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    Objectives
    • Describe three ways food service personnel can help promote healthy attitudes about food to the children at their center.
    • Name two special concerns with diets and how they can be addressed. 
    • List two ways to prepare foods for infants; for preschoolers; and for school-age children.

    Learn

    Learn

    Know

    Promoting Healthy Attitudes about Food

    As a food service personnel, your job is to nourish growing children by offering healthy meals that meet their nutritional needs, that are appealing, and that encompass diverse backgrounds, cultures, and preferences.  You promote a healthy attitude about the foods on your menu in a variety of ways, which then helps encourage children to eat the food you prepare.

    Expose children to different foods on a regular basis through the meals you serve at your facility by designing menus that include both new and known foods. This gives children the opportunity to try new foods in the context of already-familiar foods. Over time, most children will taste and accept a wider variety of foods, which makes meals easier for both children and caregivers.

    Below are some tips for helping children develop healthy attitudes about food:

    • Children are influenced heavily by their peers, so if they see their friends eating healthful food, they might also be encouraged to try that food.
    • Serve an appealing variety of foods of different colors and textures. Vary the menu offerings at your center to allow for this variety.
    • Keep portions age-appropriate, and don’t force children to keep eating if they feel full.
    • Provide at least one “safe” food—one that children are comfortable with—at each meal.
    • Talk about the food on the menu. Let children know where the food items come from and how it is grown. Coordinate with the child care staff if you are planning to serve a new food so that the children can learn about the food in their classroom. For example, a direct care staff can read a story to her class in the morning about a new food that you are going to serve during the lunchtime meal or engage them in a discussion about who has tried different foods previously. Children might watch a short video about the kinds of foods eaten in other cultures by children their own age.
    • Don’t expect that children will like everything they try. Allow them to have preferences.

    The Overcoming Picky Eating fact sheet below, from the University of Idaho, offers practical tips on how to overcome picky eating. Use the last page to keep with your facility’s records.

    Offering Healthy Choices

    Meals served in child care facilities should include healthy options from each food group. They should meet the requirements for types of foods and amounts as specified in the Child and Adult Care Food Program (CACFP) in order for your facility to be reimbursed for the meals you serve. Healthy choices include things like a variety of different colors of fruits and vegetables; whole grain breads, pasta, rice, or cereal; lean chicken or turkey, eggs, nut or soy butters, or beans; and fluid milk. Refined grain products and processed meats can contribute unnecessary fat, sodium, and sugar.

    Introducing New Foods

    Young children, especially during the preschool years, can be finicky when it comes to trying new foods. To introduce them to something new, especially foods like vegetables, a little creativity can go a long way. For instance, you can serve foods in a way that appeals to children, such as cutting vegetables into fun shapes, arranging them by color, or giving them interesting names (e.g., X-ray Vision Carrots). Serving new foods with familiar or favorite foods is another way to encourage children to try an unfamiliar food; seeing something on their plate that they recognize and know they like is comforting and can encourage them to branch out to try something new. You can also serve raw vegetables with different dips so children can experiment with flavor combinations. How you prepare foods can make them more appealing as well. A child may not like plain vegetables but would happily eat veggies that are baked and flavored with spices, such as roasted broccoli instead of plain, raw broccoli. Keep in mind that a new food will probably need to be offered multiple times before a child tries it; by giving children multiple opportunities to try a new food, you are increasing the likelihood that they will accept it.

    Special Concerns

    Some children in child care have special dietary needs, such as food allergies, cultural or religious preferences, and alternative diets, like vegetarian diets. 

    As a food service staff, your role is to work with your training and curriculum specialist or your program administrator, the child care providers, and families to ensure that children with special dietary needs receive appropriate foods when dining in your program.

    Your program administrator will ask parents about dietary needs when the child is being enrolled at the center. Specifically, they will collect information about family eating patterns, dietary requirements, food allergies, or other circumstances that need to be considered for food service and menu planning.

    Food Allergies

    Food allergies are common in young children. More than 160 foods can cause allergic reactions in people with food allergies, and eight of those foods account for 90 percent of allergic reactions to food. These eight foods are required by law to be labeled on any product that contains them:

    1. Milk
    2. Eggs
    3. Fish
    4. Crustacean shellfish (e.g. crab, lobster, shrimp)
    5. Tree nuts (e.g., almonds, walnuts, pecans)
    6. Peanuts
    7. Wheat
    8. Soybeans

    It is important to consider a child’s food allergies when planning meals. Working with parents and having documentation about the child’s food allergies can go a long way in helping you and other food service staff account for food allergies. Food allergies are covered more in-depth in Lesson Seven.

    Cultural or Religious Beliefs and Food Preferences

    We live in a very diverse country. Families have different religious or customary beliefs, some of which may dictate what foods can or cannot be eaten, whether it is year-round or at certain times of the year, such as holidays. Knowing families’ practices will help you accommodate their preferences in your menus.

    Another way to include families of different cultural backgrounds is to include foods from different cultures in the menus periodically. This not only makes the children from that culture feel more included, but it also exposes other children to new foods and customs. Consider involving the parents for ideas about menus or invite them to share about their culture with the children during mealtime.

    Vegetarian Diets in Child Care

    Families who follow a vegetarian diet may request vegetarian meals for their children. What constitutes a vegetarian diet can differ among families. For instance, some families avoid meat but still consume eggs or dairy products, while other families are vegan, meaning they do not eat any animal products. Food service staff can offer vegetarian options with meals as an alternate entrée option or substitution. In fact, even if children are not vegetarian, offering vegetarian meals as the main entrée is a great way to expose children to plant-based protein foods, which the Dietary Guidelines recommend eating more of.

    Food Preparation by Age Group

    When preparing food at your facility, there are specific considerations to take into account for each age group – Infants & Toddlers, Preschoolers, and School-Age Children. Although different age groups have different nutritional and textural needs for the food they are served, some factors are noteworthy across all age groups. 

    Infants

    Bottle Feeding

    Bottle preparation and feeding is usually the responsibility of the direct care staff.  However, from time to time, food service personnel may be asked to help with bottle preparation.  Thus, it is useful for food service staff to understand the process of storing and preparing both human milk and formula.

    Stringent preparation procedures of bottles, whether they contain human breast milk or formula, exist to reduce improper preparation and contamination that can cause mild to severe illnesses. Though preparation procedures are not difficult, they can be confusing because there are unique procedures for different types of milk (human milk and different brands and types of formula). The chance of improper preparation is greater when different staff members prepare bottles for feeding. Check with your specific program to determine how bottle preparation is handled at your facility. For instance, some programs have all bottles prepared by food service at the beginning of the day, while in other programs, bottle preparation is done in the classrooms by the direct care staff.

    Human Milk

    USDA’s Team Nutrition issued a publication entitled Feeding Infants: A Guide for Use in the Child Nutrition Programs. This useful guide lists the following guidelines for storing and preparing breastmilk:

    • It is important that the bottles are labeled with the infant's first and last name, date, and time the human milk was expressed. The labels and ink on the bottle need to be water-resistant so they are still readable if the bottle is thawed or warmed under running tap water. This is important since you may be thawing and warming bottles from different mothers at the same time in the same sink area.
    • Non-frozen human milk should be transported to your program in the containers that will be used for feedings. When you receive the milk, you must place it in the refrigerator. Use refrigerated bottles of fresh breastmilk, kept at 40° Fahrenheit or below, within 48 hours from the time they were collected. Throw out unused breastmilk if not used within 48 hours.
    • Although some programs prefer not to use frozen milk, in the event your program allows it, frozen human milk can be transported to your program and stored in single-use plastic bags and then placed in your program's freezer.  Breastmilk can be stored in a freezer (with a separate door from the refrigerator), for up to 3 months from when it was collected. Freezer temperature should be 0° Fahrenheit or below.   Once the breastmilk is removed from the freezer and thawed, refrigerate it at 40° Fahrenheit or below and use it within 24 hours; do not refreeze it. Check with your program administrators regarding your program’s policies around frozen human milk; some programs may choose not to store frozen human milk.
    • Thaw a bottle of frozen breastmilk in the refrigerator or hold it under running cold water. Thaw only as much frozen breastmilk as you think a baby will need for a feeding.
      • Do not thaw frozen breastmilk at room temperature, by heating on a stove, or in a microwave. Liquid may become very hot when microwaved even though the bottle feels cool. The hot liquid could seriously burn babies. Also, heating damages special substances in breastmilk that protect baby’s health.
      • If breastmilk has a bad odor after thawing, it may have spoiled and should be thrown out.

    Consider the information below when it comes time to feed infants human milk:

    • The feeding process should always begin with proper handwashing, followed by use of clean, sanitized bottles and nipples. Bottles that are made of plastics containing BPA should be avoided.
    • It is not necessary to wear gloves when handling or feeding human milk to an infant.
    • Shake the bottle of breastmilk before feeding the baby because breastmilk separates into two layers when it is stored.
    • For those babies who prefer a warm bottle, hold the bottle under running warm (not hot) water immediately before feeding the baby. Warm only as much breastmilk as you think a baby will need for a feeding. Feed breastmilk immediately after warming.  The temperature of the milk should not be greater than normal body temperature.
    • After a feeding, throw out any unused breastmilk left in a bottle and wash the bottle with soap and hot water immediately.
    • If there is a significant amount of human milk left in the container at the end of the day, you can return it to the family, as long as the child has not been fed directly from the container.

    When following proper bottle preparation techniques, the chance of feeding human breast milk to the wrong infant is small. However, in the event an infant is fed another child's human milk by mistake, there is the possibility that the infant has been exposed to hepatitis B, hepatitis C, or HIV. If this mistake should ever happen in your program, you should immediately notify your training and curriculum specialist and your program manager. This is important to keep in mind if you store human milk in the kitchen refrigerators, either as an every-day practice or in the event that you may need to offer temporary storage options for a classroom.

    Infant Formula

    The following are recommendations and tips for feeding an infant in your program with infant formula:

    • Thoroughly wash your hands.
    • Whether you use formula that is provided by families or by your program, it should come in a factory-sealed container.
    • If you are using infant formula provided by your program, it should be the same formula that your families use at home. Even small differences in brands can cause stomach upset and other problems in infants.
    • The infant formula families or your program provides may be ready-to-feed strength, liquid concentrate, or powdered.
      • The liquid concentrate will need to be diluted with water according to the directions on the can.
      • Powdered formula requires special care since it cannot be sterilized. Follow the manufacturer's directions on the can for safe handling. Before you open the can, wash your hands! The can and plastic lid should also be rinsed and dried. When scooping out the powder, it is important to only use the scoop that the manufacturer provides in the can. Other utensils may not measure accurately, and there is also the possibility of contamination from other utensils.
      • To dilute liquid concentrate or powdered formula using tap water, run it cold for two minutes from the tap before collecting it. If your program requires that you boil water for formula preparation, be sure to follow the guidance outlined in the protocol. A common practice is to boil the water for 1-2 minutes, then allow the water to cool completely before mixing it with the formula. Boiling water is a precautionary measure that some programs may use to reduce the risk of pathogens, such as may occur when well water is the water source. Please check with your program policies and procedures regarding boiling water for formula preparation.
    • If the formula is iron-fortified, you need to refrigerate it until just before you are ready to feed the infant.
    • Just as with human milk, all bottles of infant formula should be labeled with the child’s first and last name and time and date of preparation.
    • All prepared formula should be discarded within one hour of serving to an infant.
    • Open containers of ready-to-feed or liquid concentrate formula need to be covered, refrigerated, and labeled with the date it was opened and the child’s full name. If this formula is not used within 48 hours, it should be discarded. Prepared powdered formula that has not been fed to an infant can be stored in the refrigerator for up to 24 hours, and should be covered and labeled with the child’s name and time and date of preparation.
    • Just as with human milk, you can warm the infant formula depending on the family’s and child’s preference by running it briefly under warm water, or, if used in your program, in a bottle warmer. Again, never use a microwave to warm the bottle of formula, and do not shake the bottle excessively. Too much shaking can cause the formula to foam, which can increase the likelihood of feeding air to an infant, which can lead to discomfort and pain.
    • The temperature of the formula should not be greater than 98.6 F. You can test the temperature of the prepared formula by sprinkling a few drops of it on the inside of your wrist before feeding.

    Soy-Based Formula and Cow's Milk

    Some infants who are lactose intolerant or who have other health issues may drink soy-based formulas. These bottles should also be labeled with the infant's name, date and time of preparation. Cow's milk should never be served to infants from birth through 12 months of age unless the family provides written directions from their primary care provider. Between 12 and 24 months of age, children who are not drinking human breast milk or infant formula can be served whole milk. If there is a risk of obesity or other health concerns, these children can have reduced fat, or 2%, milk.

    Special Concerns with Bottle Feeding

    Sometimes an infant cannot have infant formula or soy-based formula due to certain health conditions. The infant may be allergic to milk or soy or may need extra calories to thrive. When this is the case, the family should provide a written plan from their primary care provider so that you can be sure to feed the infant appropriately.

    Solid Foods

    What foods are appropriate for infants who have recently transitioned to solids? The following tips from eXtension provide guidance on when to offer different types of foods and how often to serve them.

    • Start with rice cereals. Rice is less likely than other grains to cause an allergic reaction. Make sure the cereal is iron-fortified. Mix it with breast milk or infant formula to provide a good balance of protein, carbohydrate, and fat to serve as a source of iron. Measure the dry cereal before mixing it with liquids to ensure the proper amount is served. Oat and barley infant cereals can be introduced one week after rice cereal. Wheat cereal should not be introduced before age 8 months.
    • Vegetables may be introduced after cereals, at about 7 months. Mashed vegetables may be added to encourage chewing. For example, green beans, green peas, sweet potatoes, carrots, or squash are all great vegetables to introduce to infants starting on solids.  
    • Fruits should be introduced after vegetables. Use single ingredient foods such as applesauce. Other fruits that can be served at this age are apricots, bananas, pears, peaches, plums, or papayas. As with vegetables, make sure the consistency is mashed and free of chunks to prevent choking. Be cautious about citrus fruits and strawberries due to the risk of allergies. Combination baby foods, such as fruit desserts, cannot be counted for the Child and Adult Care Food Program.
    • Babies with one or two teeth can eat some lumpy foods. Some babies chew very well even without teeth. Food served to the other children may be offered to the baby. Easily mashed food, such as potatoes, carrots, bananas, or canned fruits work well. Remember though, babies do not need added sugar or salt.
    • Offer soft finger foods as soon as a baby can intentionally grasp or pick up food. Any food that will not fall apart between the plate and mouth is appropriate as a finger food. Try banana slices or tender cooked carrots. Finger foods are messy at first, but the mess will decrease with practice.
    • Meat, egg yolks, and small amounts of cheese may be added to baby’s diet starting at 8 months. Lean meat and poultry are the best meats to serve. Avoid serving fish or shellfish to infants due to the risk of allergies. Processed meats like bologna, hot dogs, sausage, and bacon should not be served to infants due to the high sodium and nitrate concentrations. Babies should not be given egg whites or whole eggs before their first birthday.
    • Breads, crackers, and noodles can be served to babies around 8-9 months old. Be sure that they are served in a manner that prevents choking (no whole pieces) and that parents have given approval first.
    • Honey and corn syrup are not recommended before 12 months. Some honey and corn syrups contain botulism spores. These are not harmful to children and adults but may produce poisons that can be fatal to babies. Infants’ digestive systems cannot destroy these spores.
    • Formula, breast milk, juices, and water may be given from a cup after 10 months. Hold the cup and serve only small amounts of liquid. Only an adult should feed an infant. By the first birthday, most babies are able to handle the cup alone.
    • Progressing the texture of solids. Babies between 6 and 12 months of age may be served a soft-cooked vegetable or fruit as long as the texture of the food is appropriately modified. As a baby’s mouth skills progress, gradually increase the thickness and lumpiness of foods. Use cooked, fresh, or frozen vegetables or fruits, and progress from pureed to ground to fork mashed and eventually to diced. Or you may purchase commercial baby foods that progress in texture. Ripe bananas do not need cooking but need to be mashed to the proper consistency. Avoid canned or frozen vegetables or fruit that are high in added sugar or salt.
    • Offer soft finger foods as soon as a baby can grasp. Any food that will not fall apart between the plate and mouth is appropriate as a finger food. Try banana slices or tender cooked carrots. Finger foods are messy at first, but the mess will decrease with practice.
    • Foods to avoid. Due to a variety of factors such as the risk of choking or allergies, or lower nutritional value, the following foods should not be served to infants eating solid foods:
      • Foods that pose a risk of choking (see Lesson Two on Family-Style Dining for more information on choking hazards)
      • Fish containing high levels of mercury (swordfish, tile fish, king mackerel, or shark)
      • Foods or drinks high in added sugars or salts; foods or drinks with artificial sweeteners
      • Allergens: avoid feeding babies the following foods before the indicated age
        • Citrus fruits, pineapple, and tomato – can be introduced at 6 months
        • Egg yolks and wheat – can be introduced at 8 months
        • Egg whites and whole eggs – can be introduced at 1 year
        • Cheese – can be introduced at 8 months
        • Honey – can be introduced at 1 year

        For a comprehensive resource on feeding infants, see the U.S. Department of Agriculture (USDA) resource, Feeding Infants in the Child and Adult Care Food Program at https://www.fns.usda.gov/tn/feeding-infants-child-and-adult-care-food-program

        Preschoolers

        When preparing meals for preschoolers, consider that children in this age range are learning independence and coordination. Choking is a big risk for preschoolers, so serve food in bite-size pieces, avoid round, hard, dense, or sticky foods, and make sure that kids are seated and calm during mealtimes. (Choking is covered in more detail in Lesson Two.) Finger foods are great for children this age while they develop fine-motor skills required for eating with utensils. Serving food in colorful, fun arrangements when possible will make the food more enticing. The following resource from the USDA highlights some key behavioral milestones for children age 2-5 years old.

        School-Aged Children

        School-age children are quite capable of feeding themselves and can eat many foods that adults also eat. In some programs, school-age children dine in a cafeteria or other common setting, while in other programs, they eat in a classroom eating area. Remember that if meals are served to school-age children in a family-style dining arrangement, the amount of food in the serving dishes needs to reflect the amount required by CACFP.

        With school-aged children, choking is still a risk because older kids may rush when eating and take big bites, or talk with their mouths full. While food service staff do not typically monitor the children as they dine, it’s helpful to know the signs of choking and be aware that it can still occur with older children.

        School-age children are the perfect age to start increasing exposure to new foods. When you include interesting facts or photos about different foods on your menu, you reinforce healthy eating behaviors and provide opportunities for nutrition education to supplement mealtimes and snacks. You can also explore the idea of having a cooking club at your program. Engaging kids in cooking increases the likelihood they will try a new food. In warmer climates, and for programs that can accommodate it, you could work with classrooms to coordinate a garden club. Fresh vegetables and herbs that the kids grow could then be incorporated into the weekly menus or after-school snacks.

        See

        What Does Proper Bottle Preparation Look Like?

        Proper handling of human milk and accurate preparation of formula are important for ensuring the nutritional needs of infants are being met. Watch these videos that show how to handle and store human milk and how to prepare infant formula.

        Preparing Human Milk

        Watch this video to learn about preparing human milk for infants.

        Preparing Formula

        Watch this video to learn about preparing formula in center settings.

        What Does Healthy Eating in Child Care Look Like?

        Healthy eating should be a requirement of your program. Snacks, meals, and beverages should all be planned to fit within the federal recommendations.

        Watch this video to learn more about healthy eating in school age programs. Notice that some of the programs engage in family-style dining.

        Healthy Eating Environments for School-Age Children:

        Watch this video to about healthy environments in school-age settings.

        Do

        In most child care centers, bottle preparation is handled by the child care provider. However, it is still important to understand how to handle and prepare infant bottles made with human milk or with formula. Set up a time to meet with the child care staff who work in the infant rooms of your child care facility. Observe them when they prepare a bottle; ask if you can assist with the process.

    Explore

    Explore

    The U.S. government has developed the MyPlate tool to guide all of us toward healthier food choices. You can find more information at www.choosemyplate.gov. You can find information about helping children and youth make healthy choices at http://www.choosemyplate.gov/kids.

    All of us need a variety of foods each day. A healthy diet includes a mix of grains, fruits, vegetables, dairy, and protein. The MyPlate guide helps you visualize the relative amounts of food you—and the children at your facility—need each day to be healthy. Half your plate should be covered with fruits and vegetables. The other half is split between grains and protein. Filling the plate with this balance of food will help children develop healthy habits.

    USDA’s Team Nutrition provides MyPlate materials that are developed specifically for kids and their parents and caregivers. Schools, summer sites, and child-care centers, homes, and sponsors that participate in USDA’s Child Nutrition Programs may request free printed copies of many of these materials. Materials available in print are on the Resource Order Form.

    Use this Team Nutrition activity guide to find important and fun information. Then share your answers with your trainer, coach, or administrator.

    Apply

    Apply

    Incorporating foods from the array of cultures represented by the children at your child care center into the menus you create is an excellent way to show these children that you respect and value their backgrounds while providing other children at the center exposure to new foods and customs, promoting diversity and variety. How do you know what foods to serve that will capture different cuisines? A simple survey is an easy way to collect this information. You can give school-age children at the center the survey to fill out. For younger children, coordinate with the direct care staff to send the surveys home with the parents. Use the survey form below, Culture Survey for Food Service, which was adapted from the USDA Team Nutrition website, to collect cultural information and food preferences for the families served by your child care center. Think of ways you can incorporate these customs and recipes into your menus.

    Glossary

    TermDescription
    Cuisinefoods and preparation techniques that typically are represented by a cultural influence, such as Chinese, Mexican or French cuisine
    Food aversionthe refusal to try or eat a certain food
    Food jageating only one type of food at each meal
    Vegan dieta diet that contains no animal products in any form, for example, no cheese or butter.

    Demonstrate

    Demonstrate
    Assessment

    Q1

    Which of the following does not help promote healthy attitudes about food at your center?

    Q2

    True or false? Eight foods account for 90 percent of food allergic reactions.

    Q3

    Which meal-time preparation practice is not advisable?

    References & Resources

    eXtension. (2015). Typical eating behaviors in young children. Kansas City: eXtension Foundation. Retrieved from https://articles.extension.org/pages/25779/typical-eating-behaviors-in-young-children

    eXtension. (2015). Accommodating Special Diets in Child Care. Kansas City: eXtension Foundation. Retrieved from https://articles.extension.org/pages/25787/accommodating-special-diets-in-child-care

    eXtension. (2015). Making mealtimes in child care pleasant, easy and appealing. Kansas City: eXtension Foundation. Retrieved from https://articles.extension.org/pages/25781/make-mealtimes-in-child-care-pleasant-easy-and-appealing

    Florida Health. Child Care Food Program. http://www.floridahealth.gov/programs-and-services/childrens-health/child-care-food-program/index.html

    Food and Nutrition Service. U.S. Department of Agriculture. (2019). Feeding infants in the child and adult care food program. Retrieved from https://www.fns.usda.gov/tn/feeding-infants-child-and-adult-care-food-program

    Food and Nutrition Service. U.S. Department of Agriculture. (2019). CACFP trainer's tools: Feeding infants. Retrieved from https://www.fns.usda.gov/tn/feeding-infants-cacfp-trainers-tools

    O’Connell, K. (2016). Food Jags. Healthline. http://www.healthline.com/health/food-jags#Overview1

    U.S. Food & Drug Administration. (2021). Food Allergies: What you need to know. https://www.fda.gov/food/buy-store-serve-safe-food/food-allergies-what-you-need-know