Guidance and resources for school nutrition professionals and staff working with students with special dietary needs and requests

Schools are encouraged to consider children’s cultural, religious and ethical preferences when planning and preparing meals. Offering a variety of choices will help accommodate children’s preferences and helps maintain participation in the National School Lunch Program and School Breakfast Program for all students.

For meal modifications due to a disability, the U.S. Department of Agriculture's Accommodating Children with Disabilities in the School Meal Programs Guidance for School Food Service Professionals is a valuable tool and resource to assist School Lunch and School Breakfast Program Sponsors in meeting the needs of students needing special dietary or meal accommodations. 

In many cases, disabilities can be managed within the program meal pattern. For example, a regular reimbursable program meal with only textural modification (e.g., pureeing food for a child who recently underwent oral surgery) would still meet the meal pattern, as would a simple substitution of a fruit component (offer canned pears for apple slices). Such a meal may be claimed for federal reimbursement regardless of whether the school food authority obtains a medical statement for the child.

For modifications that fall outside of the meal pattern, a medical statement is required and must include:

1. Information about the child's physical or mental impairment that is sufficient to allow the school food authority to understand how it restricts the child’s diet,
2.  An explanation of what must be done to accommodate the child’s disability, and
3. The food or foods to be omitted and recommended alternatives, in the case of a modified meal.

In some cases, more information may be required. For example, if the child requires caloric modifications or the substitution of a liquid nutritive formula to accommodate a disability, this information must be included in the statement. 

Schools should be working collaboratively with families so that children with disabilities have an equal opportunity to participate in and benefit from the National School Lunch Program and School Breakfast Program. School food authorities and local educational agencies should not be engaged in weighing medical evidence against legal requirements in order to determine if a medical or physical condition meets the definition of a disability. After the passage of the Americans With Disabilities Act Amendments Act, most physical and mental impairments constitute a disability.

Unless otherwise specified by the recognized medical authority*, meals modified for texture (such as chopped, ground or pureed) should consist of the same food items and quantities specified in the regular school menus. School food authorities should work with the school nurse to provide school food service staff with proper training on pureeing foods and any additional auxiliary aids or services (including necessary equipment) to implement texture modifications.

*Florida recognizes the medical authority as a state-licensed health care professional authorized to write medical prescriptions. This includes Licensed Physicians (MD, DO), Advanced Registered Nurse Practitioners (ARNP), and Physician Assistants (PA).