National School Lunch Program, School Breakfast Program and Child and Adult Care Food Program: Amendments to the Infant Meal Pattern

DEPARTMENT OF AGRICULTURE

Food and Nutrition Service

7 CFR Parts 210, 220 and 226

[RIN 0584-AB81]

National School Lunch Program, School Breakfast Program and Child

and Adult Care Food Program: Amendments to the Infant Meal Pattern

AGENCY: Food and Nutrition Service, USDA.

ACTION: Interim rule with request for comments.

-----------------------------------------------------------------------

SUMMARY: This rule amends the regulations for the National School Lunch

Program, School Breakfast Program and Child and Adult Care Food Program

to eliminate the option of serving whole cow's milk as part of

reimbursable meals for infants under one year of age. Instead, schools

and institutions are required to serve either breast milk or iron-

fortified formula with all reimbursable meals served to those infants.

This rule responds to scientific data demonstrating that infants who

consume cow's milk during their first year receive an inappropriate

level of nutrients and experience more nutrition-related health

problems than children who are fed breast milk or iron-fortified

formula. This rule also amends the definition of ``infant formula''

currently in the Child and Adult Care Food Program regulations to

conform to the definition of ``infant formula'' for the National School

Lunch and School Breakfast Programs, because the latter definition more

accurately describes the role of formula in infants' diet. This rule

further makes technical amendments to the regulations and charts

outlining the Infant Meal Patterns to clarify the role of breast milk

in these programs. Finally, this regulation authorizes reimbursement

for meals containing only breast milk. These amendments support

America's breastfeeding promotion campaign and the Healthy People 2000

goal of increasing the incidence and duration of breastfeeding to at

least 75 percent in the early postpartum period and 50 percent at 5 to

6 months and beyond, by increasing the incentive for day care providers

to encourage breast feeding and will result in children receiving

improved nutrition benefits during their first year of life.

DATES: This rule is effective December 15, 1999. To be assured of

consideration, comments must be postmarked on or before May 15, 2000.

ADDRESSES: Comments should be addressed to Mr. Robert M. Eadie, Chief,

Policy and Program Development Branch, Child Nutrition Division, Food

and Nutrition Service, USDA, 3101 Park Center Drive, Alexandria,

Virginia 22302 or via the Internet at [email protected] All

written submissions will be available for public inspection in Room

1007, 3101 Park Center Drive, Alexandria, Virginia during regular

business hours (8:30 a.m. to 5:00 p.m.), Monday through Friday.

FOR FURTHER INFORMATION CONTACT: Mr. Robert Eadie at the above address

or by telephone at (703) 305-2620.

SUPPLEMENTARY INFORMATION:

Executive Order 12866

This rule has been determined to be significant under Executive

Order 12866 and was reviewed by the Office of Management and Budget.

Public Law 104-4

Title II of the Unfunded Mandates Reform Act of 1995 (UMRA), Public

Law 104-4, establishes requirements for Federal agencies to assess the

effects of their regulatory actions on State, local and tribal

governments and the private sector. Under section 202 of the UMRA, the

Food and Nutrition Service generally prepares a written statement

including a cost-benefit analysis, for proposed and final rules with

``Federal mandates'' that may result in expenditures to State, local or

tribal governments in the aggregate, or to the private sector, of $100

million or more in any one year. When such a statement is needed for a

rule, section 205 of the UMRA generally requires the Food and Nutrition

Service to identify and consider a reasonable number of regulatory

alternatives and adopt the least costly, more cost-effective or least

burdensome alternative that achieves the objectives of the rule.

This interim rule contains no Federal mandates (under regulatory

provisions of Title II of the UMRA) for State, local and tribal

governments or the private sector of $100 million or more in any one

year. Thus, this interim rule is not subject to the requirements of

sections 202 and 205 of the UMRA. However, a Regulatory Cost/Benefit

Assessment is provided in the Appendix to this preamble.

Regulatory Flexibility Act

This rule has been reviewed with regard to the requirements of the

Regulatory Flexibility Act (5 U.S.C. 601-612). The Under Secretary for

Food, Nutrition and Consumer Services has certified that this rule will

not have a significant economic impact on a substantial number of small

entities because the number of infants who would be affected

constitutes a tiny portion of the total participation in these

programs. The principal effect of this rule will be to enhance the

nutritional benefit of meals served to infants under these programs.

Executive Order 12372

The National School Lunch Program, School Breakfast Program and

Child and Adult Care Food Program are listed in the Catalog of Federal

Domestic Assistance under Nos. 10.555, 10.553 and 10.558 respectively,

and are subject to the provisions of Executive Order 12372, which

requires intergovernmental consultation with State and local officials

(7 CFR Part 3015, Subpart V, and final rule-related notice published in

48 FR 29114, June 24, 1983).

Paperwork Reduction Act

This rule contains no new information collection requirements. In

accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. 3507),

the reporting and recordkeeping requirements included in this rule have

been previously approved by the Office of Management and Budget under

clearances 0584-0006, 0584-0012 and 0584-0055.

Executive Order 12988

This rule has been reviewed under Executive Order 12988, Civil

Justice Reform. This rule is intended to have preemptive effect with

respect to any State or local laws, regulations or policies which

conflict with its provisions or which would otherwise impede its full

implementation. This rule is not intended to have retroactive effect

unless so specified in the EFFECTIVE DATE section of this preamble.

Prior to any judicial challenge to the provisions of this rule or the

application of its provisions, all applicable administrative procedures

must be exhausted.

In the National School Lunch Program and School Breakfast Program,

the

[[Page 61771]]

administrative procedures are set forth under the following

regulations: (1) School food authority appeals of State agency findings

as a result of an administrative review must follow State agency

hearing procedures as established pursuant to 7 CFR 210.18(q); (2)

school food authority appeals of Food and Nutrition Service findings as

a result of an administrative review must follow agency hearing

procedures as established pursuant to 7 CFR 210.30(d)(3); and (3) State

agency appeals of State Administrative Expense fund sanctions under 7

CFR 235.11(b) must follow the administrative review process as

established pursuant to 7 CFR 235.11(f).

In the Child and Adult Care Food Program, the administrative

procedures are set forth under the following regulations: (1)

Institutions must follow administrative appeal procedures as

established pursuant to 7 CFR 226.6(k); and (2) State agency or

institution appeals of procurement matters must follow administrative

appeal procedures to the extent required by 7 CFR 226.22 and 7 CFR

3015.

Public Participation

In accordance with the requirements of 5 U.S.C. 553, the Under

Secretary for Food, Nutrition and Consumer Services has determined that

good cause exists for not requiring notice and comment before making

this rule effective. Scientific evidence has demonstrated that infants

should not be served whole cow's milk before their first birthday,

because it does not provide the appropriate level of nutrients needed

by very young children and can be detrimental to their health and

development. Because of the importance of maintaining high standards of

nutrition in the school meal programs and the Child and Adult Care Food

Program, prior notice and comment would be contrary to the public

interest. As specified above, the Department will consider comments

submitted in response to this rulemaking and will address those

comments in future rulemakings.

Background

Sections (9)(a)(1)(A) and 17(g)(1)(A) of the National School Lunch

Act (42 U.S.C. 1758 and 1766) and Section 4(e)(1)(A) of the Child

Nutrition Act of 1966 (42 U.S.C. 1773) require meals claimed for

reimbursement under the National School Lunch Program (NSLP), the Child

and Adult Care Food Program (CACFP) and the School Breakfast Program

(SBP) to meet nutrition requirements established by the Secretary of

Agriculture. Additionally, Section 9(a)(2)(A) of the National School

Lunch Act requires that lunches served under the NSLP offer fluid milk

as a component.

These statutory mandates have been implemented by 7 CFR 210.10 and

210.10a for the NSLP, 7 CFR 220.8 and 220.8a for the SBP and 7 CFR

226.20 for the CACFP, all of which include specific meal component and

quantity requirements for children under one year of age. The principal

component for meals served to these children is either breast milk

provided by the infant's mother (which could include breast milk

produced by a wet nurse) or iron-fortified infant formula. In addition,

while the Department recommends that either breast milk or iron-

fortified formula be served for the entire first year of the child's

life, schools and institutions currently have the option of serving

whole cow's milk to children beginning at eight months of age as long

as the infants consume at least one-third of their calories from a

balanced mixture of cereal, fruits, vegetables and other foods to

ensure that the child receives adequate levels of iron and vitamin C.

The Department originally authorized serving whole cow's milk to

older infants because of a 1983 policy statement by the American

Academy of Pediatrics which indicated that, at that time, there was no

convincing evidence from studies demonstrating that cow's milk is

harmful for children older than six months provided they consume

adequate supplementary foods. Subsequent studies have shown, however,

that consumption of whole cow's milk can be detrimental to the health

of infants between six months and one year of age as well as younger

infants.

Most seriously, consumption of whole cow's milk can lead to iron

deficiency. High levels of calcium and phosphorus and the low level of

vitamin C in whole cow's milk may inhibit an infant's ability to absorb

iron from other foods, including iron-fortified infant cereals.

Moreover, whole cow's milk has been shown to cause microscopic bleeding

and nutritionally significant blood loss from an infant's

gastrointestinal tract during the second six months of life, thereby

promoting the development of iron deficiency anemia. Studies suggest

that iron deficiency in infancy and early childhood may lead to long-

term changes in behavior that may not be reversed later even by taking

iron supplements which correct the iron deficiency anemia. In contrast

to these disadvantages associated with whole cow's milk during the

first year of life, infants who are fed breast milk or iron-fortified

formula for the entire first year of life generally maintain normal

iron status.

In addition to inadequate iron intake, infants who are fed whole

cow's milk receive low levels of linolenic acid (an essential fatty

acid) and vitamin E. On the other hand, they receive excessive levels

of sodium, potassium, chloride and protein, which can place stress on

an infant's kidneys and could be dangerous for infants suffering from

medical conditions associated with dehydration (e.g., diarrhea,

vomiting and fever). When whole cow's milk is fed to infants, their

nutrient intakes are not optimal, and their nutritional status may be

altered, with the most dramatic effect on iron status.

Based on these more recent findings, the American Academy of

Pediatrics issued a policy statement in 1992 which concluded that whole

cow's milk should not be fed to infants at all during the first year of

life. In response to this statement, the Department is amending 7 CFR

210.10(m), 210.10(n), 210.10a(h), 210.10a(j), 220.8(i), 220.8a(b) and

226.20(b) to eliminate cow's milk as an option for meals served to

infants under one year of age and to require, instead, that all

reimbursable infant meals include either breast milk or iron-fortified

formula.

Reimbursement for Breast Milk Meals

This interim rule also amends the Infant Meal Pattern regulations

to emphasize the desirability of feeding breast milk to all infants

under one year of age and to encourage breast milk feeding by

authorizing reimbursement for meals containing only breast milk.

Because of the substantial nutritional benefits of breast milk, the

regulations for the NSLP, SBP and CACFP permit breast milk or iron-

fortified formula for all infant meals served under these programs (7

CFR 210.10(m)(2), 210.10a(h), 220.8(i), 220.8a(b) and 226.20(b),

respectively). Under the current regulations, however, when breast milk

is the only component in an infant's meal, that meal may not be claimed

for reimbursement under the school meal programs or the CACFP. This

provision reflects the overall requirement that meals are not eligible

for reimbursement when all items are provided by the child's family

and, as a result, the provider has incurred no expense in obtaining the

food.

However, the Department is concerned that this restriction on

reimbursement does not reflect the Department's deep commitment to

encouraging consumption of breast milk by infants. ``Healthy People

2000, National Health Promotion and Disease

[[Page 61772]]

Prevention Objectives'' issued by the U.S. Department of Health and

Human Services in goal 2.11 on nutrition and goal 14.9 on maternal and

infant health recommend that America should increase the incidence and

duration of breastfeeding to at least 75 percent in the early

postpartum period and 50 percent at 5 to 6 months and beyond. Also, the

Food and Nutrition Service strategic plan includes breast feeding

promotion as part of Objectives 3.2 and 3.3; and Goal 3.2.1 of the Food

and Nutrition Service Annual Performance Plan provides specific annual

targets for increasing breastfeeding in support of America's overall

objectives.

In other programs, notably the Special Supplemental Nutrition

Program for Women, Infants and Children, the Department has been

actively promoting breastfeeding, and restricting its use under the

NSLP, SBP and CACFP creates an inconsistency that tends to undermine

this position. Therefore, the Department is amending the program

regulations to permit reimbursement for meals served to infants younger

than 8 months that contain only breast milk and no other items. The

Department emphasizes that this provision applies only to meals in

which breast milk is the only required item and is being adopted in

recognition of the special contribution breast milk makes to the

health, well-being and development of the child. This provision does

not apply to those situations in which infant formula is the only

required item and is provided by the parent. Moreover, meals served to

infants 8 months of age and older, which require at least one item in

addition to breast milk, continue to be ineligible for reimbursement

unless the provider also furnishes at least one item.

Minimum Quantity of Breast Milk

The current Program regulations require providers to serve minimum

portions of meal components, including breast milk, in order for the

meal to be reimbursed. The Department is aware, however, that some

infants consume, on average, less than the minimum serving of breast

milk established for their age group. Consequently, if the full portion

of breast milk is offered to an infant who does not consume that much,

some of the breast milk may be wasted. Since breast milk is provided in

very limited quantities, the Department is anxious to conserve as much

as possible of this resource. Therefore, in this interim rule, the

Department is permitting providers to serve less than the minimum

regulatory serving of breast milk to infants who regularly do not

consume that amount of breast milk. However, if the full portion is not

initially offered, the provider must offer additional breast milk if

the infant is still hungry.

The Department emphasizes that this provision is being adopted

solely in recognition of the reduced needs of some infants and the

desire to avoid wasting already limited quantities of breast milk.

Therefore, under no circumstances could providers offer less than the

stipulated minimum serving of infant formula or other components of the

meal pattern.

Technical Clarifications Regarding Service of Breast Milk

The Department is also incorporating a number of technical

amendments to clarify certain issues with regard to breast milk. First,

while the regulations for the NSLP, SBP and CACFP permit breast milk to

be substituted for iron-fortified formula (7 CFR 210.10(m)(2),

210.10a(h), 220.8(i), 220.8a(b) and 226.20(b), respectively), there is

no specific mention of breast milk in the regulatory text that outlines

the infant meal patterns for these programs. Therefore, to ensure that

there is no confusion on this point, the Department is amending the

appropriate regulatory texts outlining the infant meal patterns to

include breast milk as a specific option along with iron-fortified

formula.

Moreover, this rule adds footnotes to the chart in 7 CFR

226.20(b)(4) to clarify that breast milk may be substituted for infant

formula for all meals served to infants and that providers may serve

less than the minimum portion of breast milk to infants. This rule also

adds identical charts to 7 CFR 210.10(m), 210.10a(h), 220.8(i) and

220.8a(b).

Definition of Infant Formula

The Department is also taking this opportunity to make a technical

amendment to the CACFP regulations to conform the definition of

``infant formula'' in that program to the definition in the regulations

for the NSLP and SBP. Currently, infant formula is described in 7 CFR

226.2 as being ``intended for dietary use as a sole source of food.* *

*'' The regulations for the NSLP and SBP, however, define infant

formula as ``intended for dietary use solely as a food * * *.''

The language in the CACFP's definition has been interpreted by some

to mean that infant formula is the only allowed food source. The

definition in the school program regulations avoids this confusion by

specifying that infant formula is to be used only as a source of food

for infants and not as the only source. In the interests of

clarification, therefore, this rule proposes to amend the CACFP

regulations to conform the definition of ``infant formula'' in that

program to the definition in the NSLP and SBP regulations. The

Department emphasizes that this is not a substantive change to the meal

requirements for the CACFP but is a technical amendment to clarify what

has always been the intent of the regulation.

Care and Handling of Breast Milk

Finally, as consumption of breast milk becomes increasingly

prevalent in the NSLP, SBP and CACFP, meal providers must take care to

ensure that breast milk is stored and handled properly to prevent

possible tainting or spread of disease. In particular, all breast milk

given to the provider should have a label stating the child's name, and

providers must make sure that each child receives only the breast milk

supplied by its mother. State agencies should include breast milk

handling techniques as part of their training and technical assistance

activities, and school food authorities and child care sponsors should

take steps to make all meal providers aware of the importance of this

issue.

List of Subjects

7 CFR Part 210

Commodity School Program, Food assistance programs, Grants

programs--education, Grant programs--health, Infants and children,

Nutrition, Reporting and recordkeeping requirements, School breakfast

and lunch programs, Surplus agricultural commodities.

7 CFR Part 220

Food assistance programs, Grant programs--education, Grant

programs--health, Infants and children, Nutrition, Reporting and

recordkeeping requirements, School breakfast and lunch programs.

7 CFR Part 226

Day care, Food assistance programs, Grant programs--health, Infants

and children, Reporting and recordkeeping requirements, Surplus

agricultural commodities.

Accordingly 7 CFR Parts 210, 220 and 226 are amended, as follows:

PART 210--NATIONAL SCHOOL LUNCH PROGRAM

1. The authority citation for part 210 continues to read as

follows:

Authority: 42 U.S.C. 1751-1760, 1779.

2. In Sec. 210.10:

a. Paragraph (l)(1) is amended by revising the fifth sentence.

b. Paragraph (m)(1)(i) is amended by removing the words ``formula

or milk''

[[Page 61773]]

and adding in their place the words ``breast milk or iron-fortified

infant formula''.

c. Paragraph (m)(2) is amended by removing the ninth and tenth

sentences, revising the eleventh sentence, and adding two new sentences

immediately following the eleventh sentence.

d. Paragraphs (m)(2)(i) and (m)(2)(ii)(A) are amended by adding the

words ``breast milk or'' between the words ``of'' and ``iron-fortified

infant formula'' each time they appear.

e. Paragraph (m)(2)(iii)(A) is revised.

f. A new table ``Lunch Pattern for Infants'' is added after

paragraph (m)(2)(iii)(C).

g. Paragraphs (n)(3)(i), (n)(3)(ii) and (n)(3)(iii) are amended by

adding the words ``breast milk or iron-fortified'' between the words

``of'' and ``infant formula''. Paragraph (n)(3)(iii) is further amended

by removing the words ``or whole fluid milk''.

h. Paragraph (n)(3)(iv) is redesignated as paragraph (n)(4), and is

further amended by removing the word ``paragraph'' and adding in its

place the words ``paragraphs (n)(2) and''.

i. The table ``Supplements for Infants'' appearing after the Meal

Supplement Chart for Children in newly redesignated paragraph (n)(4) is

revised.

The revisions and additions specified above read as follows:

Sec. 210.10 Nutrition standards for lunches and menu planning methods.

* * * * *

(l) * * *

(1) * * * All milk served shall be pasteurized fluid types of milk

which meet State and local standards for such milk; except that, in the

meal pattern for infants under 1 year of age, the milk shall be breast

milk or iron-fortified infant formula. * * *

* * * * *

(m) * * *

(2) * * * Either breast milk or iron-fortified infant formula shall

be served for the entire first year. For some breastfed infants who

regularly consume less than the minimum amount of breast milk per

feeding, a serving of less than the minimum amount of breast milk may

be offered. In these situations, additional breast milk must be offered

if the infant is still hungry.* * *

* * * * *

(iii) * * *

(A) 6 to 8 fluid ounces of breast milk or iron-fortified infant

formula;

* * * * *

(C) * * *

Lunch Pattern for Infants

--------------------------------------------------------------------------------------------------------------------------------------------------------

Birth through 3 months 4 through 7 months 8 through 11 months

--------------------------------------------------------------------------------------------------------------------------------------------------------

Lunch............................ 4-6 fl.oz. breast milk 2 3 or formula 4-8 fl.oz. breast milk 2 3 or formula 6-8 fl.oz. breast milk 2 3 or formula

\1\ \1\ \1\; and

...................................... 0-3 Tbsp. Infant cereal 1 4; 2-4 Tbsp. Infant cereal 1; and/or

...................................... 0-3 Tbsp. Fruit and/or vegetable \4\ 1-4 Tbsp. meat, fish, poultry, egg

yolk, cooked dry beans, or peas; or

...................................... ...................................... \1/2\-2 oz. cheese; or

...................................... ...................................... 1-4 Tbsp. cottage cheese, cheese

food, or cheese spread; and

...................................... ...................................... 1-4 Tbsp. fruit and/or vegetable.

--------------------------------------------------------------------------------------------------------------------------------------------------------

\1\ Infant formula and dry infant cereal shall be iron-fortified.

\2\ It is recommended that breast milk be served in place of formula from birth through 11 months.

\3\ For some breastfed infants who regularly consume less than the minimum amount of breast milk per feeding, a serving of less than the minimum amount

of breast milk may be offered, with additional breast milk offered if the infant is still hungry.

\4\ A serving of this component shall be optional.

(n) * * *

(4) * * *

Supplements for Infants

--------------------------------------------------------------------------------------------------------------------------------------------------------

Birth through 3 months 4 through 7 months 8 through 11 months

--------------------------------------------------------------------------------------------------------------------------------------------------------

Supplement (snack)............... 4-6 fl. oz. breast milk 2 3 or formula 4-6 fl. oz. breast milk 2 3 or formula 2-4 fl. oz breast milk 2 3, formula

\1\ \1\ 1, or fruit juice \4\;

...................................... ...................................... 0-\1/2\ bread \5\ or

...................................... ...................................... 0-2 crackers \5\.

--------------------------------------------------------------------------------------------------------------------------------------------------------

\1\ Infant formula shall be iron-fortified.

\2\ It is recommended that breast milk be served in place of formula from birth through 11 months.

\3\ For some breastfed infants who regularly consume less than the minimum amount of breast milk per feeding, a serving of less than the minimum amount

of breast milk may be offered with additional breast milk offered if the infant is still hungry.

\4\ Fruit juice shall be full-strength.

\5\ Bread and bread alternates shall be made from whole-grain or enriched meal or flour. A serving of this component shall be optional.

* * * * *

3. In Sec. 210.10a:

a. Paragraph (a)(1) is amended by removing the words ``formula or

milk'' and adding in their place the words ``breast milk or iron-

fortified infant formula''.

b. Paragraph (d)(1) is amended by revising the third sentence.

c. The introductory text in paragraph (h) is amended by removing

the ninth and tenth sentences, revising the eleventh sentence, and

adding two new sentences immediately following the eleventh sentence.

d. Paragraphs (h)(1), (h)(2)(i) and (h)(3)(i) are amended by adding

the words ``breast milk or'' between the words ``of'' and ``iron-

fortified infant formula''. Paragraph (h)(3)(i) is further amended by

removing the words ``or 6 to 8 fluid ounces of whole milk''.

e. A new table ``Lunch Pattern for Infants'' is added after

paragraph (h)(3)(iii).

f. Paragraphs (j)(3)(i), (j)(3)(ii) and (j)(3)(iii) are amended by

adding the words ``breast milk or iron-fortified'' between the words

``of'' and ``infant formula''. Paragraph (j)(3)(iii) is further amended

by removing the words ``or whole fluid milk''.

[[Page 61774]]

g. The undesignated text after paragraph (j)(3)(iii) is designated

as paragraph (j)(4), and is further amended by removing the word

``paragraph'' and adding in its place the words ``paragraphs (j)(2)

and''.

h. The table ``Supplements for Infants'' appearing after the Meal

Supplement Chart for Children in newly designated paragraph (j)(4) is

revised.

The revisions and additions specified above read as follow:

Sec. 210.10a Lunch components and quantities for the meal pattern.

* * * * *

(d) * * *

(1) * * * All milk served shall be pasteurized fluid types of milk

which meet State and local standards for such milk; except that, in the

meal pattern for infants under 1 year of age, the milk shall be breast

milk or iron-fortified infant formula. * * *

* * * * *

(h) * * * Either breast milk or iron-fortified infant formula shall

be served for the entire first year. For some breastfed infants who

regularly consume less than the minimum amount of breast milk per

feeding, a serving of less than the minimum amount of breast milk may

be offered. In these situations, additional breast milk must be offered

if the infant is still hungry.* * *

* * * * *

(3) * * *

Lunch Pattern for Infants

--------------------------------------------------------------------------------------------------------------------------------------------------------

Birth through 3 months 4 through 7 months 8 through 11 months

--------------------------------------------------------------------------------------------------------------------------------------------------------

Lunch............................ 4-6 fl. oz. formula \1\ or breast milk 4-8 fl. oz. formula \1\ or breast milk 6-8 fl. oz. formula \1\ or breast

2 3 2 3; milk 2 3; and

...................................... 0-3 Tbsp. Infant cereal 1 4; 2-4 Tbsp. infant cereal \1\; and/or

...................................... 0-3 Tbsp. Fruit and/or vegetable \4\ 1-4 Tbsp. meat, fish, poultry, egg

yolk, cooked dry beans, or peas; or

...................................... ...................................... \1/2\-2 oz. cheese;

...................................... ...................................... or 1-4 Tbsp. cottage cheese, cheese

food, or cheese spread; and

...................................... 1-4 Tbsp. fruit and/or vegetable.

--------------------------------------------------------------------------------------------------------------------------------------------------------

\1\ Infant formula and dry infant cereal shall be iron-fortified.

\2\ It is recommended that breast milk be served in place of formula from birth through 11 months.

\3\ For some breastfed infants who regularly consume less than the minimum amount of breast milk per feeding, a serving of less than the minimum amount

of breast milk may be offered, with additional breast milk offered if the infant is still hungry.

\4\ A serving of this component shall be optional.

* * * * *

(j) * * *

(4) * * *

Supplements for Infants

--------------------------------------------------------------------------------------------------------------------------------------------------------

Birth through 3 months 4 through 7 months 8 through 11 months

--------------------------------------------------------------------------------------------------------------------------------------------------------

Supplement (snack)............... 4-6 fl.oz. formula \1\ or breast milk 4-6 fl. oz. formula 1 or breast milk 2 2-4 fl. oz. formula 1, breast milk 2

2, 3 3 3, or fruit juice 4;

0-\1/2\ bread 5 or

0-2 crackers. 5

--------------------------------------------------------------------------------------------------------------------------------------------------------

\1\ Infant formula shall be iron-fortified.

\2\ It is recommended that breast milk be served in place of formula from birth through 11 months.

\3\ For some breastfed infants who regularly consume less than the minimum amount of breast milk per feeding, a serving of less than the minimum amount

of breast milk may be offered, with additional breast milk offered if the infant is still hungry.

\4\ Fruit juice shall be full-strength.

\5\ Bread and bread alternates shall be made from whole-grain or enriched meal or flour. A serving of this component shall be optional.

PART 220--SCHOOL BREAKFAST PROGRAM

1. The authority citation for part 220 continues to read as

follows:

Authority: 42 U.S.C. 1773, 1779, unless otherwise noted.

2. In Sec. 220.2:

a. Paragraph (k) is amended by removing the words ``formula or

milk'' and adding in their place the words ``breast milk or iron-

fortified infant formula''.

b. Paragraph (n) is amended by revising the first sentence to read

as follows.

Sec. 220.2 Definitions.

* * * * *

(n) Milk means pasteurized fluid types of unflavored or flavored

whole milk, lowfat milk, skim milk, or cultured buttermilk which meet

State and local standards for such milk except that, in the meal

pattern for infants (0 to 1 year of age), milk means breast milk or

iron-fortified infant formula. * * *

* * * * *

3. In Sec. 220.8:

a. The introductory text in paragraph (i) is amended by removing

the ninth and tenth sentences, revising the eleventh sentence, and

adding two new sentences immediately following the eleventh sentence.

b. Paragraphs (i)(1), (i)(2) and (i)(3) are amended by adding the

words ``breast milk or'' between the words ``of'' and ``iron-fortified

infant formula''. Paragraph (i)(3) is further amended by removing the

words ``or 6 to 8 fluid ounces of whole milk''.

c. A new table ``Breakfast Pattern for Infants'' is added after

paragraph (i)(3).

The revision and additions specified above read as follow:

Sec. 220.8 Nutrition standards for breakfast and menu planning

alternatives.

* * * * *

(i) * * * Either breast milk or iron-fortified infant formula shall

be served for the entire first year. For some breastfed infants who

regularly consume less than the minimum amount of breast milk per

feeding, a serving of less than the minimum amount of breast milk may

be offered. In these situations,

[[Page 61775]]

additional breast milk must be offered if the infant is still hungry. *

* *

* * * * *

(3) * * *

Breakfast Pattern for Infants

--------------------------------------------------------------------------------------------------------------------------------------------------------

Birth through 3 months 4 through 7 months 8 through 11 months

--------------------------------------------------------------------------------------------------------------------------------------------------------

Breakfast........................ 4-6 fl.oz. formula 1 or breast milk 2 4-8 fl. oz. formula 1 or breast milk 2 6-8 fl. oz. formula 1 or breast milk

3 3; 2 3; and

0-3 Tbsp. Infant cereal 1, 4 2-4 Tbsp. infant cereal 1; and

1-4 Tbsp. fruit and/or vegetable.

--------------------------------------------------------------------------------------------------------------------------------------------------------

\1\ Infant formula and dry infant cereal shall be iron-fortified.

\2\ It is recommended that breast milk be served in place of formula from birth through 11 months.

\3\ For some breastfed infants who regularly consume less than the minimum amount of breast milk per feeding, a serving of less than the minimum amount

of breast milk may be offered, with additional breast milk offered if the infant is still hungry.

\4\ A serving of this component shall be optional.

* * * * *

4. In Sec. 220.8a:

a. The introductory text in paragraph (b) is amended by removing

the ninth and tenth sentences, revising the eleventh sentence, and

adding two new sentences immediately following the eleventh sentence.

b. Paragraphs (b)(1), (b)(2) and (b)(3) are amended by adding the

words ``breast milk or'' between the words ``of'' and ``iron-fortified

infant formula'' . Paragraph (b)(3) is further amended by removing the

words ``or 6 to 8 fluid ounces of whole milk''.

c. A new table ``Breakfast Pattern for Infants'' is added after

paragraph (b)(3).

The additions specified above read as follow:

Sec. 220.8a Breakfast components and quantities for the meal pattern.

* * * * *

(b) * * * Either breast milk or iron-fortified infant formula shall

be served for the entire first year. For some breastfed infants who

regularly consume less than the minimum amount of breast milk per

feeding, a serving of less than the minimum amount of breast milk may

be offered. In these situations, additional breast milk must be offered

if the infant is still hungry. * * *

* * * * *

(3) * * *

Breakfast Pattern for Infants

----------------------------------------------------------------------------------------------------------------

Birth through 3 months 4 through 7 months 8 through 11 months

----------------------------------------------------------------------------------------------------------------

Breakfast........................ 4-6 fl.oz. formula 1 or 4-8 fl. oz. formula 1 or 6-8 fl. oz. formula 1 or

breast milk 2 3. breast milk 2 3;. breast milk 2 3; and

0-3 Tbsp. Infant cereal 2-4 Tbsp. Infant cereal

1 4. 1; and

1-4 Tbsp. Fruit and/or

vegetable.

----------------------------------------------------------------------------------------------------------------

\1\ Infant formula and dry infant cereal shall be iron-fortified.

\2\ It is recommended that breast milk be served in place of formula from birth through 11 months.

\3\ For some breastfed infants who regularly consume less than the minimum amount of breast milk per feeding, a

serving of less than the minimum amount of breast milk may be offered, with additional breast milk offered if

the infant is still hungry.

\4\ A serving of this component shall be optional.

* * * * *

PART 226--CHILD AND ADULT CARE FOOD PROGRAM

1. The authority citation for part 226 continues to read as

follows:

Authority: Secs. 9, 11, 14, 16 and 17, National School Lunch

Act, as amended (42 U.S.C. 1758, 1759a, 1762a, 1765 and 1766).

2. In Sec. 226.2:

a. The definition of Infant cereal is amended by removing the words

``formula or milk'' and adding in their place the words ``breast milk

or iron-fortified infant formula''.

b. The definition of Infant formula is revised.

c. The definition of Milk is amended by revising the first

sentence.

The revisions specified above read as follow:

Sec. 226.2 Definitions

* * * * *

Infant formula means any iron-fortified formula intended for

dietary use solely as a food for normal, healthy infants; excluding

those formulas specifically formulated for infants with inborn errors

of metabolism or digestive or absorptive problems. Infant formula, as

served, must be in liquid state at recommended dilution.

* * * * *

Milk means pasteurized fluid types of unflavored or flavored whole

milk, lowfat milk, skim milk, or cultured buttermilk which meet State

and local standards for such milk, except that, in the meal pattern for

infants (0 to 1 year of age), milk means breast milk or iron-fortified

infant formula. * * *

* * * * *

3. In Sec. 226.20:

a. The introductory text in paragraph (b) is amended by removing

the ninth and tenth sentences, revising the eleventh sentence, and

adding two new sentences immediately following the eleventh sentence.

b. Paragraphs (b)(1), (b)(2), (b)(3)(i) and (b)(3)(ii) are amended

by adding the words ``breast milk or'' between the words ``of'' and

``iron-fortified infant formula'' each time they appear. Paragraphs

(b)(3)(i) and (b)(3)(ii) are further amended by removing the words ``or

6 to 8 fluid ounces whole milk'' each time they appear.

c. Paragraph (b)(3)(iii) is amended by removing the words ``whole

milk'' and adding the words ``breast milk'' in their place.

d. The ``Child Care Infant Meal Pattern'' table in paragraph (b)(4)

is revised.

The revisions and addition specified above read as follow:

[[Page 61776]]

Sec. 226.20 Requirements for meals.

* * * * *

(b) * * * Either breast milk or iron-fortified infant formula shall

be served for the entire first year. For some breastfed infants who

regularly consume less than the minimum amount of breast milk per

feeding, a serving of less than the minimum amount of breast milk may

be offered. In these situations, additional breast milk must be offered

if the infant is still hungry.* * *

* * * * *

(4) * * *

Child Care Infant Meal Pattern

----------------------------------------------------------------------------------------------------------------

Birth through 3 months 4 through 7 months 8 through 11 months

----------------------------------------------------------------------------------------------------------------

Breakfast........................ 4-6 fl. oz. formula \1\ 4-8 fl. oz. formula \1\ 6-8 fl. oz. formula \1\

or breast milk \2\ \3\. or breast milk \2\ \3\;. or breast milk \2\ \3\;

and

0-3 Tbsp. Infant cereal 2-4 Tbsp. Infant cereal

\1\ \4\. \1\,\4\; and

1-4 Tbsp. Fruit and/or

vegetable

Lunch or supper.................. 4-6 fl. oz. formula \1\ 4-8 fl. oz. formula \1\ 6-8 fl. oz. formula \1\

or breast milk \2\, \3\. or breast milk \2\, or breast milk \2\,

\3\;. \3\; and

0-3 Tbsp. Infant cereal 2-4 Tbsp. Infant cereal

\1\, \4\;. \1\; and/or

0-3 Tbsp. Fruit and/or 1-4 Tbsp. Meat, fish,

vegetable \4\. poultry, egg yolk,

cooked dry beans, or

peas; or

\1/2\-2 oz. Cheese; or

1-4 Tbsp. Cottage

cheese, cheese food, or

cheese spread; and

1-4 Tbsp. Fruit and/or

vegetable

Supplement (snack)............... 4-6 fl. oz. formula \1\ 4-6 fl. oz. formula \1\ 2-4 fl. oz. formula \1\,

or breast milk \2\ \3\. or breast milk \2\ \3\. breast milk \2\ \3\, or

fruit juice \5\;

0-\1/2\ bread \4\ \6\ or

0-2 crackers \4\ \6\

----------------------------------------------------------------------------------------------------------------

\1\ Infant formula and dry infant cereal shall be iron-fortified.

\2\ It is recommended that breast milk be served in place of formula from birth through 11 months.

\3\ For some breastfed infants who regularly consume less than the minimum amount of breast milk per feeding, a

serving of less than the minimum amount of breast milk may be offered, with additional breast milk offered if

the infant is still hungry.

\4\ A serving of this component shall be optional.

\5\ Fruit juice shall be full-strength.

\6\ Bread and bread alternates shall be made from whole-grain or enriched meal or flour.

* * * * *

Dated: October 29, 1999.

Shirley R. Watkins,

Under Secretary for Food, Nutrition and Consumer Services.

[FR Doc. 99-29546 Filed 11-12-99; 8:45 am]

BILLING CODE 3410-30-P