Nutrition Interventions for Children with Special Health Care Needs

Section 2 - Problem-Based Nutrition Interventions
foods that may be substituted (e.g. texture changes and foods substitutions) (7)
Other items that may be included in orders for children with disabilities or chronic
medical conditions are:
• Whether the allergy/medical condition is temporary or permanent. (A permanent
note will relieve the family from updating this information every year.)
• The location for maintaining this documentation to ensure that it accompanies the
student should she transfer to another school or district
Students with Other Special Dietary Needs
Schools may make food substitutions, at their discretion, for individual students
who do not have a disability, but who are medically certified as having a special
medical or dietary need. Such determinations are made only on a case-by-case basis
and must be supported by a statement or order that specifies the food substitution
needed and is signed by a recognized medical authority.
This provision covers those children who have food intolerances or allergies, but do
not have life-threatening reactions (anaphylactic reactions) when exposed to the
foods to which they are allergic. Generally, children with food allergies or intolerances
do not have a disability as defined under USDA’s regulations and school food
authorities may, but are not required to, make substitutions for them.
However, when in the physician’s assessment, food allergies may result in severe,
life-threatening (anaphylactic) reactions, the student’s condition would meet the
definition of disability and the substitutions ordered by the physician must be made
(6).
Schools are not required to make modifications to meals due to personal opinions of
the family regarding “healthful” diets.
Students with Individualized Education Plans
Many students with special needs will have an Individualized Education Plan (IEP) or
an Individualized Family Service Plan (IFSP). These are plans for students receiving
special education and related services to help the student benefit the most from the
school program. The services described in the IEP or IFSP may include special meals,
supported by a diet order. The food service director or manager is responsible for
providing meals as described in the diet order, but is not responsible for revising,
changing, or interpreting the diet order (7). Examples of IEP nutrition-related goals
that are written in collaboration with the child’s nutrition team and parents are
outlined in Appendix Q.
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