• Special Meals Prescription


    Any child requiring modification to school meals due to a disability must have the Special Meals Prescription below completed by their physician.  A copy should be sent to the Food Service Department and the school nurse. Please see the following frequently asked questions. If you have any additon inquiries about this process, please contact the food service office at 603.464.1160.

    Special Meals Prescription Form

    Q. What is the purpose of the Special Meals Prescriptions Form?

    A. The Special Meals Prescriptions form is a means to ensure children with disabilities have the same opportunities to participate school meals offered through the Child Nutrition Program, as is available to all other children. The form specifies those foods that the child "can?t have, food suggestions for "replace with" and "special food preparations" necessary for a child with disabilities, who has special dietary needs. The Special Meals Prescriptions form allows for accommodations to be made to the Child Nutrition Program meal patterns.

    Q. How does a child qualify for a Special Meals Prescription?

    A. Making accommodations for participation in school meals is required by the federal government for children who meet the guidelines of having a disability as defined in 7 CFR 15b.3(1) (Code of Federal Regulations- Title 7: Agriculture) "a physical or mental handicap which substantially limits one or more major life activities". This provision includes "eating". Determining if child has a disability that restricts his/her ability to consume the meals offered to non-disabled students must be decided by a licensed medical authority.

    Q. Who is a recognized medical authority?

    A. A recognized medical authority is a primary care physician, a specialty care physician or medical personnel working under a licensed medical authority (e.g. nurse practitioner).

    Q. What is the Special Meals Prescriptions form?

    A. The Special Meals Prescriptions form provides a document for the medical authority to define the nature of the child?s disability, the reason why the disability prevents the child from eating regular meals, and the omissions, substitutions, & modifications required for the child to safely and effectively participate in meals offered by the Child Nutrition Program.

    Q. What is considered a special dietary need?

    A. A child is considered to have a special dietary need when his/her disability prevents the child from eating meals prepared for the general population. Special dietary needs can include, but are not limited to: added or reduced calories; thickened liquids; omitting, substituted, and modifying food textures to accommodate a feeding and swallowing disorder; substituting foods due to a life threatening allergy; substituting food for a liquid formula.

    Q. Is this Special Meals Prescriptions a part of my child’s Individual Education Program or 504 Plan?

    A. Yes. If your child requires a Special Meals Prescriptions form to safely access the school lunch program, then it is to be a part of your child?s IEP or 504 Plan.

    Q. What if my child has a medical condition that requires nutrition accommodations but my child does not have an educational disability requiring an IEP?

    A. Children who have a physical disability which does not affect their learning abilities but does prevent them from accessing the same educational opportunities as other children, including safe participation in the Child Nutrition Program, the plan of care should be a 504 Plan (refer to Section 504 of the Rehabilitation Act. Of 1973). Examples of physical disabilities that may require nutrition accommodation include but are not limited to: a food allergy with a life threatening reaction (anaphylactic reaction); metabolic disease (such as diabetes, cystic fibrosis, PKU); muscular Special Meals Prescriptions-FAQ 2 dystrophy; heart disorders; celiac disease, complications from cleft palate, etc. Eligibility for all 504 Education Plans requires medical documentation of the child’s disability. Such medical documentation must be updated annually in order for the 504 plan to be accepted by the local school department and enacted by the school. If you believe your child qualifies for a 504 plan, contact your child’s school administrator or the local school administration office to obtain a parent/guardian information packet.

    Q. What about children with a food allergies or intolerances?

    A. Food allergies such as those which cause a child to have an anaphylactic reaction, and digestive conditions such as celiac disease, qualify as a physical disability and are eligible for accommodations under a 504 plan.

    For non life threatening allergies or intolerances, it is up to the discretion of each institution if and for what conditions they will provide substitutions. Special Meals Prescriptions form must be completed if you want your child?s institution to determine if your child?s allergies or intolerances are aligned with the policy and procedure.

    Institutions are not required to make modifications to meals based upon the food choices or preferences of a family or child.

    Q. What is an "accommodation"?

    A. An "accommodation" includes those necessary food omissions, modifications, and substitutions, that allow the child to participate in meals offered through the Child Nutrition Program.

    a. Can?t Have (Omit) refers to a special food item that needs to be removed from your child?s menu.

    b. Replace With (Substitutions) refers to exchanging a food on the menu determined not safe for another food suggestion of similar nutritional value that is safe for your child.

    c. Special Food Preparation (Modification) refers to taking a food offered on the menu and changing the consistency so that it is safe for your child to eat.

    Q. How are food omission, substitutions, and modifications decided for my child?

    A. For those children determined eligible for food omission, modification and/or substitutions, the special dietary request is documented on a Special Meals Prescriptions form. The medical professional determines the child?s disability status. From the determination come foods that the child "can?t have", foods suggestions to "replace with" and "special food preparations" and/or Safe Eating Plan based upon: The child having nutrition concerns such as the need for increased calories, reduced calories, foods that must be avoided due to food allergy, etc. The child having a feeding and swallowing disorder, such as chewing difficulties, problems with swallowing liquids, etc. For example, the form outlines safe consistencies of food and drink on the Special Meals Prescriptions form and safe methods for presenting food and drink, appropriate positioning, any special feeding equipment, etc. on the Safe Eating Plan section. The child having both nutrition and feeding and swallowing concerns.

    Q. If my child requires special foods not on the menu, how are these paid for?

    A. There will be no additional charge for children with an identified disability who qualify as having a special dietary need that requires omission, substitution, and modification and/or special supplement, Special Meals Prescriptions-FAQ 3

    for those meals and snacks offered through the Child Nutrition Program. Meals must also be provided at a reduced price or free for children who meet the financial guidelines.

    Q. Special Meals Prescriptions Form-

    (Instructions for Use)

    A. To navigate through the form there are 3 types of boxes to fill in.

         A. Gray Text Field: click on the gray text fields, use the tab key, or use the arrow keys to get to needed "gray field". Begin typing necessary information.

         B. Check Boxes: click on the checkboxes or press the spacebar. It will put an "x" in the box selected. To remove the "x", click on the checkbox or use the spacebar a second time.  

         C. Drop-down menu boxes: select one of the fields marked „[choose one]?, click on the arrow in the right side of the box and select an item from the drop-down list.

    Q. After the form is completed and signed by the child’s physician/medical authority, what happens next?

    A. Return the Special Meals Prescriptions form to the special education director for your child?s institution. This information is available through your child?s institutions website or School Administrative Unit (SAU) office. This person is responsible for distributing the signed form to the persons caring for your child at school.

    Q. How often does the form need to be updated?

    A. Just as with Individual Educational Programs (IEPs) and 504 Educational Plans, a Special Meals Prescriptions form need to be updated annually.

    Q. How can I get the Special Meals Prescriptions form?


          a. at your local institution

          b. NH Department of Education Website- http://education.nh.gov/program/nutrition/documents/spec_diet_needs_prescript.pdf

          c. Nutrition, Feeding and Swallowing Program- www.childhealthservices.org

    Q. If I have further questions about special dietary needs, who can I contact to answer these?

    A. Nutrition, Feeding and Swallowing Program offers families of children with special healthcare needs, community-based nutrition and feeding and swallowing services to assist with these concerns. For further information contact the Nutrition, Feeding and Swallowing Program at: 603-606-5453 ext 158. These services do not require financial eligibility and are provided at no "out of pocket" costs to families. In addition, there are some pediatric rehabilitation departments of local hospitals and private practitioners who can provide this technical support.

    Q. Where can I find further information or research regarding special dietary needs for school children?

    A. See attached resource page, also available on the NH Department of Education Website- http://education.nh.gov/program/nutrition/spec_diet.htm