Nutrition and Wellness Programs

Kids LunchAccommodating Children with Special Dietary Needs

The United Stated Department of Agriculture’s (USDA’s) nondiscrimination regulation (7 CFR 15d) applies to any site participating in a federally-funded meal program, including the National School Lunch Program (NSLP), School Breakfast Program (SBP), Special Milk Program (SMP), Child and Adult Care Food Program (CACFP), and Summer Food Service Program (SFSP).

If a requested substitution meets the meal pattern requirements under any child nutrition program, the substitution can be made, but is not required.

For a child with a disability

Substitutions must be made to the regular meal, including milk for any child with disabilities (i.e. a life-threatening reaction when exposed to the food and/or beverage) when the following two requirements are met:

  • A licensed physician’s statement is required. Pursuant to Section 27-8.1 of the School Code, the licensed physician that may perform student health examinations is a physician licensed to practice medicine in all of its branches. Schools can provide the Physician’s Statement for Food Substitutions sample form to families for a physician to complete.
  • The statement must include the child’s disability, explanation as to how the disability restricts the child’s diet, the major life activity affected by a disability, and food(s)/beverage(s) to be omitted and foods/beverages to be substituted.

For children with disabilities only requiring modifications in food texture (such as chopped, ground, or pureed), a licensed physician’s written instructions indicating the appropriate texture is recommended, but not required

For a child without a disability

Substitutions may be made to the reimbursable meal for any child who has a food intolerance or allergies that do not rise to the level of a disability when the following two requirements are met:

  • A signed statement from a “medical authority” is required. A medical authority would include licensed physicians, chiropractic physicians, physician assistants, and nurse practitioners. Schools can provide the Physician’s Statement for Food Substitutions sample form to families for a physician to complete.
  • The statement must include the medical or other special dietary reason for the need for substitution, the food(s)/beverage(s) to be omitted, and food(s)/beverage(s) to be substituted. If a non-dairy milk substitute (ie; soy milk) is served, it must meet the nutritional standards of milk as outlined below.

For a child without a disability who is requesting JUST a fluid milk substitution from the meal pattern requirement

Any fluid milk substitution that meets these requirements may be made by the SFA for non-disabled students when the following requirements are met:

  • A signed statement from a medical authority, parent or guardian which includes the medical or other special dietary reason for the need for substitution. Any reasonable request could be accepted (e.g. milk allergy, vegan diet, and religious, cultural or ethical reasons). If a request only states that a child does not like milk, the student can be offered flavored milk instead of a milk substitute.
  • The SFA may choose the nondairy beverage to be provided, as long as the substituted beverage includes the following nutrients:

    Nutrient Per Cup
    Calcium 276 mg
    Protein 8 g
    Vitamin A 500 IU
    Vitamin D 100 IU
    Magnesium 24 mg
    Phosphorus 222 mg
    Potassium 349 mg
    Riboflavin 0.44 mg
    Vitamin B-12 1.1 mcg

    Because the Nutrition Facts Label on food products does not list all the required nutrients listed above, the food service operation must request documentation from the product manufacturer to confirm the presence of all required nutrients at the proper level. NOTE: Lactose-free milk provides the same nutrients found in regular cow’s milk; therefore, it can be served as part of the reimbursable meal without documentation/written statement.
  • Expenses that exceed program reimbursements must be paid by the SFA for fluid milk substitutions.
  • The SFA must inform the State agency of schools that choose to offer fluid milk substitutes for non-disabled students.
  • The substitution request must remain in effect until the request is revoked or the school changes its fluid milk substitution policy for non-disabled students.

Schools can receive reimbursement for meals without milk if they operate Offer versus Serve (OVS), under which milk or other meal component(s) could be declined by a student. If a school does not however operate OVS, a non-disabled child with a medical or special dietary need must take the regular fluid milk or an acceptable milk substitute provided by the school in order for school to claim meal for reimbursement.


Questions regarding school meal or milk accommodations? Contact Nutrition Programs Division at 800/545-7892 or

Questions regarding accommodations within the school beyond the meal programs? Contact Special Education Division at 217/782-5589.