Federal Register, Volume 64 Issue 219 (Monday, November 15, 1999)

[Federal Register Volume 64, Number 219 (Monday, November 15, 1999)]
[Rules and Regulations]
[Pages 61770-61776]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-29546]

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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.

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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.

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