Meal Substitutions for Children with Special Needs

A child with a disability that restricts his or her diet is entitled to receive special meals, when that need is supported by a statement signed by a licensed physician. However, sponsors are not expected to make accommodations that are so expensive or difficult that they would cause the sponsor undue hardship. In most cases, children with disabilities can be accommodated with little extra expense or difficulty. A statement from the child's physician is required to ensure that the substitutions in foods meet nutrition standards that are medically appropriate for that child, and to justify that the modified meal is reimbursable.  

The physician's statement must identify: 

1. the child's disability and an explanation of why the disability restricts the child's diet; 

2. the major life activity affected by the disability; and 

3. the food or foods to be omitted from the child's diet, and the food or choice of foods that must be substituted. 

Food substitutions may be made, at a sponsor's discretion, for an individual child who does not have a disability, but who is medically certified as having a special medical or dietary need. Such determinations are only made on a case-by-case basis and must be supported by a statement that indicates which foods to avoid and to substitute. This type of statement must be signed by a recognized medical authority (e.g., physician, physician assistant, nurse practitioner, or registered nurse) or other health professional.