Nutrition Requirements for Fluid Milk and Substitutions in the CACFP, Questions and Answers

This memorandum details the nutrition requirements for fluid milk and fluid milk substitutes in the Child and Adult Care Food Program (CACFP) and includes a series of frequently asked questions and answers. This memorandum supersedes CACFP 17-2016, Nutrition Requirements for Fluid Milk and Fluid Milk Substitutions in the Child and Adult Care Food Program, Questions and Answers, July 14, 2016. This memorandum also supersedes information previously included in the Food and Consumer Service Instruction Number 783-7 REV. 1, Milk Requirement - Child Nutrition Programs, released January 24, 1995, as this Instruction has since been rescinded.

In addition to the information included in previous memoranda, this memorandum specifically:

• Clarifies who may sign medical statements;
• Provides technical updates on units of measurement for vitamins A and D in fluid milk substitutes;
• Includes a table of the nutrition requirements for fluid milk substitutes;
• Provides information related to temporary and ongoing unavailability of fluid milk;
• Adopts standardized terminology such as “institutions and facilities;” and
• Reorganizes information throughout the memorandum for clarity.

Background

On April 25, 2024, FNS published the final rule, Child Nutrition Programs: Meal Patterns Consistent with the 2020-2025 Dietary Guidelines for Americans (89 FR 31962). While the majority of this final rule focused on gradual updates to the school nutrition requirements, the rule also included a few updates to the CACFP in order to better align child nutrition program requirements. This final rule updated the Vitamin A and Vitamin D units of measurement for fluid milk substitutes from International Units (IUs) to micrograms (mcg). The amount of Vitamin A and Vitamin D required in fluid milk substitutes did not change, only the unit of measurement changed to conform to U.S. Food and Drug Administration (FDA) labeling requirements. The final rule also clarified that both state licensed healthcare professionals and registered dietitians may write medical statements to request meal modifications on behalf of participants with disabilities. Prior to this final rule, only state licensed healthcare professionals were able to make meal modification requests.

Fluid Milk

Fluid milk is a required component for reimbursable meals in the CACFP. Institutions and facilities have the option to serve fluid milk as one of the two components of a snack served in the CACFP; however, the other required meal component must not also be a beverage when fluid milk is served at snack. Fluid milk must be served as a beverage or on cereal, or a combination of both.

Fluid milk must be pasteurized and meet state and local standards. Fluid milk refers to the following varieties of pasteurized or Ultra High Temperature (UHT) milk:

• fat-free (skim) milk;
• low-fat (1%) milk;
• reduced-fat (2%) milk;
• whole milk;
• lactose-free milk;
• lactose-reduced milk;
• cultured milk, such as cultured buttermilk, cultured kefir milk, and cultured acidophilus milk; and
• acidified milk, such as acidified kefir milk and acidified acidophilus milk.

Goat’s milk may be served in place of cow’s milk, provided it meets state and local standards for fluid milk. Age-specific requirements for percent fat content and flavored vs. unflavored apply regardless of type of fluid milk served.

One Year Old Children

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 and the Dietary Guidelines for Americans, 2020-2025. There may be some cases when a one-year-old child’s physician recommends low-fat (1%) 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 (1%) milk, or any type of milk other than whole milk, a meal modification may be made by following the requirements for modifications for disability reasons outlined in 7 CFR 226.20(g)(1). Additionally, breastmilk is considered an allowable fluid milk substitute for children of any age if a parent chooses to breastfeed their child past 1 year of age.

Reimbursable milk for one-year-old children includes breastmilk, whole milk, whole lactose-reduced milk, whole lactose-free milk, whole cultured milk, or whole acidified milk (7 CFR 226.20(a)(1)).

FNS recognizes that switching immediately from breastmilk or iron-fortified formula to whole milk when a child turns one year old may be challenging. Therefore, iron-fortified formula may be served to children between the ages of 12 months and 13 months to help with the transition to whole milk. Breastmilk may be served to a child of any age.

Children Two Years Old and Older and Adults

Fluid milk served to children two–years old and older and adult participants must be low-fat (1%) milk or fat-free (skim) milk. Whole milk and reduced-fat (2%) milk may not be served to participants two years of age and older or adult participants except in the case of a modification for disability reasons as outlined in 7 CFR 226.20(g)(1).

FNS recognizes that switching immediately from whole milk to low-fat (1%) milk or fat-free (skim) milk when a child turns two years old may be challenging. Therefore, unflavored whole milk and reduced-fat (2%) milk may be served to children between the ages of 24 months to 25 months to help with the transition to fat-free (skim) milk or low-fat (1%) milk. Meals served to children 24 months to 25 months old may be reimbursable when they contain breastmilk, whole milk, reduced-fat (2%) milk, low-fat (1%) milk, fat-free (skim) milk, or a combination of these milk types.

Reimbursable milk for children two years old and older and adult participants includes low-fat (1%) milk or fat-free (skim) milk, low-fat or fat-free lactose reduced milk, low-fat or fat-free lactose free milk, low-fat or fat-free buttermilk, or low-fat or fat-free acidified milk (7 CFR 226.20(a)(1)). Breastmilk is considered an allowable fluid milk substitute for children of any age when provided by the parent or guardian.

Fluid Milk Flexibilities for Adult Participants

Institutions and facilities may use the following meal pattern flexibilities as they relate to fluid milk to meet the needs and preferences of their adult day care participants. Flexibilities are optional, not required. For CACFP adult day care participants only:

• A serving of fluid milk is optional for suppers served to adult participants. USDA encourages institutions and facilities to serve water as a beverage for adult participants when fluid milk is not served at supper.
• Once per day, 6 ounces by weight or ¾ cup by volume of yogurt may be served in place of an 8 fluid ounce serving of milk for adult participants only. Yogurt must not be served as a meat alternate in the same meal (7 CFR 226.20(a)(1)(iv)). Yogurt must contain no more than 12 grams of added sugars per 6 ounces. Allowing yogurt to substitute for 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.

Flavored Milk

Flavored milk contains all the nutrients found in unflavored milk. Flavored milk (which includes both commercially prepared flavored milk and plain milk that is flavored with syrup, powders, straws or other flavorings) typically 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, flavored milk may only be served to participants 6 years old and older:

• Children 1 through 5 years old: Flavored fluid milks and flavored non-dairy beverages served to children 1 through 5 years old 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 adult participants it must be low-fat (1%) milk or fat-free (skim) milk. USDA encourages CACFP institutions and facilities to consider choosing milks that are lower in added sugars.

Fluid Milk Substitutes for Non-Disability Reasons

Non-Dairy Beverages (Fluid Milk Substitutes)

For participants who do not consume fluid milk due to non-disability reasons that include, but are not limited to cultural, ethical, Tribal and religious preferences, fluid milk substitutes may be served in place of fluid milk in order to better meet the dietary preferences of participants. Program operators are encouraged but not obligated to meet requests that are not related to a participant’s disability.

Program regulations encourage program operators to meet and consider participants’ dietary preferences when planning and preparing meals and snacks; however, variations must be consistent with the meal pattern requirements outlined at 7 CFR 226.20. Fluid milk substitutes 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. Requiring fluid milk substitutes to be nutritionally equivalent to cow’s milk ensures participants receive vital nutrients needed for growth and development. The nutrient standards for non-dairy beverages are outlined in the CACFP regulations at 7 CFR 226.20(g)(3)(ii) and are detailed in the table below. The nutrition requirements for fluid milk substitutes apply only in non-disability situations.

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 fluid milk substitute that is nutritionally equivalent to milk. A medical statement is not required. For example, if a child follows a vegan diet, the parent or guardian must submit a written request to the child’s center or day care home asking that a fluid milk substitute be served in place of cow’s milk. An institution or facility choosing to offer fluid milk substitutes for a non-disability reason is not required to offer the specific fluid milk substitute(s) requested but may offer an allowable fluid milk substitute(s) of its choice. Additionally, the parent, guardian, adult participant, or a person on behalf of an adult participant may choose to supply one meal component, including a fluid milk substitute that is nutritionally equivalent to cow’s milk; the institution or facility must provide all remaining meal components in order for the meal or snack to be reimbursable.

Fluid Milk Modifications for Disability Reasons

Program operators are required to provide fluid milk substitutions requested due to a disability. To receive reimbursement when a modified meal related to a disability does not meet the meal pattern requirements, a written medical statement signed by a state licensed healthcare professional or registered dietitian must be on file. Therefore, a medical statement is required if the milk substitute requested does not meet the nutritional standards of cow’s milk as described above. The medical statement must provide information about the participant’s dietary restrictions, such as foods or beverages to be omitted and recommended alternatives, if appropriate. Regulations at 7 CFR 226.20(g)(1)(iv) allow a parent, guardian, adult participant, or a person on behalf of an adult participant to supply one or more components of the reimbursable meal for a participant with a disability, as long as the program operator provides at least one required meal component. However, program operators may not require a parent, guardian, adult participant, or a person on behalf of an adult participant to provide any of the required components of a meal.

Unavailability of Fluid Milk

Temporary Unavailability

State agencies may allow institutions and facilities experiencing milk supply shortages to serve meals during an emergency period with an alternate form of fluid milk or without fluid milk as detailed at 7 CFR 226.20(e)(1). Institutions and facilities are expected to meet the fluid milk requirements to the greatest extent possible. Supply chain disruptions, including disruptions that limit milk variety or affect serving size, would be considered a temporary emergency condition for purposes of this flexibility. Because this is an existing regulatory flexibility, a waiver is not required for state agencies to exercise this authority. Additionally, state agencies are reminded that monitoring reviews should accurately account for any waivers or flexibilities that have been provided to program operators.

Continuing Unavailability

When an institution or facility is unable to obtain a supply of fluid milk on a continuing basis, the state agency may approve service of meals without milk, as long as an equivalent amount of canned dry, whole dry, or fat-free dry milk is used in the preparation of the components of the meal (7 CFR 226.20(e)(2)). These flexibilities are not allowable for crediting fluid milk under normal circumstances. Institutions and facilities should work with their state agency when requesting use of this flexibility.

Compliance

In order to ensure compliance with the fluid milk requirements outlined in 7 CFR 226.20(a)(1) and this memorandum, institutions and facilities must document the type of milk served on their menus. Documentation includes listing the fat content (e.g., whole, reduced-fat (2%), low-fat (1%), and fat-free (skim)) and whether the milk is flavored or unflavored. 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.

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 agencies should direct questions to the appropriate FNS regional office.

J. Kevin Maskornick
Director
Community Meals Policy Division
Child Nutrition Programs

Attachment

• Questions and Answers

¹ Fluid milk substitutes served to children 1 through 5 years old must be unflavored.