Appendix E7: Nutrition Requirements for Fluid Milk and Milk Substitutions

Food and
Nutrition
Service
Park Office
Center

DATE:

July 14, 2016

MEMO CODE:

CACFP 17-2016

SUBJECT:

Nutrition Requirements for Fluid Milk and Fluid Milk
Substitutions in the Child and Adult Care Food Program,
Questions and Answers

TO:

Regional Directors
Special Nutrition Programs
All Regions

3101 Park
Center Drive
Alexandria
VA 22302

State Directors
Child Nutrition Programs
All States
This memorandum explains the nutrition requirements for fluid milk and fluid milk
substitutes in the Child and Adult Care Food Program (CACFP) and includes questions
and answers. This memorandum supersedes CACFP 21-2011-REVISED Child Nutrition
Reauthorization 2010: Nutrition Requirements for Fluid Milk and Fluid Milk
Substitutions in the Child and Adult Care Food Program, Questions and Answers,
September 15, 2011.
Background
The Healthy, Hunger-Free Kids Act of 2010 (the Act), Public Law 111-296, amended
section 17(g) of the Richard B. Russell National School Lunch Act (NSLA), 42 U.S.C.
1766(g), to require that fluid milk served in the CACFP be consistent with the most
recent version of the Dietary Guidelines for Americans. The 2015-2020 Dietary
Guidelines for Americans (Dietary Guidelines) recommend that persons over two years
of age consume low-fat (1%) or fat-free (skim) fluid milk. In addition, the Act provided
the flexibility to substitute fluid milk with non-dairy beverages that are nutritionally
equivalent to fluid milk for children or adults with special dietary needs. Subsequently,
on September 15, 2011 the U.S. Department of Agriculture’s (USDA) Food and
Nutrition Service (FNS) issued the memorandum CACFP 21-2011-REVISED Child
Nutrition Reauthorization 2010: Nutrition Requirements for Fluid Milk and Fluid Milk
Substitutions in the Child and Adult Care Food Program, Questions and Answers. That
memorandum required that fluid milk served to children two years old and older and
adults be low-fat or fat-free and allowed the substitution of non-dairy beverages that are
nutritionally equivalent to fluid milk for children or adults with special dietary needs.
The Act further amended section 17 of the NSLA to require the USDA to update the
CACFP meal pattern requirements to make them consistent with (a) the most recent
version of the Dietary Guidelines for Americans, (b) the most recent relevant nutrition
science, and (c) appropriate authoritative scientific agency and organization
USDA is an Equal Opportunity Provider, Employer and Lender

Regional Directors
State Directors
Page 2
recommendations. On April 25, 2016 USDA published the final rule “Child and Adult Care
Food Program: Meal Pattern Revisions Related to the Healthy, Hunger-Free Kids Act” (81
FR 24348). This final rule added the fluid milk requirements and allowance of non-dairy
beverages outlined in memorandum CACFP 21-2011-REVISED to the CACFP regulations
under 7 CFR 226.20(a)(1) and 226.20(g)(3), respectively. The final rule also established
additional nutrition requirements and flexibilities for fluid milk served in the CACFP.
This memorandum explains all the nutrition requirements for fluid milk and non-dairy milk
substitutes in the CACFP and provides guidance on implementation. Milk is a critical
component of the CACFP meal patterns because it provides nutrients that are vital for
health and maintenance of the body. These nutrients include calcium, potassium, vitamin
D, and protein. Consuming dairy products, such as milk, is especially important to bone
health during childhood and adolescence when bone mass is built.
I. FLUID MILK
One Year Old Children
Beginning October 1, 2017, one year old children must be served unflavored whole milk (7
CFR 226.20(a)(1)(i)). This is consistent with recommendations from the National Academy
of Medicine. There may be some cases when a one year old child’s physician recommends
low-fat milk if the child’s growth and weight gain is appropriate, or for other medical
reasons. If it is medically and nutritionally appropriate for a one year old child to consume
low-fat milk, or any type of milk other than whole milk, a meal accommodation may be
made by following the substitution requirements outlined in 7 CFR 226.20(g).
Additionally, breastmilk is considered an allowable fluid milk substitute for children of any
age if a mother chooses to breastfeed her child past 1 year of age.
Children Two Years Old and Older and Adults
As stated in the Background section above, milk served to children two years old and older
and adults must be low-fat or fat-free. Whole milk and reduced-fat (2%) milk may not be
served to participants two years of age and older and adults. This has been in effect since
September 15, 2011.
FNS recognizes that switching immediately from whole milk to low-fat or fat-free milk
when a child turns two years old may be challenging. Therefore, FNS is granting a onemonth transition period. This means that meals served to children 24 months to 25 months
old that contain whole milk or reduced-fat milk (2%) may be claimed for reimbursement.
Reimbursable milks for children two years old and older and adults include low-fat or fatfree milk, low-fat or fat-free lactose reduced milk, low-fat or fat-free lactose free milk, lowfat or fat-free buttermilk, or low-fat or fat-free acidified milk (7 CFR 226.20(a)(1)). Milk
must be pasteurized fluid milk that meets State and local standards.

Regional Directors
State Directors
Page 3
Flavored Milk
Flavored milk contains all the major nutrients found in unflavored milk. Flavored milk
(commercially prepared and plain milk that is flavored with syrup or straws) also contains
added sugars and the Dietary Guidelines recommends that all Americans reduce their
consumption of added sugars. To better align with the Dietary Guidelines’ recommendation
and help children develop healthy eating practices early, FNS established new requirements
for flavored milk:


Children 1 through 5 years old: Meals served to children 1 through 5 years old that
contain flavored fluid milk and flavored non-dairy beverages cannot be claimed for
reimbursement.



Children 6 years old and older and adults: If flavored milk is served to children 6
years old and older or adults it must be fat-free. This is consistent with the National
School Lunch and School Breakfast Programs.

CACFP centers and day care homes must comply with these flavored milk requirements no
later than October 1, 2017.
II. FLUID MILK SUBSTITUTES
Non-Dairy Beverages
For children or adults who cannot consume fluid milk due to non-disability medical or
other special dietary needs, non-dairy beverages may be served in place of fluid milk. This
has been in effect since September 15, 2011 and allows the CACFP to better serve the
dietary needs of its participants. Non-dairy beverages must be nutritionally equivalent to
milk and meet the nutritional standards for fortification of calcium, protein, vitamin A,
vitamin D, and other nutrients to levels found in cow’s milk. The nutrient standards for
non-dairy beverages are outlined in the CACFP regulations at 7 CFR 226.20(g)(3). As
stated above, non-dairy beverages served to children 1 through 5 years old must be
unflavored due to the higher sugar content of flavored varieties.
CACFP State agencies have the discretion to identify appropriate substitutions that meet
these requirements. FNS encourages CACFP State agencies to coordinate with the State
agency operating the National School Lunch Program to ensure that the identified locally
available substitutions are consistent among the Child Nutrition Programs.
Parents, guardians, adult participants, or a person on-behalf of the adult participant, must
provide a written request for the non-dairy milk substitution that is nutritionally equivalent
to milk. A medical statement is not required. For example, if a parent has a child who
follows a vegan diet, the parent must submit a written request to the child’s center or day
care home asking that soy milk be served in place of cow’s milk. The written request must
identify the medical or other special dietary need that restricts the diet of the child or adult.
Non-dairy beverage substitutions are served at the option and the expense of the center or
day care home.

Regional Directors
State Directors
Page 4
A medical statement is required for non-dairy substitutions due to a disability that do not
meet the nutritional standards of cow’s milk as described above. Requiring non-dairy
beverages to be nutritionally equivalent to cow’s milk ensures children receive vital
nutrients needed for growth and development. A medical statement for non-dairy beverages
that are not nutritionally equivalent to cow’s milk provides the assurance that the beverage
substitute is meeting the nutritional needs of the child or adult participant. The
requirements related to milk or food substitutions for a participant who has a disability and
who submits a medical statement signed by a licensed physician or a licensed health care
professional who is authorized by State law to write medical prescriptions remain
unchanged.
Yogurt (Adults Only)
Beginning October 1, 2017, yogurt (6 ounces by weight or ¾ cup by volume) may meet the
fluid milk requirement once per day for adults, only (7 CFR 226.20(a)(1)(iv)). State
agencies have the discretion to begin allowing this flexibility prior to October 1, 2017.
Please see memorandum SP 42-2016, CACFP 14-2016 Early Implementation of the Child
and Adult Care Food Program Meal Patterns
(http://www.fns.usda.gov/sites/default/files/cacfp/SP42_CACFP14_2016os_0.pdf) for
more information.
Allowing yogurt to substitute fluid milk once per day for adults offers greater flexibility to
the menu planner and will help encourage consumption of a calcium rich food among adult
participants. Yogurt may not be substituted for fluid milk for children of any age. This is
because milk provides a wealth of nutrients growing children need, such as vitamin A and
D, and comparable quantities of these nutrients are not currently found in commercially
available yogurts.
III. COMPLIANCE
In order to ensure compliance with the milk requirements outlined in 7 CFR 226.20(a)(1)
and this memorandum, centers and day care homes must document the type of milk served
on their menu. This includes listing the fat content (e.g. whole, low-fat or 1%, and fat-free
or skim) and if the milk is flavored. It is the responsibility of the State agency or sponsor,
as applicable, to further ensure that the correct type of milk is being served when
conducting reviews.

Regional Directors
State Directors
Page 5
IV. SUMMARY OF IMPLEMENTATION DATES:
Implementation Date
In Effect

Effective October 1, 2017

Requirement
 Milk served to children two years old and older and
adults must be low-fat or fat-free; and
 Non-dairy beverages that are nutritionally equivalent
to cow’s milk may be served in place of fluid milk for
children or adults with special dietary needs.
 Milk served to one year old children must be
unflavored whole milk;
 Flavored milk, including flavored non-dairy
beverages, cannot be served to children 1 through 5
years old;
 Flavored milk served to children 6 years old and older
and adults must be fat-free; and
 Yogurt may be served in place of fluid milk for adults
once per day, unless the State agency chooses to
implement this flexibility prior to October 1, 2017.

Please see memorandum SP 42-2016, CACFP 14-2016 Early Implementation of the Child
and Adult Care Food Program Meal Patterns
(http://www.fns.usda.gov/sites/default/files/cacfp/SP42_CACFP14_2016os_0.pdf) for
information on implementing the updated meal pattern requirements prior to October 1,
2017. FNS strongly supports implementing the updated meal patterns, including the fluid
milk provisions outlined in this memorandum, as soon as possible because it will greatly
benefit participating children and adults.
State agencies are reminded to distribute this information to Program operators
immediately. Program operators should direct any questions regarding this memorandum to
the appropriate State agency. State agency contact information is available at
http://www.fns.usda.gov/cnd/Contacts/StateDirectory.htm. State agencies should direct
questions to the appropriate FNS Regional Office

Angela Kline
Director
Policy and Program Development Division
Child Nutrition Programs
Attachment

Questions and Answers
I. FLAVORED MILK
1.

Can a center or day care home add chocolate or strawberry syrup to
unflavored milk and serve it to children 1 through 5 years old?
No, adding syrup to unflavored milk adds sugar to the unflavored milk and turns the
beverage into flavored milk. Flavored milk is not allowed as part of a reimbursable
meal for children 1 through 5 years old starting October 1, 2017. Added sugars are
currently consumed in excessive amounts and contribute a substantial portion of
calories consumed by Americans without contributing importantly to the overall
nutritional adequacy of the diet.
Additionally, zero calorie and sugar-free syrups are not allowed to be added to
unflavored milk served to children 1 through 5 years old. Research indicates that
flavor and food preferences are shaped early in life and that the more sweet foods
children consume, the more they prefer sweet foods. It is important to establish in
young children the habit of drinking unflavored milk as taste preferences are
developed at a young age.
Similarly, syrup (including zero calorie and sugar-free syrups) may not be added to
low-fat (1%) milk for children ages 6 years old and older and adults. This is because
when flavored milk is served to children 6 years old and older and adults, it must be
fat-free starting October 1, 2017.

2.

Can a center or day care home start implementing the flavored milk provisions
prior to October 1, 2017?
Yes, centers and day care homes may stop serving flavored milk to children 1
through 5 years old and start serving only fat-free flavored milk to children 6 years
old and older and adults at any time. This is because the flavored milk provisions in
the updated meal patterns are consistent with the current meal pattern requirements.
FNS strongly encourages implementing these flavored milk provisions, and other
provisions under the updated meal patterns that are consistent with the current meal
patterns (e.g. serving whole grains, limiting juice and sugar, prohibiting grain-based
desserts, etc.), as soon as is feasible for the center or home.
Please note, State agencies cannot disallow meals that are not compliant with the
updated meal patterns until the updated meal patterns are implemented on October 1,
2017. See the memorandum SP 42-2016, CACFP 14-2016 Early Implementation of
the Child and Adult Care Food Program Meal Patterns
(http://www.fns.usda.gov/sites/default/files/cacfp/SP42_CACFP14_2016os_0.pdf)
for more information on implementing the updated meal patterns prior to October 1,
2017.
CACFP 17-2016
July 14, 2016
Page 1

II. NON-DAIRY MILK SUBSTITUTIONS
1.

Is a center or day care home required to provide a non-dairy milk
substitute if it is not related to a disability?
No. It is at the center’s or day care home’s discretion to provide a non-dairy milk
substitute if it is not related to a disability. However, FNS strongly encourages
centers and day care homes to make meal modifications to accommodate
participants’ non-disability special dietary needs.

2. Must non-dairy beverages served to children 1 through 5 be unflavored?
Yes, fluid milk and non-dairy beverages that are served to children 1 through
5 years of age must be unflavored starting October 1, 2017.
3. Must non-dairy beverages meet the fat content requirements of fluid
milk?
No. Non-dairy beverages are not required to be low-fat or fat-free when
served to children 2 years old and older and adults. In order for a non-dairy
beverage to meet the nutrient requirements for milk substitutes, they must be
fortified and some fat is needed to help mask the flavor of the nutrient packet
added. Therefore, setting a fat standard for non-dairy beverages would
severely restrict the number of available non-dairy beverage options that are
nutritionally equivalent to cow’s milk. This would consequently limit centers’
and day care homes’ ability to meet the special dietary needs of children or
adults requesting a substitute.
4.

Will centers and day care homes receive additional meal reimbursements
if they provide a non-dairy milk substitution?
No. Modified meals that are due to a disability or non-disability, including meals
with non-dairy milk substitutions, are reimbursed at the same rate as regular meals.
Centers and day care homes cannot require a parent or guardian to pay the
difference between the fluid milk and the non-dairy milk substitute if the non-dairy
milk substitute costs more than the fluid milk.

5.

If a parent provides a creditable non-dairy milk beverage, can the center or
day care home serve it and still receive reimbursement?
Yes. If a parent provides a non-dairy milk beverage that meets the nutritional
standards outlined in 7 CFR 226.20(g)(3), the center or day care home may serve
the non-dairy milk substitute and claim reimbursement for the meal.
CACFP 17-2016
July 14, 2016
Page 2

6.

If a parent or adult participant can request a non-dairy milk substitute
that is equivalent to cow’s milk, can the parent or adult participant also
request that their child or themselves be served whole or reduced-fat
(2%) milk?
No. Milk served to children two years old and older and adult must be low-fat or
fat-free in order to be reimbursable (7 CFR 226.20(a)(1)). Therefore, any request
for higher fat milk must be made through a medical statement, related to a
disability, and prescribed by a licensed physician or a licensed health care
professional in order to be reimbursable.

III.
1.

COMPLIANCE
When submitting menus for review, do centers and day care homes need to
document the type of milk that they serve?
Yes. Starting October 1, 2017, centers and day care homes must document the type
of milk served on their menus. The menu must indicate the fat content of the milk
and if it is flavored. In addition, it is the responsibility of the State or sponsor, as
applicable, to further ensure that the correct type of milk is being served when
conducting reviews.

2.

If one year old and two year old children sit together for the same meal, must
they be served different types of milk?
Yes, starting October 1, 2017 children two years old and older must be served
unflavored low-fat or unflavored fat-free milk and children one year of age must be
served unflavored whole milk. The fluid milk requirements are based on age to
ensure that children are receiving the nutrients they need for growth and
development. Centers and day care homes must ensure that children of various
ages seated together receive the appropriate type of milk.

3.

What if the parent agrees to provide the non-dairy substitute, but brings in
one that does not meet the USDA’s nutritional standards; can the center
or day care home serve it and still receive reimbursement?
Centers and day care homes should inform parents, guardians, and adult participants
about the types of creditable non-dairy milk substitutes. If a non-dairy milk
substitute is served that does not meet the nutritional standards outlined in 7 CFR
226.20(g)(3), then the meal is not reimbursable.

CACFP 17-2016
July 14, 2016
Page 3