Food allergies affect about four to six percent of children and milk allergies are one of the most common food allergies. Cow’s milk is a nutritious beverage packed full of several important nutrients including protein, calcium, and vitamin D, but for children with an allergy or intolerance to milk, other nutritious, safe beverage options must be considered. The U.S. Department of Agriculture (USDA) requires that milk be offered as part of a balanced meal in the School Breakfast Program and the National School Lunch Program; however, schools have options to provide safe milk substitutes for children who cannot drink milk because of an allergy or intolerance or choose not to drink milk due to personal preference or for religious/cultural reasons.
If a child’s allergy or intolerance to milk is considered a dietary disability, the school must provide a substitute. The appropriate substitute must be identified by the child’s physician and documentation must be on file with the school food service. School food service staff must provide the substitute indicated by the physician. Substitutes may include beverages such as soy, rice, almond or coconut milk, special formulas, or juice.
If a child’s allergy or intolerance to milk is not considered a dietary disability or if the child prefers not to drink cow’s milk, the school has the option to provide a milk substitute but is not required to do so. If the school decides to provide milk substitutions for non-disabilities or personal preference, the substitute must meet specific nutrient requirements for calcium, protein, vitamin A, vitamin D, magnesium, phosphorous, potassium, riboflavin and vitamin B-12. Beverages that meet these nutrient requirements typically include some soy and lactose-free milks. Most juice, water, rice milk, almond milk and coconut milk products do not contain sufficient amounts of the identified nutrients to qualify as substitutes. The appropriate substitute that meets the nutrient requirements must be identified by either the parent or proper medical provider (e.g. physician, physician’s assistant or nurse practitioner) and documentation must be on file with the school food service.
Another option for schools to accommodate students who do not have a dietary disability and students who prefer not to drink milk is to implement offer versus serve, a concept that applies to menu planning and meal service that allows students to decline some of the food items offered as part of the school meal. By implementing offer versus serve, students can choose not to select milk and still receive a reimbursable meal. Additionally, schools are required to offer free potable water during lunch and breakfast service, and therefore all students have access to this healthy beverage.
Best practices for schools:
- Develop a food allergy policy outlining how the school will accommodate students with dietary disabilities, allergies/intolerances that are not considered a dietary disability and personal preferences
- Educate school staff, parents and students on the policy. For example, send a letter home to households outlining the district’s policy and train school staff during district-wide trainings.
- Ensure school staff receives training and/or professional development opportunities on managing food allergies. For example, school staff can attend webinars or take online courses through the Food Allergy and Anaphylaxis Network, the National Food Service Management Institute or the School Nutrition Association.
- Work with staff, parents and students to ensure all students are able to participate in school meal programs
- Implement offer-versus-serve to give students a choice in selecting food items
School meal programs provide students with many healthy food choices. As allergies continue to affect many children, it is important for schools to work with staff, parents and students to ensure all students have access to nutritious, safe meals at school.
For more resources about managing food allergies in schools click here!
Amanda Mercer, MS, RD, Colorado Department of Education, Office of School Nutrition