CACFP Manual for Emergency Shelters

Emergency shelters participating in CACFP must provide meals that meet meal pattern guidelines to infants enrolled in care.

Infant Feeding

Infants enrolled for care at a participating Child and Adult Care Food Program (CACFP) emergency shelter must be offered a meal that complies with the CACFP infant meal pattern requirements (7 CFR 226.20(b)). Shelters must make reasonable modifications, including substitutions for meals and snacks, for infants with a disability and whose disability restricts their diet (7 CFR 226.20(g)(1)).

Infant Feeding Highlights

• At least one brand of iron-fortified infant formula must be on hand at the shelter. This is considered the “house” formula and must be offered as a choice. The “house” formula should be one that is used by most infants in care.
• Complete a daily Infant Meal Record for each infant and serve them food per the Food Chart for Infants according to age group: birth to 5 months and 6 through 11 months. Infant Meal Records are available on the CACFP webpage [NEEDS LINK] at under Menus. File Infant Meal Records with other monthly records.
• Infants must be recorded on the resident roster, which must be updated daily, and daily meal count records. They must be claimed for reimbursement the same as for older children: three meals or two meals and one snack per infant per day.
• Serve infant meals that meet the minimum requirements by age group listed on the Food Chart for Infants.
• Infants may get hungry at times outside of typical mealtimes. For this reason, it is recommended that infants be fed on demand, which means feeding them when they show signs of being hungry. Infant meals must not be disallowed solely due to the fact that they are not served within the shelter’s established mealtime periods. To learn more about hunger and satiety cues, see the Feeding Infants in the CACFP guide, available at the USDA website.
• Since infants eat on demand when hungry, record each meal if it contains all the required meal components. The meal components do not have to be served as a unit; foods served at different times may be grouped together for a reimbursable meal.
• When infants from birth through 11 months of age are fed in the private family quarters of the shelter residence, and the infant is documented on the resident roster, these infant meals may be claimed for reimbursement. This includes when a mother directly breastfeeds in her room. Mothers are required to tell shelter staff that they fed their infant, and then that infant’s meal can be counted. No other documentation is required. When an infant is in residence during the meal service period, the shelter must offer the infant a meal that meets program requirements.
• Meals containing parent or guardian-provided expressed breastmilk or creditable infant formula served to the infant by the child care provider are eligible for reimbursement, including meals when an infant is only consuming breastmilk or infant formula.
• Shelters may claim reimbursement of meals when a mother directly breastfeeds her infant at the shelter. This includes meals when an infant is only consuming breastmilk.
• When a parent or guardian chooses to provide breastmilk (expressed breastmilk or by directly breastfeeding on site) or creditable infant formula and the infant is consuming solid foods, the shelter must supply all the other required food components for the meal to be reimbursable.
• Introduce solid foods of appropriate texture and consistency when each infant is developmentally ready. The parent or guardian should update the Infant and Toddler Feeding and Care Plan form or the Infant Feeding Preference form as their infant becomes developmentally ready for solid foods.

Creditable Infant Formulas

As part of offering a meal that is compliant with the CACFP infant meal pattern requirements, centers with infants in their care must offer at least one type of iron-fortified infant formula (7 CFR 226.20(b)(2)). The Food and Drug Administration (FDA) defines iron-fortified infant formula as a product “which contains 1 milligram or more of iron in a quantity of product that supplies 100 kilocalories when prepared in accordance with label directions for infant consumption” (21 CFR 107.10(b)(4)(i)). The number of milligrams (mg) of iron per 100 kilocalories (calories) of formula can be found on the Nutrition Facts label of infant formulas.

The following criteria may be used to determine whether a formula is eligible for reimbursement:

1. Ensure the formula is not an FDA-exempt infant formula. An exempt infant formula is labeled for use by infants who have inborn errors of metabolism or low birth weight or who otherwise have unusual medical or dietary problems defined in 21 CFR 107.3. The FDA has a webpage, Exempt Infant Formulas Marketed in the United States By Manufacturer and Category, that provides more information and a list of FDA-exempt infant Formulas.
2. Look for “Infant Formula with Iron” or a similar statement on the front of the formula package. All iron-fortified infant formulas must have this type of statement on the package.
3. Use the Nutrition Facts as a guide to ensure the formula is iron-fortified. The nutritive values of each formula are listed on the product’s Nutrition Facts label. To be considered iron-fortified, an infant formula must have 1 mg of iron or more per 100 calories of formula when prepared in accordance with label directions.

Additionally, to be creditable for reimbursement, infant formula must meet the definition of an infant formula in section 201(z) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321z) and meet the requirements for an infant formula under section 412 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 350a) and the regulations at 21 CFR parts 106 and 107. Requiring an infant formula to comply with the FDA regulatory standards on infant formula is consistent with the Special Supplemental Nutrition Program for Women, Infants, and Children’s (WIC) infant formula requirements. It also ensures that all infant formulas served in the CACFP meet nutrient specifications and safety requirements.

If a formula is purchased outside of the United States, it is likely that the formula is not regulated by the FDA. Infant formula that is imported into the U.S. as a result of the 2022 FDA Infant Formula Enforcement Discretion Policy may be served in the CACFP as detailed in CACFP 01- 2023. Infant formulas that the FDA does not regulate are not creditable in the CACFP.

Formulas classified as Exempt Infant Formulas by the FDA may be served as a part of a reimbursable meal if the substitution is due to a disability and is supported by a medical statement signed by a registered dietitian or a state-licensed healthcare professional, which is defined as an individual authorized to write medical prescriptions under state law. In Missouri, state-licensed healthcare professionals include physicians, physician assistants, and nurse practitioners. Medical statements must be submitted and kept on file in a secure location by the center. For more information on providing meal accommodations for participants with disabilities, see CACFP 14-2017, SFSP 10-2017 Modifications to Accommodate Disabilities in the Child and Adult Care Food Program and Summer Food Service Program.

Parent or Guardian Provided Breastmilk or Formula

An infant’s parent or guardian may, at their discretion, decline the infant formula offered by the shelter and provide expressed breastmilk or a creditable infant formula instead. Meals containing parent or guardian-provided expressed breastmilk or creditable infant formula that are served to the infant by the child care provider are eligible for reimbursement, including meals when an infant is only consuming breastmilk or infant formula. In recognition of the numerous benefits of breastfeeding, including the recommendation of the American Academy of Pediatrics (AAP) and the Dietary Guidelines for Americans (DGAs) to feed infants human milk (breastmilk) exclusively for approximately six months after birth, if possible, and continue to feed infants breastmilk, along with complementary foods through at least the first year of life, and longer if desired, shelters may claim reimbursement of meals when a parent directly breastfeeds their infant at the shelter. This includes meals when an infant is only consuming breastmilk. This added flexibility in the infant meal pattern is consistent with FNS efforts to support and encourage breastfeeding. Therefore, meals when a parent directly breastfeeds their infant on-site are eligible for reimbursement. When a mother directly breastfeeds in the private family quarters, she is required to tell the shelter staff that she fed her infant, and then that infant’s meal can be counted.

While shelters must maintain menus showing what foods an infant is served, there is no Federal requirement to document the delivery method for breastmilk (e.g., if it was served in a bottle or if the parent breastfed on-site). A shelter may simply indicate on the menu that the infant was offered breastmilk. Additionally, shelters do not need to record the amount of breastmilk a parent directly breastfeeds their infant.

When a parent or guardian chooses to provide breastmilk (expressed breastmilk or by directly breastfeeding on-site) or creditable infant formula and the infant is consuming solid foods, the shelter must supply all the other required meal components for the meal to be reimbursable.

Source: CACFP 06-2025 Feeding Infants and Meal Pattern Requirements in the Child and Adult Care Food Program; Questions and Answers (Revised December 2024)

Breastmilk and Formula Food Safety Considerations

Expressed Breastmilk Storage

In the Pediatric Nutrition Handbook, 8th Edition, the American Academy of Pediatrics (AAP) generally recommends storing expressed breastmilk in the refrigerator for up to four days. This recommendation may vary if the breastmilk is to be fed to an infant who is either preterm or ill. For general CACFP purposes, breastmilk may be stored at the shelter in a refrigerator for up to four days from the date the breastmilk was expressed. The previously established standard was 72 hours (or three days) from the time it was expressed. Bottles of expressed breastmilk must be stored in a refrigerator at 40°F (4°C) or below. Previously frozen breastmilk that is thawed and stored in the refrigerator should be used within 24 hours and should never be refrozen. This is consistent with recommendations from the AAP and the Centers for Disease Control and Prevention. Shelters should continue to follow all other breastmilk handling and storage guidelines listed in the Feeding Infants in the CACFP guide. If your local authorities have stricter health and safety regulations for handling and storing food, including breastmilk or formula, follow those stricter regulations.

Formula Food Safety Considerations

The Food and Drug Administration (FDA) strongly advises against homemade formula, stating that recipes are often not safe, do not meet infants’ nutritional needs, and, in some cases, can be life-threatening. Homemade infant formulas are not regulated by the FDA and are not creditable under any circumstances in the CACFP.

When preparing infant formula, only use water from a safe source. If you are not sure if your tap water is safe to use for preparing infant formula, contact your local health department or use bottled water. Use the amount of water and number of powder scoops listed on the instructions on the infant formula label when preparing the formula from powder. Be sure to use the scoop provided by the manufacturer. Always measure the water first and then add the powder. Using more or less water and powdered formula than instructed changes the amount of calories and nutrients in the bottle, which can affect an infant’s growth and development.

Formula that is not prepared correctly cannot be credited towards a reimbursable meal or snack in the CACFP unless the change is due to a disability and is supported by a medical statement signed by a registered dietitian or a state-licensed healthcare professional, which is defined as an individual authorized to write medical prescriptions under state law. In Missouri, state-licensed healthcare professionals include physicians, physician assistants, and nurse practitioners. The statement must be submitted and kept on file in a secure location by the shelter. For more information on providing meal accommodations for participants with disabilities, see CACFP 14-2017, SFSP 10-2017 Modifications to Accommodate Disabilities in the Child and Adult Care Food Program and Summer Food Service Program.

Use prepared infant formula within two hours of preparation. If the prepared infant formula is not being fed within two hours, refrigerate it right away in a refrigerator kept at 40°F (4 °C) or below, keep refrigerated until feeding, and use within 24 hours. Once you start feeding an infant, make sure the infant formula is consumed within one hour. Throw away any leftover formula that is in the bottle.

Do not buy or use infant formula if the container has dents, bulges, pinched tops or bottoms, puffed ends, leaks, rust spots, or has been opened. The formula in these containers may be unsafe. Check the infant formula “use by” date. The “use by” date is the date up to which the manufacturer guarantees the nutrient content and the quality of the formula. After this date, a package or container of infant formula should not be fed to infants. Store unopened containers of infant formula in a cool, dry, indoor place – not in a refrigerator or freezer, or in vehicles, garages, or outdoors.

Facilities should prepare, use, and store infant formula according to the product directions on the container or as directed by the infant’s health care provider. More information on formula handling and storage can be found in the Feeding Infants in the CACFP guide.

Source: CACFP 06-2025 Feeding Infants and Meal Pattern Requirements in the Child and Adult Care Food Program; Questions and Answers (Revised December 2024)

Solid Foods (Complementary Foods)

The Child and Adult Care Food Program (CACFP) infant meal pattern includes two infant age groups: birth through the end of 5 months and the beginning of 6 months through the end of 11 months. These infant age groups are consistent with the infant age groups in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program. In addition, the infant age groups will help delay the introduction of solid foods until around 6 months of age. It is important to delay the introduction of solid foods until around 6 months of age because most infants are typically not developmentally ready to consume solid foods until midway through the first year of life. The Dietary Guidelines for Americans (DGAs) state that human milk (breastmilk) can support an infant’s nutrient needs for about the first 6 months of life, except for Vitamin D and potentially iron. At about age 6 months, infants should be introduced to nutrient-dense, developmentally appropriate foods to complement breastmilk or iron-fortified infant formula. Some infants show developmental signs of readiness before age 6 months, but introducing complementary foods before age 4 months is not recommended. According to the AAP, 6 to 8 months of age is often referred to as a critical window for initiating the introduction of solid foods to infants. In addition, by 7 to 8 months of age, infants should be consuming solid foods from all food groups (vegetables, fruits, grains, protein foods, and dairy).

Solid foods must be served to infants around 6 months of age, as it is developmentally appropriate for each individual infant. Once an infant is developmentally ready to accept solid foods, the shelter is required to offer them to the infant. However, as solid foods are introduced gradually, new foods may be introduced one at a time over the course of a few days, and as an infant’s eating patterns may change. For example, an infant may eat a cracker one week and not the next week. Shelters must follow the eating habits of the infant. Meals should not be disallowed simply because one food was offered one day and not the next, if that is consistent with the infant’s eating habits. In addition, solid foods served to infants must be of a texture and consistency that is appropriate for the age and development of the infant being fed.

There is no single, direct signal to determine when an infant is developmentally ready to accept solid foods. An infant’s readiness depends on their rate of development, and infants develop at different rates. Shelters should be in constant communication with infants’ parents or guardians about when and what solid foods to serve while the infant is in their care. As a best practice, it is recommended that parents or guardians request in writing when a shelter should start serving solid foods to their infant. When talking with parents or guardians about when to serve solid foods to infants in care, the following guidelines from the American Academy of Pediatrics (AAP) can help determine if an infant is developmentally ready to begin eating solid foods:

• The infant is able to sit in a high chair, feeding seat, or infant seat with good head control;
• The infant opens their mouth when food comes their way. The infant may watch others eat, reach for food, and seem eager to be fed;
• The infant can move food from a spoon into their throat; and
• The infant has doubled their birth weight and weighs about 13 pounds or more.

Allowing solid foods to be served when the infant is developmentally ready (around 6 months of age) better accommodates infants’ varying rates of development and allows shelters to work together with the infant’s parents or guardians to determine when solid foods should be served.

Shelters are required to make substitutions to meals for participants when the substitution is due to a disability and is supported by a medical statement signed by a registered dietitian or a state-licensed healthcare professional, which is defined as an individual authorized to write medical prescriptions under state law. In Missouri, state-licensed healthcare professionals include physicians, physician assistants, and nurse practitioners. The statement must be submitted and kept on file in a secure location by the facility. For more information on providing meal accommodations for participants with disabilities, see CACFP 14-2017, SFSP 10-2017 Modifications to Accommodate Disabilities in the Child and Adult Care Food Program and Summer Food Service Program.

Shelters may receive reimbursement for a meal modification request without a medical statement when the accommodation can be made within the program meal pattern. For example, if an infant has an allergy to one fruit or vegetable, the shelter can substitute another fruit or vegetable. Shelters are not obligated to meet requests unrelated to a participant’s disability; however, they are encouraged to meet and consider participants’ dietary preferences when planning and preparing meals and snacks, and use flexibilities whenever possible. Variations must be consistent with the meal pattern requirements. In situations where the facility does not obtain a medical statement, they are encouraged to make note of the actions taken in acknowledging children’s accommodations.

For more information and best practices on serving solid foods to infants, including food safety considerations and for infants with special dietary needs, please see the Feeding Infants in the CACFP guide.

For more information and best practices on serving solid foods to infants with non-disability related dietary requests, please refer to CACFP 14-2017, SFSP 10-2017 Modifications to Accommodate Disabilities in the Child and Adult Care Food Program and Summer Food Service Program.

Vegetables and Fruits

The primary goal of the CACFP meal pattern is to help children establish healthy eating patterns at an early age. Offering a variety of nutrient-dense foods, including vegetables and fruits (cooked, mashed, pureed, or small diced, no larger than ½ inch, as needed to obtain the appropriate texture and consistency), can help promote good nutritional status in infants. Additionally, the AAP recommends infants consume more vegetables and fruits. Vegetables, fruits, or a combination of both are required at breakfast, lunch, and supper meals, as well as snacks for infants that are developmentally ready to accept them (around 6 months of age). However, fruit juice, vegetable juice, or a combination of both juices cannot be served as part of a reimbursable meal for infants of any age under the infant meal pattern.

Grains

Grains are an important part of meals and snacks in the CACFP. To ensure infants get enough grains, the required amounts of grain items are listed in the infant meal pattern as ounce equivalents (oz eq). Ounce equivalents approximate the amount of grain in a portion of food. Iron-fortified infant cereal is the only grain that may count towards a reimbursable breakfast, lunch, or supper in the CACFP infant meal pattern. Serving infant cereal in a bottle is not allowed. Neither the infant cereal nor the breast milk or formula in the bottle may be claimed for reimbursement when infant cereal is added to breast milk or formula in a bottle unless it is supported by a signed medical statement. Facilities may serve bread/bread-like items, crackers, iron-fortified infant cereal, or ready-to-eat cereal as part of a reimbursable snack to infants who are developmentally ready to accept them. The ounce equivalent requirements vary for the different grain items. For more information on crediting grains in ounce equivalents, please see the Feeding Infants Using Ounce Equivalents for Grains in the CACFP worksheet.

As a reminder, all ready-to-eat cereals served to infants must meet the same sugar limit as breakfast cereals served to children and adults in the CACFP. The product-based sugar limits for breakfast cereals have been updated to replace total sugar limits with added sugar limits. By October 1, 2025, breakfast cereals must contain no more than 6 grams of added sugars per dry ounce. Ready-to-eat cereals must also be whole grain-rich, enriched, or fortified to be creditable in the CACFP. For more information on the breakfast cereal sugar limit and creditable grains, please see memorandum CACFP 05-2025, Grain Requirements in the Child and Adult Care Food Program; Questions and Answers, December 19, 2024.

Meats and Meat Alternates

Meats and meat alternates are good sources of protein and provide essential nutrients, such as iron and zinc, for growing infants. Since yogurt is often served to infants as they are developmentally ready, the infant meal pattern allows yogurt, including soy yogurt, as a meat alternate for older infants who are developmentally ready to accept them. The product-based sugar limits for yogurt have been updated to replace total sugar limits with added sugar limits. By October 1, 2025, yogurt must contain no more than 12 grams of added sugars per 6 ounces.

In addition, while cheese food and cheese spread are creditable for children one year and older, the infant meal pattern does not allow cheese food or cheese spread as a creditable meat alternate. This is due to these products’ higher sodium content, and the AAP and DGA recommend that caregivers choose products that are lower in sodium. Natural or processed cheese is creditable, while cheese products are not creditable in the CACFP for infants or any other age group.

Tofu may credit as a meat alternate in the CACFP infant meal pattern. Tofu must be commercially prepared and meet the following definition, established in 7 CFR 226.2: “a soybean-derived food...basic ingredients [in tofu] are whole soybeans, one or more food-grade coagulants (typically a salt or acid), and water.” Noncommercial tofu and soy products are not creditable. The minimum serving amount of tofu for infants 6 through 11 months is 0- 4 tablespoons (¼ cup), or 2.2 oz., containing at least 5 grams of protein. For more information refer to CACFP 02-2024, Crediting Tofu and Soy Products in the School Meals Programs, Child and Adult Care Food Program, and Summer Food Service Program, November 29, 2023.

DHA Enriched Infant Foods

Docosahexaenoic acid, known as DHA, is an omega-3 fatty acid that may be added to infant formulas and infant foods. While more research on the benefits of DHA and ARA (arachidonic acid, an omega-6 fatty acid) is needed, some studies suggest they may have positive effects on visual function and neural development.

Since 2015, infant foods containing DHA have been creditable in the CACFP infant meal pattern. Infant foods containing DHA may be served and claimed as part of a reimbursable meal, as long as they meet all other crediting requirements. Infants with a known DHA allergy should not be served foods containing DHA.

Source: CACFP 06-2025 Feeding Infants and Meal Pattern Requirements in the Child and Adult Care Food Program; Questions and Answers (Revised December 2024)

Feeding Infants in the Child and Adult Care Food Program

Feeding Infants in the Child and Adult Care Food Program (CACFP) guide is a training tool for CACFP operators who have infants enrolled at their child care site. It covers topics such as the infant meal pattern, developmental readiness, hunger and fullness signs, handling and storing breastmilk and infant formula, solid foods, what is creditable in the infant meal pattern, and much more. Find parent communication tools, child care provider handouts, practice scenarios, and check your knowledge questions in this guide as well.

Please note that as of April 2024, this resource is under revision to reflect the current CACFP policies related to breastmilk storage guidelines, ounce equivalents, and crediting soy-based products such as soy yogurt and tofu.

Mealtimes with Toddlers in the Child and Adult Care Food Program

The Mealtimes with Toddlers in the Child and Adult Care Food Program (CACFP) resource assists CACFP operators in meeting meal pattern requirements and creating positive mealtime environments for children 1-2 years.

A separate Mealtimes with Toddlers Family Handout is available at this link for CACFP operators to share information with parents and guardians.

Feeding Infants in the Child and Adult Care Food Program and Mealtimes with Toddlers in the Child and Adult Care Food Program are available in both English and Spanish.