[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.

* * * * *
    (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