Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 11 - Bureau of Child Care Facilities › Subpart 55 - Child Care Facilities Licensure › Chapter 4 - REGULATIONS GOVERNING LICENSURE OF YOUTH CAMPS › Appendix 15-11-55-4-C

Current through June 25, 2024
Nutritional Standards
Introduction
Meals shall meet the nutritional standards as prescribed in
					 this section. A child care facility shall provide adequate and nutritious meals
					 prepared in a safe and sanitary manner.
Healthy diets help children grow, develop, and perform well
					 in learning environments. Healthy diets contain the amounts of essential
					 nutrients and calories needed to prevent nutritional deficiencies while
					 preventing an excess amount of discretionary calories. Planned meals and snacks
					 provide the right balance of carbohydrate, fat, and protein to reduce risks of
					 chronic diseases, and are part of a full and productive lifestyle. Such diets
					 are obtained from a variety of foods.
Nutrition and feeding practices for children strongly
					 affect the development and long-term health of the child. Proper nutritional
					 care during the early years is essential for intellectual, social, emotional,
					 and physical growth. It is also necessary that an environment be provided which
					 encourages the development of good food habits.
Meals and vending services shall meet the standards from
					 the Offices of Healthy Schools and Child Nutrition for the Mississippi State
					 Department of Education as well as USDA Food and Nutrition Service
					 guidelines.
THE GOALS OF A CHILD CARE FACILITY IN RELATION TO
					 NUTRITION SHALL BE:
1. Menus
				  shall be nutritionally adequate and consistent with the Dietary Guidelines for
				  Americans.
2. Foods shall be
				  provided in quantities and meal patterns that balance energy and nutrients with
				  children's ages, appetites, activity levels, special needs, and cultural and
				  ethnic differences in food habits.
3. Parents shall be involved in the nutrition
				  component of their child-care facility.
4. A variety of fruits, vegetables, and
				  whole-grain products shall be offered to children for meals and snacks.
				  Mealtime should be used as an opportunity to teach nutrition and/or food
				  concepts.
5. The addition of fat,
				  sugar, and sources of sodium shall be minimal in food preparation and
				  service.
6. Food preparation and
				  service shall be consistent with best practices for food safety and
				  sanitation.
7. Furniture and eating
				  utensils shall be age-appropriate and developmentally suitable to encourage
				  children to accept and enjoy mealtime.
8. Child-care personnel shall encourage
				  positive experiences with food and eating.
9. Caregivers shall receive appropriate
				  training in nutrition, food preparation, and food service.
10. Child-care facilities shall obtain
				  assistance as needed from the Child Care Licensure Division and the supportive
				  staff.
11. Nutrition education for
				  children and for their parents shall be encouraged as a component of the
				  child-care program.
12. Child-care
				  programs must comply with local and state regulations related to wholesomeness
				  of food, food preparation facilities, food safety, and sanitation.
13. Family style dining is encouraged.
Based upon the American Dietetic Association
					 Benchmarks for Nutrition Programs in Child-Care Settings
FEEDING SCHEDULE FOR INFANTS AND CHILDREN ONE YEAR
					 AND OLDER
1. Children's food
				  needs are based on the amount of time spent in the child care
				  facility.
2. Any child in a child
				  care facility at the time of service of a meal or snack will be served that
				  meal or snack
3. Child care
				  facilities that are open 24 hours are required to serve three meals and three
				  snacks.
IF YOU ARE OPEN
YOU MUST SERVE
Nine hours or less
Two snacks and one meal
OR
One snack and two meals
Over nine hours
Two snacks and two meals
OR
Three snacks and one meal
24 hours or during all meals
Three meal and three snacks: one snack
							 should be a late night snack only served to children who are awake.
I. Meal Time
Meals and snacks shall be served at regularly scheduled
					 times each day.
The same meal or snack shall not be served more than one
					 time in any 24-hour (one-day) period.
No more than four and no less than a two and one-half hour
					 period must elapse between the beginning of a meal and a snack.
If breakfast is not served, then a mid-morning snack shall
					 be provided.
Since not all children arrive at the facility at the same
					 time, certain parental options regarding breakfast will be allowed as
					 follows:
1. Parent can feed the child
				  prior to arrival at the child care facility.
2. The parent may have the meal provided by
				  the child care facility.
Note: Either option above must be documented and included
					 in the child's record.
Outside foods shall not be brought into the facility, with
					 the exception of special dietary needs. Exempt facilities are facilities that
					 operate less than six hours and as noted in the regulations, otherwise noted in
					 other sections of the standards. Any outside foods shall meet the Office of
					 Healthy School and MSDH Nutrition Standard guidelines.
II. Meal Time Environment
Age appropriate utensils, plates, bowls, cups, and dining
					 area shall be provided.
Children shall not wait longer than fifteen minutes at the
					 table for food to be served.
Sufficient time shall be allowed for children to wash their
					 hands and prepare for the meal.
Mealtime shall be used for socialization, and shall be a
					 relaxed, happy time for the children. No media, e.g., televisions, videos, or
					 DVD's may be viewed during meal and snack times. Family style dining is
					 encouraged with serving platters, bowls, and pitchers on the table so that all
					 present can serve him/her self. Children are encouraged to assist with table
					 setting and bowling up fruits for dessert. All foods served must meet the
					 serving guidelines, and be age appropriate. "Seconds" of foods can be served as
					 indicated at the request of the child or by hunger cues.
A caregiver shall sit and join the children while they are
					 eating. When caregivers are allowed to eat with the children, which is
					 encouraged, staff will eat items that meet nutrition standards. It is suggested
					 that the staff eat the same food items that are served to the children. The
					 staff will encourage social interaction, conversation, and use the mealtime for
					 education purposes. Extra assistance and time shall be provided for slow
					 eaters.
Caregivers shall not eat foods outside of the foods served
					 in the facility in front of the children.
Food shall not be used as a reward or punishment. Children
					 will not be encouraged to "clean your plate," but encouraging children to try
					 two bites of each food served is acceptable.
Additional servings shall be provided for the child who
					 requests more food at a meal or snack. It is at the discretion of the facility
					 and knowledge of the child's eating pattern to allow seconds on food items.
					 This time to teach children on portion control, monitoring extra intake, and
					 better food selections is higher in nutritional value.
Meals and snacks provided by a parent must not be shared
					 with other children, unless a parent is providing baked goods for a celebration
					 or party being held at the operation. Foods for a party or celebration shall
					 meet the Office of Healthy School guidelines.
Children will be permitted in meal preparation areas when
					 under the direct supervision of a staff person, when there is no danger of
					 injury from equipment, and for instruction/teaching purposes only.
III. Menus
A complete two-week cycle of menu plans shall be submitted
					 annually to Child Care Licensure as part of the renewal process. Although a
					 minimum complete, two-week cycle menu is required to be submitted annually,
					 child care facilities at their discretion may submit a 4 to 8 week cycle of
					 menu plans.
Daily menus for all meals and snacks prepared and/or served
					 in the child care facility shall be plainly posted. Any substitution shall be
					 of comparable food value and shall be recorded on the menu and dated.
Menus shall be written at least one week in advance. Menus
					 can be completed on a rotating cycle for 4-12 weeks.
Menus shall be posted in the food preparation area and in a
					 conspicuous place in the child care facility at all times.
Menus shall be planned to include food with variety in
					 texture, color, and shape. Record of dated menus served, and any substitutions
					 made, shall be kept on file for a minimum of one year.
New food shall be introduced to help develop good food
					 habits. Introduce only one new food per meal or snack. Foods used for
					 activities/teaching can be included on the written record of foods served for
					 the day.
It is the facility's responsibility to discuss recurring
					 eating problems with the child's parent.
IV. Child Requiring a Special Diet
A child requiring a special diet due to medical reasons,
					 allergic reactions, or religious beliefs, shall be provided meals and snacks in
					 accordance with the child's needs. If medical reasons exist for the special
					 diet, a medical prescription from the child's physician stating that the
					 special diet is medically necessary is required. Information required for
					 dietary modifications include:
* Child's full name and date of instructions, updated
					 annually;
*Any dietary restrictions based on the special
					 needs;
*Any special feeding or eating utensils;
*Any foods to be omitted from the diet and any foods to be
					 substituted;
* Limitations of life activities;
* Any other pertinent special needs information;
* What, if anything, needs to be done if the child is
					 exposed to restricted foods.
Religious or ethnic requests should include the above
					 information as needed, plus a certified statement of request based upon the
					 religious or ethnic beliefs of the family.
The facility shall not serve nutrient concentrates and
					 supplements such as protein powders, liquid protein, vitamins, minerals, and
					 other nonfood substances without written instructions from the child's
					 physician.
The child's parent shall meet with the facility staff
					 and/or director to review the written instructions. Such instructions shall
					 list any dietary restrictions/requirements and shall be signed and dated by the
					 child's physician requesting the special diet.
Parents of children with severe restrictions and dietary
					 needs will be given a copy of the facility's menu to pre-select foods to be
					 served. The parents will be responsible for ensuring the accuracy of foods
					 served based upon the preplanned menu.
The child care facility may request the parent to
					 supplement food served by the child care facility. When food is supplied by the
					 parent, the child care facility shall be responsible for assuring that it is
					 properly stored and served to the child in accordance with the diet
					 instructions on file at the child care facility. Any food item that must
					 cooked, shall be prepared by the facility, such as a soy patties. Meals and
					 snacks provided by a parent must not be shared with other children, unless a
					 parent is providing baked goods for a celebration or party being held at the
					 operation.
Records of food intake shall be maintained when indicated
					 by the child's physician.
Vegetarian/Vegan Dietary Requests
Request for a vegetarian/vegan diet shall be accommodated
					 with the same information completed as for dietary modifications. Specialty
					 items may be supplied by the parent to meet nutritional needs. Contact with the
					 nutritionist with MSDH is recommended.
To the extent authorized by Federal laws, the facility may
					 determine that the special nutritional needs of a child cannot be met at the
					 facility and the child may be excluded from admission into the facility.
V. Food Preparation
Recipes shall be used and a file of recipes used to prepare
					 the food shall be maintained.
Foods shall be prepared in a form that is easy for children
					 to handle. Bite size pieces and finger foods are suitable. Bones shall be
					 removed from any food served to any child in the child care setting.
Foods shall be prepared as close to serving time as
					 possible to preserve nutrients, flavor, and color.
Food should not be highly seasoned. No extra salt or fats
					 should be added to the foods in cooking. The use of salt free, low fat products
					 is allowed. Children need to learn the flavors of food.
Raw vegetables and foods that may cause choking in young
					 children shall not be served to children less than two years of age.
VI. Choking Prevention
A caregiver shall join the children while they are eating.
					 This is an opportunity to teach socialization skills, nutrition education, and
					 is a safety measure to help prevent choking.
Children should be encouraged to eat slowly, take small
					 bites, and chew well before swallowing.
FOODS THAT MAY CAUSE CHOKING
Sausage shaped meats (hot dogs)* Pop Corn
Hard Candy* Chips*
Nuts Thick Pretzels Rods* Thin pretzel sticks and rounds
					 would be allowed
Grapes Chunks of peanut butter
Gum* Marshmallows
Dried Fruits
*Not allowed to be served
To Reduce Choking Hazards
Cook food until soft and cut into short strips, not round
					 slices. Serve other foods in thin slices or small pieces. Remove bones from
					 meat, chicken, and fish, and remove seeds and pits from fruit. With toddlers,
					 cutting foods into "pea" size is recommended.
VII. Feeding of Infants
When a pregnant mother is visiting the facility to consider
					 enrollment, breastfeeding should be encouraged.
Breast milk is the recommended feeding for infants and
					 should be encouraged and supported by child care facility staff. The mother may
					 choose to come to the child care facility to nurse her infant, or may choose to
					 supply bottles of expressed breast milk for the child care facility staff to
					 feed the infant. To help a mother be successful with breastfeeding the faculty
					 may:
1. Encourage the mother to come
				  to the facility to breastfeed and provide a
* Quiet, comfortable and private place to feed;
*Place to wash the hands;
* Pillow to support her infant if desired;
*A comfortable chair, stool for feet while nursing;
* The mother may opt to nurse while in the infants
					 room;
2. Encourage the
				  mother to provide a back-up supply of frozen breast milk that is labeled with
				  the infant's name and date of expression. The mother's expressed milk shall be
				  used for her infant only. Note:
Excessive shaking of human milk may
				  damage some components that are valuable to the infant.
The Centers for Disease Control's (CDC) guidelines
					 for storage of frozen expressed breast milk are as follows:
* Freezer compartment of a refrigerator at a temperature of
					 5° F or -15° C the expressed breast milk can be safely stored for 2
					 weeks
* Freezer compartment of refrigerator with separate doors
					 0° F or -18° C the expressed breast milk can be safely stored for 3-6
					 months
" Freezer compartment of refrigerator with separate doors
					 -4° F or -20° C the expressed breast milk can be safely stored for 6-12
					 months
Note: Store milk toward the back of the freezer, where
					 temperature is most constant. Milk stored for longer durations in the ranges
					 listed is safe, but some of the lipids in the milk undergo degradation
					 resulting in lower quality. You can go to the CDC website at
http://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm
for more information.
3.
				  Note: for the breast fed infant, it is acceptable to introduce iron-fortified
				  cereal earlier, at four months if desired, but preferably at 6 months.
A written schedule for feeding the infant shall be provided
					 by the parent and posted for reference by the child care facility staff.
Feeding should be by hunger cues whenever possible. Hunger
					 cues may include:
* Sucking on his tongue, lips, hands, or fingers while
					 asleep
* Moving his arms and hands toward his mouth
*Restless movements while asleep
* Rapid eye movements under his eyelids
* Opening his mouth when his lips are touched
* "Rooting" or searching for your nipple
* Making small sounds
Late hunger cues include:
* Crying
* Fussiness
Signals when an infant is full and feeding should
					 stop:
* "Falls off" your breast, releasing the nipple;
* Falls asleep; or " Relaxes his body and opens his
					 fists.
Breast milk or formula shall be brought to the child care
					 facility daily, ready to be warmed and fed. Each bottle shall be labeled with
					 the infant's name and the date. No cereal, juice or other foods may be added to
					 the infant's breast milk/formula without a physician's written request, as done
					 for a child with special needs.
Bottles should be warmed for five minutes in a pan of hot,
					 not boiling water;
never
microwave.
					 Before feeding, test the temperature by squirting a couple of drops on the back
					 of your hand.
At the end of each feeding, discard any milk left in the
					 bottle. Staff will send all used bottles home with the parent for proper
					 cleaning and sanitizing.
Age-appropriate solid foods (complimentary foods) may be
					 introduced no sooner than when the child has reached 4 months of age, but
					 ideally at six months. The first food introduced usually is cereal mixed with
					 breast milk or formula (not in a bottle). Adding juice to dry cereal is not
					 allowed.
Commercially prepared  baby foods shall be brought in unopened jars
					 and labeled with the infant's name. Home prepared/blended and home canned
					 infant foods shall not be served. A facility may chose to mash and puree the
					 foods served to older children for the infants 7 months to one year - no
					 additional juice, sauces, or fats may be added to the pureed foods.
Iron-fortified dry infant cereal shall be brought in sealed
					 container premeasured for each feeding and labeled with the infant's
					 name.
Juice shall not be served to infants (children less
					 than 12 months of age).
A small amount of water is encouraged at 8-12
					 months.
Infants shall be held cradled in the arms during feeding.
					 At no time shall an infant be fed by propping a bottle.
Introduction of solid foods to an infant should be done in
					 consultation with the parent and/or according to the schedule of the
					 Mississippi State Department of Health Infant Feeding Guide.
Solid foods must be spoon-fed. No solid foods shall be fed
					 by bottle or infant feeder without written direction from a physician.
Infants are fed when hungry by noting hunger cues,
					 such as crying, being restless. Feeding is stopped when it is determined that
					 the infant is satisfied. Signs of satiety include, refusing the nurse, turning
					 away from the nipple, falling asleep.
Infants are encouraged to start using a cup at six to nine
					 months, based upon motor skills. When the cup is used, the breast milk or
					 formula may be brought into the center in a clean closed container that is
					 clearly labeled. By the age of one, all children should be off a bottle.
Older infants are encouraged to hold and drink from cups,
					 to use child appropriate eating and serving utensils. Self-feeding should be
					 encouraged. All food should be served in a manner to prevent choking, such as
					 mashing, cutting in small "pea" size portions.
Breast or formula is served to at least 12 months. Cow's
					 milk is not served until age one, unless provided with a written exception from
					 the infant's physician. Children ages one to two, shall be served whole cow's
					 milk, after age two, toddlers should be served fat free/skim milk.
When
					 there are children older than two in the classroom with younger children, all
					 children shall be served the whole milk.
Guidelines for Milk Storage and Use for All
					 Infants
Storage Method and Temperature
Maximum Amount of Time For Storage
Room (25 C or 77 F)
4 hours
Refrigerator (4 C or 39 F)
48 hours
Previously thawed
Refrigerated milk
24 hours
Freezer (-20 C or 0 F)
3 months
From the ACOG/AAP publication: Breastfeeding
					 Handbook for
Physicians
When centers are reimbursed for meals and must supply
					 formula for their infants, only ready to use formula may be purchased for use.
					 The center may require the parents to supply clean bottles daily. If the center
					 supplies the bottles, there must be provisions in place for the proper
					 cleaning, sanitizing, and drying of all bottles and supplies outside of the
					 infant room.
FEEDING SCHEDULE FOR INFANTS THROUGH ONE
					 YEAR
INFANT'S FOOD NEEDS ARE BASED ON THE AMOUNT OF TIME SPENT
					 IN THE CHILD CARE FACILITY.
ANY INFANT IN A CHILD CARE FACILITY AT THE TIME OF SERVICE
					 OF A MEAL OR SNACK SHALL BE SERVED FOODS APPROPRIATE TO THE AGE.
MEAL/SNACK
BIRTH
THROUGH 5
MONTHS
6 THROUGH 12
MONTHS
Breakfast
4-6 fl. oz. breast milk or formula
6-8 fl. oz. breast milk or formula 2-4 Tbsp. prepared
							 infant cereal (optional) 1-4 Tbsp. fruit and/or vegetable(infant or mashed)
Lunch or Supper
4-6 fl. oz. breast milk or formula
6-8 fl. oz. breast milk or formula 2-4 Tbsp. prepared
							 infant cereal (optional) 1-4 Tbsp. fruit and/or vegetable(infant or mashed) 1-4
							 Tbsp. infant meat
Supplement/Snack
4-6 fl. oz. breast milk or formula
2-4 fl. oz. breast milk or formula 0-1/2 dry bread or
							 0-2 crackers (optional)
Infant cereal and formulas shall be iron fortified.
					 Infant feeding is individualized after consultation with the parent and by
					 hunger cues from the infant.
MENU PLANNING
Dietary Guidelines for Americans provide assistance in
					 planning meals for ages two and older, which will promote health and prevent
					 disease.
The guidelines, applied to child care feeding are:
1. Offer a variety of foods.
2. Serve meals and snacks that help maintain
				  a healthy weight.
3. Serve fresh,
				  frozen, canned, or dried vegetables, fruits whenever possible, and whole grain
				  products.
4. Avoid excessive fat,
				  saturated fat, and cholesterol. No fried foods or foods with transfats shall be
				  served.
5. Use and serve sugar only
				  in meal preparation and then in moderation. No concentrated sweets, such as
				  candy, syrup, sweetened drinks sodas, or flavored milks may be
				  served.
6. Limit sodium products
				  and the use of salt.
7. Promote an
				  alcohol, tobacco and drug free lifestyle for children, parents, and
				  caregivers.
8. Promote and
				  encourage daily physical activity.