NUTRITION AND FOODS BROUGHT FROM HOME
Resources for Child Care Givers
Provided by All Family Resources

Eating nutritious food and learning good meal-time behaviors are important for children due to the rapid growth and the major developmental changes that they undergo. Meal times can also be an opportunity for learning and developing social and motor skills, and for being introduced to new foods. Skills such as handwashing, table manners, and carrying on a conversation at the dinner table can be developed and reinforced. Age-appropriate motor skills can be fostered by encouraging children to use child-sized utensils and encouraging children to clear their dishes and utensils from the table. Child-sized furniture and handwashing sinks help children feel comfortable and help the children learn.

To promote good nutrition:

• Provide attractive, nourishing food that is appropriate to the children's age and based on a planned, written menu. Contact your local health department or USDA extension service to get the federal guidelines for meals and snacks developed by the U.S. Department of Agriculture's Child Care Food Program and published in the Code of Federal Regulations.

  Infants

• Make sure that parents clearly label each child's bottle of formula or breast milk with the child's name and the date. Only use a bottle labeled for that child on that date. Never accept an unlabeled bottle from a parent. Do not use any unlabeled bottles that have been accidentally accepted. By observing this rule, you can prevent giving a child another child's bottle. However, in the event that a child has mistakenly been given another child's bottle of expressed breastmilk, follow the guidelines under the section on expressed breast milk and possible HIV exposure on the next page.
• Feed infants expressed breast milk or iron-fortified formula on demand unless the parent provides written instructions otherwise.
• Thaw frozen expressed breast milk in the refrigerator or under cold running water.
• Heat bottles in a pan of hot (not boiling) water for 5 minutes, then shake the bottle and test the fluid's temperature before feeding the child. Never heat a child's bottle of formula or expressed breast milk in a microwave. Bottles warmed in microwave ovens heat unevenly and, even after shaking, may have hot spots that could severely burn a child's mouth. Instead, heat a bowl of water in the microwave, then warm the bottle in the bowl of hot water. Or, use a crockpot to heat water for warming bottles.
• Don’t allow bottles to warm at room temperature or for long periods; this promotes bacterial growth.
• Always hold young infants during bottle feeding. An infant fed with a propped up bottle is at risk for choking, tooth decay, and ear infections.
• Place older infants in a sitting position for feeding.
• Clean and disinfect reusable bottles, bottle caps, and bottle nipples by washing in a dishwasher or by boiling for 5 minutes just prior to filling.

  Toddlers and Preschoolers

• Serve children in care for 8 hours or less at least one meal and two snacks or two meals and one snack. Offer children in care for more than 8 hours two meals and two snacks or one meal and three snacks.
• Don't feed children sticky, high sugar foods such as raisins. Foods that stick to the teeth for long periods of time cause tooth decay.
• Don't feed children juice "drinks." Feed them 100 percent juice to get the most nutrition.
• Do not allow children who can walk to carry bottles.
• Don't feed children foods or pieces of food that are the size and shape of a marble. Food this size can be swallowed whole and could become lodged in a child's throat and cause the child to choke. Examples include round slices of hot dogs, whole grapes, marshmallows, chips, and pretzels. Cut round objects, such as grapes, melon balls, or marshmallows, in half. Slice hot dogs lengthwise into quarters and then slice across into pieces. You should not give hard candy, dried fruit, popcorn, and other foods that can’t be cut into smaller pieces to young children.

  All Children

• Make sure that all children and staff wash their hands both before and after eating.
• Serve food "family style" and eat as a group. This gives the provider the opportunity to promote good table manners by setting an example and gives the children the chance to follow that behavior and talk with the other children.
• Serve small portions, but offer additional servings to meet individual needs.
• Don't force a child to eat. Young children vary the amount of food they consume from day to day and may also have very strong likes and dislikes.
• Don't use food as a reward or punishment.
• Make sure that children with special needs receive any particular foods or assistance in eating that they may require. Check with the child's parents or health care professional for specific instructions.

Expressed Breast Milk and Possible HIV Exposure

If a child has been mistakenly fed another child's bottle of expressed breast milk, the possible exposure to HIV should be treated the same as accidental exposure to other body fluids. You should:

• Inform the parents of the child who was given the wrong bottle that:
  --their child was given another child's bottle of expressed breast milk,
  --the risk of transmission of HIV is very small (see discussion below),
  --they should notify the child's physician of the exposure, and
  --the child should have a baseline test for HIV.
• Inform the mother who expressed the breast milk of the bottle switch, and ask:
  --if she has ever had an HIV test and, if so, if she would be willing to share the results with the parents,
  --if she does not know if she has ever had an HIV test, if she would be willing to contact her obstetrician and find out and, if she has, share the results with the parents,
  --if she has never had an HIV test, if she would be willing to have one and share the results with the parents, and
  --when the breast milk was expressed and how it was handled prior to being brought to the facility.
• Provide the exposed child's physician information on when the milk was expressed and how the milk was handled prior to being brought to the facility.

Risk of HIV transmission from expressed breast milk drunk by another child is believed to be low because:

• In the United States, women who are HIV positive and aware of that fact are advised not to breast feed their infants.
• Chemicals present in breast milk act, together with time and cold temperatures, to destroy the HIV present in expressed breast milk.

The risk to child care providers who feed children bottles of expressed breast milk is extremely low because the risk of transmission from skin/mucous membrane exposures to HIV is extremely low (probably much lower than the 0.5% involved with blood and other body fluids with higher levels of virus). Therefore, you do not need to wear gloves when giving bottles of expressed breast milk. If breast milk is spilled on your skin, wash the area with soap and water as soon as possible.

Foods Brought from Home

You should develop a written policy about food brought from home. Parents should be given a copy of this policy when they enroll their child in your child care facility. Foodborne illness and poisoning can result from food that is improperly prepared or stored. You can ensure that the food the children in your care eat is nutritious and safe by planning menus and buying and making the food yourself. Many child care providers provide two snacks and one meal a day to the children in their care. (See sections on Foodborne Illnesses and Nutrition.)

However, if parents provide the food their child is to eat each day, you should make sure that:

• Each individual child's lunch brought from home is clearly labeled with the child's name, the date, and the type of food.
• The food is stored at an appropriate temperature until eaten.
• The food brought from one child's home is not fed to another child.
• Children do not share their food.
• Food brought from home meets the child's nutritional requirements. If you notice that the meal provided by the parents for a child is not nutritionally complete, you should supplement it with food you have on hand. If the food provided for a child consistently does not meet the nutritional requirements of the child, you will need to explain to the parents what foods they need to provide for their child. You can also refer them to their health care professional for nutrition information and meal planning advice.

Sometimes, particularly for birthdays or other special occasions, parents may want to bring a food treat, such as a cake, cupcakes, or other "party" food, to share with all the children at your facility. Tell the parents that food brought into the child-care setting to celebrate these special occasions should be bought at a store or restaurant approved and inspected by the local health authority. Many institutional outbreaks of gastrointestinal illness, including infectious hepatitis, have been linked to eating home-prepared foods. Tell parents that your policy will protect all the children in your care from such foodborne illnesses.