate requirement. All foods 

served to infants must be of a shape, size, and 

texture appropriate for the age and

development of the infant. See the Food 

Buying Guide for Child Nutrition Programs for 

more information.

Meat and Meat Alternates continued from pg 155
Appendixes | 157 

Combination foods, 

commercial baby food X See Baby foods, store-bought 

(commercial), combination foods.

Cream cheese X

Cream cheese is not creditable; it 

contains less protein and more fat than 

creditable cheeses.

Egg whites or egg yolks X Only whole eggs are creditable.

Eggs X

Whole eggs, including pasteurized, liquid 

whole eggs, and dried whole eggs, containing 

the yolk and egg white, are creditable. Eggs 

must be fully cooked. Serve only after it has 

been introduced at home with no problems.

Fish, boneless, 

store-bought (commercial) X

Only fish purchased from licensed vendors is 

creditable. May be served to infants who are 

developmentally ready to accept them. All 

foods must be of a shape, size, and texture 

for an infant to avoid choking. Examine fish 

closely to make sure it is free of bones. Serve 

only after it has been introduced at home 

with no problems. The U.S. Food and Drug 

Administration and the Dietary Guidelines for 

Americans recommend that pregnant women 

and young children avoid eating types of 

fish that typically have higher mercury levels, 

including shark, swordfish, king mackerel, 

tilefish, bigeye tuna, orange roughy, and marlin.

Fish, home-caught 

(noncommercial) X

Home-caught fish is only creditable if it meets 

State or local public health policies regarding 

food safety.
158 | Appendixes

Food

Creditable

Comments

Yes Maybe No

Fish sticks or portions, 

store-bought (commercial) X

Only the edible fish portion credits toward 

the meat/meat alternate requirement. May 

be served to infants who are developmentally 

ready to accept them. All foods served to 

infants must be of a shape, size, and texture 

for an infant to avoid choking. Fish must 

be fully cooked. Includes store-bought, 

commercially prepared breaded or battered 

fish and fish portions. See the Food Buying 

Guide for Child Nutrition Programs for more 

information.

Home-canned baby foods X See Canned foods, homemade.

Homemade baby foods X Foods should be cooked, if necessary, and 

pureed, mashed, or finely diced.

Hot dogs or frankfurters X

May be served to infants who are 

developmentally ready to accept them. 

Should be prepared to the appropriate shape, 

size, and texture for an infant to avoid 

choking. Do not serve whole hot dogs or hot 

dog rounds. This product tends to be higher 

in sodium and saturated fat. If the product 

contains byproducts, cereals, or binders/

extenders, it must be accompanied by a Child 

Nutrition label or Product Formulation 

Statement. Examples of binders/extenders 

are starch, cellulose, and nonfat dry milk. 

Examples of byproducts are glands, hearts, 

and other organ meats. See the “Meats/Meat 

Alternates” section in the Food Buying Guide 

for Child Nutrition Programs.

Meat and Meat Alternates continued from pg 157
Appendixes | 159 

Infant meat and 

poultry sticks (not dried or 

semi-dried)

X See Hot dogs or frankfurters.

Meats, plain, cooked, 

homemade X

Cooked meats are creditable and may be 

served to infants who are developmentally ready 

to accept them. Fresh or frozen meats must be 

cooked thoroughly and then prepared 

to the appropriate shape, size, and texture for 

infants to avoid choking.

Meats, single-component, 

store-bought (commercial) 

baby food

X

Store-bought baby food meats, such as 

pureed or mashed ham, turkey, chicken, beef, 

and so on, usually contain broth or gravy. 

These are creditable. 

Nuts X Nuts are not creditable in a reimbursable 

infant meal.

Peanut butter (or other nut 

butters or seed butters) X

Peanut butter and other nut butters or seed 

butters are not creditable in a reimbursable 

infant meal. Chunks of nut or seed butters 

pose a choking risk for infants. Peanut butter 

or other nut butters can get stuck to the roof 

of the mouth making it difficult to swallow.

Sausage (all forms) X

May be served to infants who are 

developmentally ready to accept it. Should be 

prepared to the appropriate shape, size, and 

texture for an infant to avoid choking. Products 

labeled “fresh pork sausage” or “fresh Italian 

sausage” may be credited. See the “Meats/Meat 

Alternates” section in the Food Buying Guide for 

Child Nutrition Programs.

Seeds X

Seeds are not creditable in a reimbursable 

infant meal.
160 | Appendixes

Food

Creditable

Comments

Yes Maybe No

Shellfish (such as crab, 

shrimp, clams, mussels) X

Shellfish must be fully cooked; only the edible 

fish portion is creditable. May be served to 

infants who are developmentally ready to 

accept it. Should be prepared to the 

appropriate shape, size, and texture for an 

infant to avoid choking. Be sure to remove all 

shells. See the “Meats/Meat Alternates” 

section in the Food Buying Guide for Child 

Nutrition Programs.

Single-component

baby foods, store-bought 

(commercial)

X See Baby foods, store-bought (commercial), 

single-component.

Soy yogurt X Soy yogurt is not creditable in a reimbursable 

infant meal. 

Soybeans (edamame) X

Soybeans can be credited either as a 

vegetable or a meat alternate, but not both 

in the same meal or snack. They should be 

cooked and prepared to the appropriate 

texture for infants (pureed or mashed). Do 

not serve whole soybeans because they may 

cause infants to choke.

Tofu X Tofu is not creditable in a reimbursable 

infant meal.

Vienna sausage X

May be served to infants who are 

developmentally ready to accept it. Should 

be prepared to the appropriate shape, size, 

and texture for an infant to avoid choking. 

This product is high in fat and sodium. Only 

creditable when free of byproducts, cereals, 

and extenders. See the Food Buying Guide for 

Child Nutrition Programs for more information.

Whole Egg X See Eggs.

Meat and Meat Alternates continued from pg 159
Appendixes | 161 

Yogurt, freeze-dried 

snacks X

Freeze-dried yogurt snacks are not creditable 

and do not meet the Food and Drug 

Administration’s standard of identity for yogurt.

Yogurt, frozen X

Program operators may credit yogurt that 

they have frozen. See Yogurt, store-bought 

(commercial), plain, unflavored, flavored. 

Please note that crediting of a meat/meat 

alternate in this form is discouraged, as it is 

perceived as a dessert. Commercial frozen 

yogurt is not creditable. Please see the “Other 

Foods” section in the Food Buying Guide for 

Child Nutrition Programs.

Yogurt, homemade X Homemade yogurt is not creditable due to food 

safety issues.

Yogurt in a tube X

Must meet the Food and Drug Administration’s 

standard of identity for yogurt to be creditable. 

A 2.2 ounce tube provides 1⁄2 ounce equivalent 

meat alternate. Must contain no more than 23 

grams of total sugars per 6 ounces.

Yogurt, liquid form

(drinkable) X

Liquid yogurt and yogurt that can be consumed 

from a bottle are not creditable. Liquid 

“yogurt” does not meet the Food and Drug 

Administration’s standard of identity for yogurt.

Yogurt products, 

storebought (commercial), 

such as frozen yogurt, 

yogurt bars, yogurt flavored 

products, yogurt covered 

fruits or nuts, or similar 

products)

X

These products are not creditable. See the 

“Other Foods” section in the Food Buying 

Guide for Child Nutrition Programs for 

information on commercial frozen yogurt.

Yogurt, store-bought 

(commercial), plain, 

unflavored, flavored

X

Store-bought (commercial) yogurt may be 

served to infants who are developmentally 

ready to accept it. The yogurt must contain no 

more than 23 grams of sugar per 6 ounces to 

be creditable. Soy yogurt is not creditable as 

part of a reimbursable infant meal.
162 | Appendixes

Food

Creditable

Comments

Yes Maybe No

Baby foods, store-bought 

(commercial), combination 

foods (such as chicken 

and vegetables)

X

The American Academy of Pediatrics 

recommends introducing single-ingredient 

foods to babies first before giving a mix of 

foods, or combination foods. It is encouraged 

that once the baby is developmentally 

ready, and has eaten all ingredients within a 

combination food individually without having 

an allergic reaction, then combination foods 

can be served. For example, a baby should 

try chicken separate from vegetables first 

before trying a mixed chicken and vegetables 

baby food dinner. Some mixed dishes may 

contain foods that do not credit towards the 

infant meal pattern, such as rice or pasta.

Baby foods,

store-bought (commercial), 

single-component (such 

as plain vegetables, 

mixed vegetables, mixed 

vegetables and fruit)

X

Store-bought baby foods that contain one food 

component and are packaged in a jar, plastic 

container, pouch, or any other packaging are 

creditable in the CACFP. The way a food is 

packaged does not impact whether a food is 

creditable or not.

Beans and peas, 

dry or canned X

Beans or peas can be credited either as a 

vegetable or a meat alternate, but not both 

in the same meal or snack. They should be 

cooked and prepared to the appropriate texture 

for infants (pureed or mashed). Do not serve 

whole beans or peas because they may cause 

infants to choke. If serving canned beans or 

peas, drain them first and rinse with clean, safe 

water before using to reduce the amount of salt.

Canned foods, homemade X

Home-canned foods are not creditable due 

to food safety issues that can arise during the 

home canning process.

Combination foods, 

commercial baby food X See Baby foods, store-bought (commercial), 

combination foods.

Vegetables
Appendixes | 163 

Freeze-dried fruit and 

vegetable snacks X See Fruit Snacks.

Fruit/Vegetable juice blends X Juice is not creditable as part of a 

reimbursable infant meal.

Home-canned baby foods X See Canned foods, homemade.

Homemade baby foods X

Foods should be cooked, if necessary, and 

pureed, mashed, or finely chopped. 

Parents may only provide one component of 

a reimbursable meal.

Mixed fruits and 

vegetables, store-bought 

(commercial) baby food

X

Store-bought baby foods with more than one 

fruit and vegetable on the ingredients list are 

creditable because vegetables and fruit are one 

component in the infant meal pattern.

Mixed vegetables, 

store-bought (commercial) 

baby food

X

See Baby foods, store-bought (commercial), 

single-component (such as plain vegetables, 

mixed vegetables, mixed vegetables and fruit).

Single-component 

baby foods, store-bought 

(commercial)

X

See Baby foods, store-bought (commercial), 

single-component (such as plain vegetables, 

mixed vegetables, mixed vegetables and fruit).

Vegetable juice X Juice cannot count towards a reimbursable 

infant meal.

Vegetables, plain, cooked 

(homemade) X

Fresh, plain vegetables are creditable. 

Vegetables should be cooked, if necessary, and 

pureed, mashed, or finely chopped for an infant 

to avoid choking. All foods served to infants 

must be of a shape, size, and texture 

appropriate for the age and development of the 

infant. Parents may only provide one component 

as part of a reimbursable meal.
164 | Appendixes

Vegetables, plain, frozen 

(homemade) X

Frozen, plain vegetables are creditable. 

Vegetables should be cooked and pureed, 

mashed, ground, or finely chopped for an 

infant to avoid choking. All foods served to 

infants must be of a shape, size, and texture 

appropriate for the age and development 

of the infant. Parents may only provide one 

component as part of a reimbursable meal.

Vegetables,

single-component

store-bought (commercial) 

baby food

X See Baby foods, store-bought 

(commercial), single-component.

Vegetables continued from pg 163

Food

Creditable

Comments

Yes Maybe No

Baby foods, desserts

(such as baby puddings,

custards, cobblers, fruit

desserts)

X These are not 100% fruit, and are often high 

in added sugars and fat and low in nutrients.

Baby foods, store-bought 

(commercial), combination 

foods (such as chicken 

and fruits)

X

The American Academy of Pediatrics 

recommends introducing single-ingredient foods 

to babies first before giving a mix of foods, or 

combination foods. It is encouraged that once 

the baby is developmentally ready, and has 

eaten all ingredients in a combination food 

individually without having an allergic reaction, 

then combination foods can be served. For 

example, a baby should try chicken separate 

from apricots first before trying a mixed chicken 

and apricot baby food dinner. Some mixed 

dishes may contain foods that do not credit 

towards the infant meal pattern, such as rice 

or pasta.

Fruit
Appendixes | 165 

Baby foods, store-bought 

(commercial), singlecomponent (such as plain 

fruits, mixed fruits, mixed 

fruits and vegetables)

X

Store-bought baby foods that contain one 

food component and are packaged in a jar, 

plastic container, pouch, or any other 

packaging are creditable in the CACFP. The 

way a food is packaged does not impact 

whether a food is creditable or not.

Canned foods, homemade X

Home-canned foods are not creditable due 

to food safety issues that can arise during the 

home canning process.

Combination foods, 

commercial baby food X See Baby foods, store-bought (commercial), 

combination foods.

Desserts, baby food X See Baby foods, desserts.

Freeze-dried fruit and 

vegetable snacks X See Fruit snacks.

Fruit drinks and fruit punch X Fruit drinks and fruit punch are not creditable 

as part of a reimbursable infant meal.

Fruit juice X Juice is not creditable as part of a 

reimbursable infant meal.

Fruit, plain, cooked 

(homemade) X

Fresh, plain fruits are creditable. All foods 

served to infants must be of a size, shape, 

and texture appropriate for the age and 

development of the infant. Fruits should be 

cooked, if necessary, and pureed, mashed, 

ground, and finely chopped for an infant to 

avoid choking. Parents can only provide one 

component as part of a reimbursable meal.

Fruit, plain, frozen 

(homemade) X

Frozen, plain fruits are creditable. Fruits should 

be thawed and, if necessary, cooked and 

cooled. All foods served to infants must be of 

a size, shape, and texture appropriate for the 

age and development of the infant. Parents 

can only provide one component as part of a 

reimbursable meal.
166 | Appendixes

Fruit, single-component, 

store-bought (commercial) 

baby food

X

See Baby foods, store-bought (commercial), 

single-component (such as plain fruits, mixed 

fruits, mixed fruits and vegetables).

Fruit snacks (such as 

100% fruit strips or fruit 

leather, freeze-dried fruit 

snacks, fruit drops, or 

other snack-type products)

X Fruit snacks are not creditable as part of a 

reimbursable infant meal.

Fruit/Vegetable juice blends X Juice is not creditable as part of a 

reimbursable infant meal.

Juice X See Fruit juice and Vegetable juice.

Mixed fruits and 

vegetables, store-bought 

(commercial) baby food

X

Store-bought baby foods with more than one 

fruit and vegetable on the ingredients list are 

creditable because vegetables and fruit are one 

component in the infant meal pattern.

Mixed fruits, store-bought 

(commercial) baby food X

See Baby foods, store-bought 

(commercial), single-component (such 

as plain fruits, mixed fruits, mixed fruits and 

vegetables).

Single-component 

baby foods, store-bought 

(commercial)

X

See Baby foods, store-bought (commercial), 

single-component (such as plain fruits, mixed 

fruits, mixed fruits and vegetables).

Fruit continued from pg 165
Appendixes | 167 

Food

Creditable

Comments

Yes Maybe No

Animal crackers X See Crackers.

Baby foods, desserts

(such as baby puddings, 

custards, cobblers, fruit

desserts)

X

These foods often contain insufficient amounts 

of creditable ingredients. They are not 100% 

fruit, and are often high in sugar and fat and 

low in nutrients.

Baby foods, store-bought 

(commercial), combination 

foods (such as 

chicken and rice)

X

The American Academy of Pediatrics 

recommends introducing single-ingredient 

foods to babies first before giving a mix of 

foods, or combination foods. It is encouraged 

that once the baby is developmentally ready, 

and has eaten each ingredient in a combination 

food individually without having an allergic 

reaction, then combination foods can be 

served. For example, a baby should try chicken 

separate from rice before trying a mixed 

chicken and rice baby food. Some mixed 

dishes may contain foods that do not credit 

towards the infant meal pattern, such as rice 

or pasta.

Baby foods, 

store-bought (commercial), 

single-component

X

Store-bought baby foods that contain one food 

component and are packaged in a jar, plastic 

container, pouch, or any other packaging are 

creditable in the CACFP. The way a food is 

packaged does not impact whether a food is 

creditable or not.

Bagels X See Bread.

Biscuits X See Bread.

Grains
168 | Appendixes

Food

Creditable

Comments

Yes Maybe No

Bread X

Bread or toast is creditable for infants who 

are developmentally ready to accept it. Bread 

is only reimbursable at snack and should be 

served only in small, thin strips or pieces. 

Should not contain nuts or seeds to reduce the 

risk of choking. Grains served must be made 

with enriched or whole grain meal or flour.

Buns, hamburger 

and hot dog X See Bread.

Cakes X Cakes are considered grain-based desserts, 

which are not creditable.

Cereal, infant, iron-fortified, 

multiple grains X

Iron-fortified dry infant cereals with multiple 

grains are creditable for infants that are 

developmentally ready to accept them. The 

American Academy of Pediatrics recommends 

introducing single-ingredient foods to babies 

first before giving a mix of foods.

Cereal, infant, iron-fortified, 

single grain X

Iron-fortified infant cereals such as rice, barley, 

and oatmeal are creditable for infants who are 

developmentally ready to accept them. The 

American Academy of Pediatrics recommends 

introducing single-ingredient foods first before 

giving a mix of foods.

Cereal, ready-to-eat X

Ready-to-eat cereals are creditable at snack 

for infants that are developmentally ready to 

accept them. The cereal must contain no more 

than 6 grams of sugar per dry ounce and must 

be iron fortified. Ready-to-eat cereals must 

be made with enriched or whole grain meal or 

flour, or be fortified.

Grains continued from pg 167
Appendixes | 169 

Combination dinners, 

commercial baby food X See Baby foods, store-bought 

(commercial), combination foods.

Cookies X Cookies are considered grain-based desserts, 

which are not creditable.

Corn muffins X See Bread.

Cornbread X See Bread.

Crackers X

Crackers may be served at snack and are 

creditable to infants who are developmentally 

ready to accept them. Crackers served must 

be made with enriched or whole grain meal or 

flour. Should not contain seeds, nuts, or whole 

grain kernels to reduce the risk of choking.

Croissants X See Bread.

Desserts, baby food X See Baby foods, desserts.

English muffins X See Bread.

Farina X

Farina is not creditable as part of a 

reimbursable infant meal. Farina is not a 

ready-to-eat cereal or iron-fortified infant cereal.

Graham crackers X See Crackers.

Grits X

Grits are not creditable as part of a 

reimbursable infant meal. Grits are not a 

ready-to-eat cereal or iron-fortified infant cereal.

Home-canned baby foods X See Canned foods, homemade.
170 | Appendixes

Grains continued from pg 169

Food

Creditable

Comments

Yes Maybe No

Homemade baby foods X

Foods should be cooked, if necessary, and 

pureed, mashed, or finely chopped. Parent 

can only provide one component as part of a 

reimbursable meal.

Infant cereal X

See Cereal, infant, iron-fortified, single 

grain and Cereal, infant, iron-fortified, 

multiple grains.

Oatmeal, instant 

and regular X

Instant and regular cooked oatmeal is not 

creditable as part of a reimbursable infant 

meal. Oatmeal is not a ready-to-eat cereal or 

iron-fortified infant cereal.

Pancakes X See Bread.

Pita bread X See Bread.

Pizza crust X See Bread.

Pretzels, soft X See Bread.

Puff cereal snacks X

It is up to the program operator to determine if 

the puff cereal snack is easily recognizable as a 

ready-to-eat cereal. It may resemble puffed rice 

cereals or whole grain O’s. It should easily 

dissolve in an infant’s mouth and should not 

contain nuts, seeds, or hard pieces that can 

cause choking. Some of these products can be 

higher in sodium. If the program operator 

determines it is a ready-to-eat cereal, it may be 

served at snack to infants who are 

developmentally ready to accept it. The cereal 

must contain no more than 6 grams of sugar 

per dry ounce. Ready-to-eat cereals must be 

made with enriched or whole grain meal or 

flour, or be fortified.
Appendixes | 171 

Rolls X See Bread.

Single-component 

baby foods, store-bought 

(commercial)

X See Baby foods, store-bought 

(commercial), single-item.

Teething crackers, 

biscuits, toasts X

Teething snacks may be served at snack 

and are creditable for infants who are 

developmentally ready to accept them. Grains 

served to infants must be made with enriched 

or whole grain meal or flour, or be fortified.

Tortilla, soft (flour, whole 

wheat, and corn tortillas) X See Bread.

Waffles X See Bread.
172 | Appendixes

1. How can I be reimbursed when a baby does 

not eat at a normal or set mealtime? 

As long as you offer all required food 

components over the course of the day, the foods 

may be counted towards reimbursable meals and 

snacks. For example, the baby may be offered 

breastmilk at 9 a.m. and then infant cereal and 

pureed fruit at 10:30 a.m., based on when the

baby shows signs of being hungry. The baby does 

not have to eat the entire meal in order for the 

meal to be reimbursed. 

2. A parent wants to bring in mashed 

bananas in addition to breastmilk. What 

should I tell them? 

Parents can only bring one food component 

at a meal or snack that can count towards a 

reimbursable meal or snack in the CACFP. Let 

parents know that you can serve either the 

breastmilk or bananas, and will give their baby 

other foods at meal or snack time to make sure 

they are eating a variety of healthy foods. If the 

parent wants both the breastmilk and bananas

served at the same meal, you can offer one of the 

parent-provided items as an additional food item. 

3. A baby is breastfeeding, and the 

parent wants the baby to also have organic 

vegetables, but I don’t serve organic foods. I 

know a parent is only allowed to bring in one 

food component in the CACFP, but she really 

wants to bring in her own vegetables. Can my 

child care site claim reimbursement for her 

baby’s meals and snacks if the parent brings in 

their own foods to be served to her baby? 

No. This is because the parent is providing more 

than one food component: breastmilk and solid 

foods. Parents are only allowed to provide one food 

component as part of a reimbursable meal or snack. 

4. As a child care provider, how should I 

document infant menus when the items each 

baby eats vary so much? 

You must keep records of menus, and your State 

agency and/or sponsoring organization may have 

additional guidance on how to document infant 

meals. You will need to vary the foods served to 

each infant based on the baby’s developmental 

readiness. All babies must be served breastmilk or 

infant formula, but not all babies should be served 

solid foods unless they are developmentally ready. 

One option for showing the various foods babies 

are served is to have a standard menu for all the 

babies in your care and adjust the menu for each 

baby based on what each baby is offered. For 

example, you can use a template that outlines the 

meal pattern requirements in one column and a 

space in another column for you to fill in what was 

served to each baby. 

Check with your State agency or sponsoring 

organization to see how they prefer you to 

document infant meals. See Appendix B: 

Sample Infant Menu (6 Through 11 Months) for an 

example. However, follow the guidance your State 

agency or sponsoring organization provides. The 

Sample Infant Menu provided in this guide is only 

to serve as an example. 

5. Is a meal still reimbursable if a baby in my 

care gets both breastmilk and infant formula? 

Yes. Meals served to babies younger than 12 

months of age may include iron-fortified infant 

formula, breastmilk, or both.

General Questions 

Appendix G: 

CACFP Questions and Answers 
Appendixes | 173 

6. What if a baby doesn’t finish all of the 

breastmilk or infant formula I give to him 

or her at a meal or snack? Can I still claim 

reimbursement for that meal or snack? 

Yes. As long as you offer the minimum amount 

of breastmilk or iron-fortified infant formula to the 

baby, then the meal is reimbursable. The minimum 

amount of breastmilk for babies 0 through 5

months at breakfast, lunch, supper, and snack is 

4–6 fluid ounces. The minimum amount of 

breastmilk for babies 6 through 11 months is 6–8

fluid ounces at breakfast, lunch and supper, and 

2–4 fluid ounces at snack. 

7. A father told me that their baby’s doctor says 

it’s okay to start giving their 10-month-old 

whole cow’s milk instead of infant formula. 

If he gives me a medical statement signed 

by the baby’s health care provider, are meals 

and snacks where cow’s milk is served 

reimbursable? 

Yes. For children younger than 12 months of age, 

cow’s milk may be served in place of breastmilk 

and/or infant formula if the family provides a

medical statement signed by the baby’s health 

care provider. The medical statement must include 

the type of milk to be avoided, explain how the 

milk affects the baby, specify what product(s) 

should be provided as a substitute, and be signed 

by the baby’s health care provider. 

Recommended substitutions of milk can also 

be included on the medical statement. Keep the 

medical statement on file in a secure location at 

your child care site in order for the meal or snack 

to be reimbursable. 

8. If a mother breastfeeds her 13-month-old, 

or older, child at my child care site, can 

this breastmilk count towards the fluid milk

component of a reimbursable meal? 

Yes. Breastmilk can replace the fluid milk 

component for children of any age. If a mother 

breastfeeds her baby at your child care site, the

meal is reimbursable. A written request for this 

substitution is not required nor is documentation of 

the amount of milk fed to the child. 

9. I have a 1-year-old child at my child 

care site and the mother provides pumped 

breastmilk for her child. However, she is only 

able to provide 2 fluid ounces. Can I serve 

her child 2 fluid ounces of unflavored whole 

milk alongside the breastmilk in order to meet 

the minimum fluid milk requirement of 4 fluid

ounces (1⁄2 cup)? 

Yes. If a mother provides less than the 

minimum amount of fluid milk for her 1-year-old 

child, then unflavored whole milk may be served 

alongside the breastmilk to meet the minimum 

fluid milk requirement. Be sure to discuss this 

with the parents. The two milks do not need to be 

mixed in the same cup. Remember that you must 

provide all other required food components in 

order for the meal to be reimbursable. 

10. A mother brought in an infant formula that 

is not iron-fortified. What should I do? 

You should ask the mother to bring in a medical 

statement signed by their baby’s health care 

provider before serving the infant formula that 

is not iron-fortified. Infant formulas that are not 

iron-fortified are allowed if the mother brings in a 

medical statement signed by the baby’s health 

care provider. The medical statement must include 

the type of infant formula to be avoided, explain 

how the formula affects the baby, specify what 

product(s) should be provided as a substitute 

and be signed by the baby’s health care provider. 

Recommended substitutions of infant formula can 

also be included on the medical statement. Keep 

the medical statement on file in a secure location 

at your child care site. 

Breastmilk and Infant Formula 
174 | Appendixes

11. A parent asked me to start serving their 

5-month-old baby solid foods at my child care 

site, but I know the infant meal pattern age 

groups are 0 through 5 months and 6 through 

11 months. If I serve the baby solid foods at 5 

months, can I still claim reimbursement for his 

meals and snacks? 

If the baby is developmentally ready to accept 

solid foods, then yes, you can claim 

reimbursement for solid foods at meals and 

snacks, even if the baby is younger than 6 months 

old. As a general best practice, it is recommended 

to get a written note from the parent stating 

that the baby can be served solid foods, but it is 

not required. 

12. What if a baby has just been introduced 

to solid foods at home and is only eating ironfortified infant cereal at this time? Do I have 

to serve it at every meal or snack where infant 

cereal is required? 

It depends. Solid foods are introduced

gradually, one at a time over the course of a few 

days. This means that it may be okay to serve the 

solid food only once per day until the baby can 

tolerate more than one serving of that food. 

13. As a child care provider, what should I do 

if I feel a baby is developmentally ready to 

start eating solid foods, but the baby’s parents 

do not want the baby to be introduced to 

solid foods? 

If you feel that a baby is developmentally 

ready to start eating solid foods, talk with the 

baby’s parents. 

You can tell the parents about the signs you 

have seen indicating the infant is ready to start 

solid foods and ask if they would like solid foods to 

be served while the baby is in your care. 

Remember to be in constant communication with 

the baby’s parents about the baby’s eating habits 

as well as when and what solid foods should be

served while the infant is in your care. Check out 

the “For Parents: Is Your Baby Ready for Solid

Foods?” handout on page 12 to help with talking 

to parents about introducing solid foods. 

If the parent does not want the baby to be served 

solid foods while the baby is in your care, respect 

that decision and do not serve the baby solid 

foods. In this situation, as long as you continue 

to serve the infant the required amount of 

breastmilk or iron-fortified infant formula, the 

meals are still reimbursable. 

14. Can I serve babies in my care pancakes,

kiwi, and formula at breakfast and claim it 

as a reimbursable meal? I serve this to the 

toddlers (over the age of 1 year old), so it 

would be easier for me to serve the babies 

the same thing. 

No. The only grain that is allowed at breakfast in 

the updated infant meal pattern is iron-fortified 

infant cereal. Other grain items, like pancakes, 

cannot be served in place of infant cereal at 

breakfast and be claimed for reimbursement. The 

pancake could be an extra food, not part of the

reimbursable meal. Therefore, at breakfast, infants

must be served infant cereal or a creditable meat/ 

meat alternate when they are developmentally 

ready. However, a pancake can be served at 

snack and be claimed for reimbursement since it 

is a bread-like item. Ready-to-eat cereals, bread, 

and crackers can be served at snack only. See 

Appendix F: Infant Foods List on page 149 for a 

full list of creditable grains. 

15. Can infant cereal be served in a bottle 

to babies? 

No. Serving infant cereal in a bottle to babies 

is not allowed. Neither the infant cereal nor the 

breastmilk or formula in the bottle may be claimed 

for reimbursement when they are served in the same 

bottle, unless it is supported by a medical statement 

signed by the baby’s health care provider.

Solid Foods 
Appendixes | 175 

16. Is there a sugar limit for infant cereals and 

ready-to-eat cereals served to babies?

Yes. All cereals served in the CACFP must 

contain no more than 6 grams of sugar per dry 

ounce. Almost all infant cereals meet this sugar 

requirement, and there are many types of readyto-eat cereal that meet this sugar requirement 

as well. To find a cereal that meets the sugar 

requirement, you can use any cereal that is listed 

on any State agency’s Special Supplemental 

Nutrition Program for Women, Infants, and 

Children (WIC)-approved cereal list, found as part 

of the State’s approved food lists: https://www.fns. 

usda.gov/wic/links-state-agency-wic-approvedfood-lists. 

You can also use USDA Team Nutrition’s Choose 

Breakfast Cereals That Are Lower in Added 

Sugars training worksheet at https://www.fns. 

usda.gov/cacfp-training-tools to see if a cereal 

meets the sugar limit. 

17. Is there a whole grain-rich requirement in 

the CACFP for infants? 

No. The requirement to serve at least one 

whole-grain rich food per day is only required under 

the CACFP child and adult meal patterns. Grains 

served must be made with enriched or whole grain 

meal or flour. Ready-to-eat breakfast cereals and 

infant cereals that are fortified are also creditable. 

18. Is yogurt creditable in the infant 

meal pattern? 

Yes. Yogurt is an allowable meat alternate for 

infants who are eating solid foods. All yogurts 

served in the CACFP, including those served to 

babies, must contain no more than 23 grams of 

sugar per 6 ounces of yogurt. 

To help you identify yogurts with no more than 23 

grams of sugar per 6 ounces, check out USDA 

Team Nutrition’s Choose Yogurts That Are Lower

in Added Sugars training worksheet (Appendix E) 

at https://www.fns.usda.gov/cacfp-training-tools. 

19. What is the minimum amount of iron an 

infant cereal must contain in order to be 

considered “iron-fortified”? 

Infant cereal must have some iron in it in order 

to be creditable in the CACFP. However, there is 

no minimum amount of iron required. Look at the 

ingredients list on the back of the infant cereal 

package. As long as one of the ingredients listed is 

“iron,” “ferric fumarate,” “electrolytic iron,” or “iron 

(electrolytic),” then the cereal is iron-fortified. See 

page 71 for more information. 

20. How do I know which foods I can serve and 

which foods I cannot in order to be reimbursed 

for meals and snacks served to the babies in

my care? 

Check out Appendix F: Infant Foods List on page 

149 for a list of common foods served in child 

care centers and family child care homes. Please 

note, this list of creditable and non-creditable 

foods does not include every food you may or may 

not serve. This list includes only those foods that 

are most commonly served in child care centers 

and family child care homes. If a food is not 

listed that you wish to serve, please contact your

State agency or sponsoring organization before 

serving to make sure you can claim it as part of a 

reimbursable meal or snack.
176 | Appendixes

1. All of these pictures show a baby giving a sign he or she is hungry, except (circle one):

2. All of these pictures show a baby giving a sign he or she is full, except (circle one): 

3. A mother brings in an infant formula for her baby. The child care provider has worked with babies 

for years, and prepares the infant formula the same way she does with all other formulas. Is the child 

care provider preparing the infant formula correctly? Why or why not? 

4. The parents of a 9-month-old tell you that they are going to switch their baby from formula to 

whole cow’s milk. This is because the rest of the family drinks cow’s milk and it will be cheaper. Which 

of the following would be an appropriate response: 

A. Cow’s milk is not safe for children younger than 12 months because it does not provide the 

 nutrition those infants need and can be hard for a baby to digest. 

B. This may be difficult since cow’s milk tastes different. Adding flavor or sweetener can help the 

 baby transition. 

C. Formula can be expensive, but there is a local WIC clinic that can help. 

D. A and C. 

E. All of the above. 

5. Which foods are creditable in the infant meal pattern and can be offered when the baby is 

developmentally ready? Circle all that apply. 

Appendix H: Feeding Infants Pre- and Post-Test 

Finely chopped Granola bar

baked chicken

Soy yogurt Pureed carrots 

Makes sucking noises Opens mouth for bottle Sleeping Rooting 

Pushing food away Crying Stops sucking Seals lips together 
Appendixes | 177 

6. You are serving older children fat-free (skim) milk, pancakes, and strawberries for breakfast. 

Which of these foods can you also serve the 10-month-old in your program in order to claim 

reimbursement for the breakfast meal? Choose all that apply: 

A. Fat-free (skim) milk 

B. Breastmilk or iron-fortified infant formula 

C. Pancakes 

D. Finely chopped strawberries 

E. Iron-fortified infant cereal 

7. All of the following baby foods from the store are creditable, except: 

A. Meat with gravy 

B. Fruits and vegetables 

C. Vegetables and meat 

D. Pudding 

8. All of the following finger foods are creditable in the CACFP infant meal pattern and can be 

prepared the right way to avoid choking, except: 

A. Small strips of bread 

B. Finely chopped watermelon 

C. Chunks of peanut butter or other nut butters 

D. Soft, cooked, chopped vegetables 

9. In the Child and Adult Care Food Program, a baby should be given solid foods: 

A. When the parents tell you to. 

B. When the baby is sitting up with good 

head control and reaches for food. 

C. At exactly 6 months of age. 

D. A and B. 

10. Select which items are important for parents and child care providers to share with each other: 

A. Baby’s food allergies or intolerances. 

B. If the baby has eaten solid foods and if so, which ones. 

C. Baby’s usual eating habits when fed breastmilk, iron-fortified infant formula, and solid foods when 

developmentally appropriate. 

D. Food preferences (cultural or other) that are important to the family. 

E. All of the above. 

No. The child care provider is not preparing the infant formula 3. • Crying 2. • Sleeping 1. Answers: 

the correct way. She should always follow the instructions on the package to make sure she is adding 

Pureed carrots and finely chopped baked 5. • D 4. • the correct amount of water to the infant formula. 

E 10. • D 9. • C 8. • D 7. • B, D, E 6. • chicken. 
178 | Index

Age groups 14 

Allergic reaction 2, 65, 121 

Artificial sweeteners 82 

Beans and peas, dry 78, 100, 

155, 162 

Beverages 55-56 

Bottle 20, 23, 28, 33, 42-45, 

47, 50-54, 114, 125 

Bowel movements 29 

Breads 74, 167 

Breastmilk 7, 10, 15, 16, 20, 

21, 23, 25, 26, 28, 29, 41-45, 

50, 53, 55, 84, 87, 143, 144, 

152 

Handling 42, 44 

Storing 43, 44 

Burping 52, 55 

Cheese 75, 87, 93, 143, 156 

Child and Adult Care Food 

Program (CACFP) 1, 6, 14, 

15, 172-175 

Child care site 1, 6, 20, 22, 

24, 27, 33, 37, 42-44, 97, 99, 

110, 129 

Choking prevention 114-116, 

149 

Complementary foods 6, 20, 

59 

Cottage cheese 75, 156 

Crackers 74, 93, 169 

Creditable 1, 32, 35-38, 71, 

74, 75, 78, 79, 81-83, 85, 93, 

94-96, 100, 116, 149-171 

Cup 51, 53, 54 

Desserts 81, 150, 151, 165, 

167, 169 

Developmental readiness 1, 

10, 59 

Eating habits 6, 7, 25 

Eggs 78, 100, 102, 103, 119, 

157, 161 

Enriched grains 1, 71, 72, 

149 

Feeding skills 2, 10, 11, 54, 

59, 65, 68 

Fish 74, 75, 93, 100, 102, 

115, 116, 119, 157, 158 

Food and Drug 

Administration (FDA) 32, 37, 

56, 75, 79, 153 

Food allergy 2, 36, 74, 78, 

119-121, 149 

Food component 2, 14-17, 

32, 70, 83, 84, 150, 151, 167 

Food intolerance 2, 7, 36, 

119-121, 131 

Fortified grains 2, 71, 72, 87, 

168 

Fruits 15-17, 81, 87, 93, 99, 

103, 115, 116, 143, 144, 149, 

164-166 

Fullness signs/Full 7, 9, 51 

Gag reflex 2, 11 

Grains 15, 16, 62, 70-72, 93, 

149, 167-171 

Hand washing 106-109, 111 

Health care provider 2, 7, 23, 

29, 32, 36-38, 45, 46, 51, 53, 

56, 61, 62, 84, 121, 125 

Index

Honey 81, 125, 126, 151 

Hunger signs/ Hungry 6, 7, 8, 

28 

Infant 3, 6, 14, 17 

Infant cereal 3, 15, 16, 20, 65, 

71, 72, 87, 93 

Infant formula 3, 6, 7, 15, 16, 

17, 28, 32-38, 42, 43, 45-47, 

55, 61, 68, 83-85, 87, 96, 153 

FDA Exempt 37, 153 

Handling 42, 46, 47 

Lactose-Free 36, 153 

Low-Iron 37, 153 

Low Lactose 36, 153 

Older babies and 

toddlers 38 

Preparing 46 

Soy-Based 36, 85, 153, 154 

Storing 43, 46, 47 

Infant meal pattern 6, 14-17, 

28, 32, 38, 59, 60, 70-75, 78, 

79, 81-83, 85, 143, 144 

Introducing new foods 65, 68, 

82 

Iron 35, 65, 71, 74, 76 

Iron-fortified dry 

infant cereal 65, 71, 168 

Lead 46, 110 

Mashed foods 3, 69, 70, 88, 

89 

Meat and Meat Alternates 15, 

60, 62, 65, 69, 70, 74, 75, 78, 

79, 82, 84, 87, 93, 100, 102, 

103, 115, 116, 143, 155-161
Index | 179 

Medical statement 3, 36-38, 

45, 46, 56, 61, 84, 85 

Milk 29, 36, 38, 56, 75, 83, 

85, 119, 149, 152-154 

Motor development 3, 62 

Nuts 68, 72, 74, 78, 116, 

119, 149, 159 

Nut butters 78, 85, 116, 159 

On-demand feeding 3, 6, 7 

Paced bottle feeding 51, 52, 

55 

Palmar grasp 3, 11 

Parent provided 

component 17, 83, 84 

Pincer grasp 3, 11, 70 

Poultry 15, 65, 74, 78, 82, 87, 

93, 100, 103, 115, 143, 159 

Processed meats 78 

Pumped breastmilk 4, 20, 25, 

29, 42-44, 53 

Pureed foods 4, 6, 59, 65, 68, 

69, 78, 88, 89, 98-101, 115, 

116, 149 

Ready-to-eat cereal 4, 16, 68, 

71-73, 87, 93, 115, 144, 149, 

168 

Reflux 4, 55 

Reimbursable 4, 6, 14, 15, 

17, 28, 29, 32, 36, 37, 45, 46, 

50, 61, 70, 78, 79, 81-85, 93, 

97, 100, 150-171 

Responsive feeding 4, 7 

Rooting 4, 8, 11 

Seeds 68, 74, 78, 81, 98, 99, 

115, 116, 159 

Seed butters 78, 85, 159 

Serving sizes 15, 17, 

140-144 

Shellfish 2, 74, 93, 100, 119, 

149, 160 

Single-component foods 4, 

82, 151, 155, 159, 162-164, 

166, 167, 171 

Solid foods 4, 6, 7, 11-17, 

59-89, 101-103, 114, 120, 

121, 133 

Freezing 101 

Preparing 97-100 

Reheating 101 

Storing 101, 103 

Table foods 82 

Thawing 101 

Special dietary needs 37, 84 

Special Supplemental 

Nutrition Program for Women, 

Infants, and Children (WIC) 5, 

24, 35, 72 

Spit up 52, 55 

Store-bought baby foods 5, 

93-96, 120, 150, 155, 162-167 

Buying 93-95 

Creditable 93, 94 

Non-creditable 93, 95 

Selecting 95 

Storing 96 

Sugar limit 72, 73, 79, 80, 

145-148 

Ready-to-eat cereal 72, 73, 

145, 146 

Yogurt 79, 80, 147, 148 

Teething 126 

Temperature 43, 44, 46, 67, 

101-103, 110 

Texture 5, 6, 10, 12, 15, 65, 

68, 69, 70, 88, 89, 98, 115 

Tofu 78, 79, 85, 160 

Tongue thrust 5, 11 

Tooth decay 5, 52, 54, 96, 

124, 125 

Vegan 36, 85 

Vegetables 15-17, 60, 69, 

70, 78, 81, 87-89, 93, 99, 103, 

116, 143, 144, 162-164 

Vegetarian 85 

Vomiting 55, 56, 121 

Warming 45, 67, 101 

Bottles 45 

Solid Foods 67, 101 

Wean 5, 54 

Whole grain-rich foods 71
180 | Acknowledgements

American Dental Association 

Chicago, Illinois 

Jessica Bridgman, MPH, RDN, LDN 

Nutrition Program Consultant 

North Carolina Department of Health and 

Human Services 

Division of Public Health 

Nutrition Services Division 

Raleigh, North Carolina 

Kimberley Catlett 

Nutrition and Wellness Administrator 

KinderCare Education, LLC 

Portland, Oregon 

Carole Dennis 

CACFP Program Specialist II 

New Hampshire Department of Education 

Bureau of School Wellness 

Office of Nutrition Programs and Services 

Concord, New Hampshire 

Jessica Gottung, MS, RDN, CDN 

Public Health Nutritionist 

New York State Department of Health 

Child and Adult Care Food Program 

Albany, New York 

Acknowledgments 

This publication was revised by the Nutrition Education and Promotion 

Branch within the Nutrition Education, Training, and Technical Assistance 

Division at the United States Department of Agriculture, Food and 

Nutrition Service. We would like to acknowledge and express our 

appreciation to the following individuals who reviewed this edition of the 

publication and provided valuable feedback: 

Frank R. Greer, MD 

Professor of Pediatrics, emeritus 

University of Wisconsin 

Department of Pediatrics 

Madison, Wisconsin 

Juliann Jacobson 

Kids’ Nutrition Company, Inc. 

Lakewood, Colorado 

Susan L. Johnson, PhD 

Professor 

University of Colorado Anschutz 

Medical Campus 

Department of Pediatrics/Nutrition 

Aurora, Colorado 

Kelley Knapp, MS, RD 

Nutrition Education Consultant 

California Department of Education 

Nutrition Services Division 

Sacramento, California 

Laura McCabe 

Director 

KidCare Nutrition Sponsor 

Greeley, Colorado

External Reviewers 
Acknowledgments | 181 

Lisabeth S. Melnik, MPH, RDN, CLC 

Public Health Nutritionist 

New York State, Department of Health, 

Division of Nutrition, Child and Adult Care 

Food Program 

Albany, New York 

Robin Holz Moberley, MS, RDN, LD 

Lead Child Nutrition Consultant 

Iowa Department of Education 

Bureau of Nutrition and Health Services 

Des Moines, Iowa 

Mary A. Musil, MS, RD 

Pediatric Nutritionist 

Helena, Montana 

National CACFP Sponsors Association 

Krista Schoen, MS, RD, LD

Public Health Nutritionist 

Florida Department of Health 

Bureau of Child Care Food Programs 

Tallahassee, Florida 

Sarah Jane Schwarzenberg, MD 

Professor of Pediatrics 

University of Minnesota 

Department of Pediatrics 

Minneapolis, Minnesota 

Linda Simmons, MSHP, RD, LD 

Nutrition Specialist 

Food and Nutrition/ Texas Department 

of Agriculture 

Austin, Texas 

Theresa Stretch, MS, RDN, CP-FS 

Education and Training Specialist I 

Institute of Child Nutrition 

University of Mississippi 

University, Mississippi 

Jamie Wise, RDN, LDN, CD 

Health Coach 

Seattle, Washington 

Reviewers from Federal Agencies 

Erica H. Anstey, PhD, MA, CLC 

Program Coordinator, Contractor 

Centers for Disease Control and Prevention 

Atlanta, Georgia 

Ellen O. Boundy, ScD, MS, RN, CNM 

Epidemic Intelligence Service Officer 

Centers for Disease Control and Prevention 

Atlanta, Georgia 

Heather C. Hamner, PhD, MS, MPH 

Health Scientist 

Centers for Disease Control and Prevention 

Atlanta, Georgia 

Carol A. MacGowan, MPH, RDN, LDN 

Public Health Advisory 

Centers for Disease Control and Prevention 

Atlanta, Georgia 

Staff from the Food, Nutrition, and 

Consumer Services, USDA 

Center for Nutrition Policy and Promotion 

Nutrition, Education, Training and Technical 

Assistance Division 

Office of Community Food Systems 

Office of Food Safety 

Policy and Program Development Division 

Program Monitoring and Operational 

Support Division 

Special Supplemental Nutrition Program for 

Women, Infants, and Children 

USDA Mountain Plains Regional Office 

USDA Western Regional Office
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