Part 6 — Nutrition

Part 6.1 Requirements for Infants Under One Year

Ontario Regulation 137/15 ss. 42(1)

Intent

Getting enough nutrition and the right kind of nutrition is needed so that children can grow and develop as expected. Child care providers play a very important role in meeting the nutrition needs of children.

What children under one year of age eat/drink, how much they eat/drink and when and how often they eat/drink varies from child to child, so a one-size fits all approach does not work. That is why subsection 42(1) is in place; it is there to make sure that children under one year of age are getting the nutrients they need by requiring that what they are given to eat/drink at the child care centre follow the parent’s instructions.

Clarifying Guidance

Children under one year old must be fed following the written instructions provided by their parents; there are no exceptions to this requirement.

Important information: Unless parents give feeding instructions that are different, children under one year of age who are being given a bottle should be held in a semi-upright position when feeding, their heads should be supported, and an adult should always hold the bottle until a child is able to do so by themselves.

Giving infants bottles when they are lying flat on their back is dangerous because this can cause choking and/or the child can breathe the breast milk/formula into their lungs.

Bottles should never be propped up against something or left in a child’s mouth when they are falling asleep or asleep.

Cross-references:

The regulation prohibits people at the centre from depriving a child of basic needs, including food and drink. The regulation also prohibits the force-feeding (of either solids or liquids) of children. See section 48.

The regulation requires that when parents send any food or drink for the children to the child care centre, the container that holds the food or drink must be labelled with the child’s name. Containers include bottles, sippy cups, formula mix packages, etc. See clause 42(1)b.

The regulation requires child care centres to maintain a children’s record for every child in the centre. For any child under one year of age, their record must include written instructions from a parent about feeding the child and these instructions must be signed by a parent. See paragraph 11 of subsection 72(1).

The regulation has requirements around the posting of menus around the centre. See section 43.

Administrative Penalty

Contravening section 48(1) is very serious. Licensees can be issued an administrative penalty (which is commonly referred to as a fine) of up to $100,000 if there are contraventions of anything in section 48. For more information about administrative penalties. See section 78 and item 3 of Table 2 in section 78. Contravention of/failure to comply with section 48 is an offence under the CCEYA.

Best Practices

It makes the most sense and is easiest when bottles and foods can be stored and heated as needed within the infant room of the centre so that staff do not have to leave the room. If possible, centres should have a fridge and a way to heat up bottles located in the infant room, rather than in a separate kitchen, unless the local medical officer of health says otherwise.

Even though children under one year of age may not eat what older children eat at child care, staff should encourage parents to review the menu of food that older children will be eating. Parents may want to look out for food that is safe for their child under one year of age to consume (for examples, fruit being served to older children can be pureed or cut up into small pieces for a child who is starting to eat solid food).

Compliance Indicators

• Records for all children under one year contain written instructions from a parent of the child with regard to feeding.
• Children under one year are observed to be fed in accordance with the written instructions on file

Or

• Staff confirm that all children under one year are fed in accordance with the written instructions on file.

Part 6.2 Food Labelling

Ontario Regulation 137/15 ss. 42(1)

Intent

Subsection 42(1) is in place so that children eat/drink what is intended for them when food/drink is brought into the centre by parents from home.

Labelling containers for food/drink is very important for several reasons:

• Children with a medical condition may be on a special diet (for example, a child may only be able to eat foods that have a certain consistency)
• Children have allergies to things in food/drink or other intolerances or restrictions related to food/drink
• Children can be part of a family that eats in a way that observes their religion, personal beliefs or personal preferences (for example, kosher food, halal food, vegetarian or vegan)
• Children should never share bottles or sippy cups with other children for health reasons and also because some bottles/sippy cups may be specially designed because the child needs a modification to these items.

Clarifying Guidance

Cross-references

The regulation requires child care centres that operate for six hours or more a day and prepare food on site, they must have a designated space for food preparation. See paragraph 15(3)2 of the regulation.

Licensees must follow any direction provided by the local medical officer of health around anything that has to do with the health and well-being of children in the centre. See subsection 32(1).

The regulation requires that a centre’s anaphylactic policy include rules for parents who send food with their child to the centre. See paragraph 39(1)1.

The rules about food being sent from home must also be included in the centre’s parent handbook. See clause 45(1)(a.1.1).

Best Practices

Licensees may wish to review the requirements of Ontario Regulation 493 (Food Premises) made under the Health Protection and Promotion Act. If a licensee is unsure as to whether or not these rules apply to their centre, they may wish to contact their local medical officer of health. 

Compliance Indicators

• Food or drink supplied by a parent is observed to be in a container labelled with the child's name.

Part 6.3 Nutrition Requirements

Ontario Regulation 137-15 ss. 42(2)

Intent

Subsection 42(2) is in place to make sure that, when children are in a child care centre, they are getting the right kinds of nutrition in the right amounts to facilitate healthy growth and development. Child care providers play a very important role in meeting the nutritional needs of children because they can set up the environment in the centre that encourages and supports good nutrition and eating habits.

Drinking water is important for children, particularly during hot summer months, and water suitable for drinking must be available at all times, including in between snacks and meal times.

Clarifying Guidance

Quick reference

The licensee must provide:

A meal to a child who is:

• Between 12 months – 44 months of age

And

• is at the centre during a meal time (this means broadly breakfast, lunch, dinner)

Snacks

In addition to required meals:

• in addition to supplying and providing required meals, 1 snack must be supplied and provided to children who are older than 1 year of age but younger than 44 months of age if they are in the centre for less than 6 hours
• in addition to offering required meals, if children are there more than 6 hours, two snacks must be offered

Drinking water

Available at all times to all children over one year of age. There are no exceptions.

Helpful information: Licensees may choose to serve hot meals, however it is not a regulatory requirement.

All meals and snacks must meet recommendations in the latest Health Canada food guide.

The foundational resources required for menu planning are:

• Canada's Food Guide
• Eating Well with Canada’s Food Guide – First Nations, Inuit and Métis

It is also important to remember that children's appetites vary from meal to meal and may change over time. Parents should be advised to consult with their child’s doctor if the child has a pattern of refusing to eat.

Proper hydration is important for children, particularly during hot summer months, and water suitable for drinking must be available at all times, including between snacks and meal times.

Licensees must ensure that meals and snacks that are brought from home for children who are 44 months and older are labelled and comply with the centre’s anaphylactic policy.

Exception: Despite the requirements in subsection 42(2), a licensee can agree with a parent to provide special dietary and feeding arrangements for their child. These special arrangements must be provided in writing to the licensee and the licensee must ensure that they are carried out. See section 44 of the regulation.

Cross-references

Any special dietary and feeding arrangements in place for a child must be included in the child’s record. See subclause 72(1)(11)

The regulation prohibits people at the centre from depriving a child of basic needs, including food and drink. The regulation also prohibits the force-feeding (of either solids or liquids) of children. See section 48.

Licensees must follow any direction provided by the local medical officer of health around anything that has to do with the health and well-being of children in the centre See subsection 32(1)

The regulation requires licensees to have an anaphylactic policy which includes, among other things, rules that parents have to follow when sending food into the child care centre from home. See paragraph 39(1)(1).

The regulation requires licensees to maintain a daily written record and note any incidents that affect the health, safety or well-being of children (as well as others). See subsection 37(1)

Administrative Penalty

Contravening section 48(1) is very serious. Licensees can be issued an administrative penalty (which is commonly referred to as a fine) of up to $100,000 if there are contraventions of anything in section 48. For more information about administrative penalties. See section 78 and item 3 of Table 2 in section 78. Contravention of/failure to comply with section 48 is an offence under the CCEYA.

Best Practices

Tips for ensuring proper nutrition

All centres should provide:

• opportunities for children to develop a positive attitude toward a wide variety of foods
• opportunities for children to prepare and serve food
• opportunities to develop and enhance socialization skills, self-regulation, and language skills
• models about hunger cues; for example, staff can model saying things like “I’m hungry” and “I’m full”

Program staff should always be aware of possible choking hazards (foods such as raw fruits and vegetables, hot dogs, grapes, cherry tomatoes, etc.) and take precautions, such as cutting food into smaller pieces, if these items are offered as part of a meal or snack.

Promoting good eating habits

Enjoying food and meal times depends to a great extent on the way food is offered and the behaviour modelled by adults. Staff can have a positive influence on children by:

• providing nutritious food and beverages that incorporate family and cultural preferences
• creating positive eating environments with foods and portion sizes that are responsive to children’s cues of hunger and fullness
• using a bright, attractive, well-ventilated and comfortable room for serving meals
• providing suitable child-sized tables and chairs
• supplying dishes and eating utensils that are attractive, durable and of a suitable size and shape for small hands
• ensuring that dishes and utensils match the children's capabilities so that they can graduate from bowls and spoons to forks and plates
• providing a quiet time just before meals so that the atmosphere can be friendly and relaxed at meal time
• avoiding delays in food services so that the children will not have to sit and wait
• eating with the children whenever possible and eating the same meal as the children
• providing an opportunity for children to leave the table if they become restless before the meal is over (for example, staff can let a child take their plates to the counter and bring their dessert back to the table)
• encouraging children to practice important skills such as feeding themselves
• setting a good example by having a positive approach to trying new foods
• being prepared for spills and calmly cleaning up while telling the children that everything is ok and that accidents sometimes happen
• encouraging interesting conversation and modeling language related to food, drink and eating to support communication development

Snacks

• snacks should be served at least 2 hours before a main meal is scheduled, otherwise children may not be hungry for the main meal. Afternoon snacks should take into consideration that many children may not eat dinner until 6:00 p.m. or later.
• certain foods that are high in sugar or salt content (such as candy, dried fruit, cookies, chips, pretzels and more) are not consistent with Canada’s food guide as they do not have a lot of nutrition and can cause cavities. Licensees should limit serving such foods to children.

For children 44 months and older who bring meals/snacks from home, centres should consider the following:

When a centre has children over 44 months of age bringing in their own lunches and snacks, it is best practice to:

• establish guidelines for the content of bagged lunches and examples of bagged lunches so that parents know that what they are sending from home meets the recommendations in the Canada Food Guide requirements
• program staff should monitor the content of bagged lunches. Staff need to talk to the child’s parents if they have concerns that what is being sent from home is not nutritious
• consider how food/drink from a child’s home will be properly stored so the food is maintained at a safe temperature (for example, need to plan for refrigeration or the use of cold packs)
• have a back-up plan if a child loses or forgets their lunch/snack or if what the child has brought into the centre contravenes the centre’s anaphylactic policy
• consider having extra food or snacks available if a child’s food from lunch is not very nutritious and/or if the child is still hungry because there wasn’t enough food sent from home

Helpful information

The federal government’s Canada's food guide website has helpful information about nutrition. Local public health units may also have resources about nutrition that are tailored for child care centres.

In addition, the Ontario Dietitians in Public Health group has free, publicly available child care resources including guides, tools and online learning modules. These resources were developed with the requirements around food/drink in Ontario Regulation 137/15 in mind.

Compliance Indicators

• Menus show that meals are provided for each meal time that occurs during program hours for children under 44 months of age.

And

• Children one year of age or older but younger than 44 months of age who are present at meal time are provided a meal by the licensee unless special dietary and feeding instructions are on file (see s. 44).
• Children one year of age or older are provided between meal snacks by the licensee unless special dietary and feeding instructions are on file (see s. 44).
• Menus show that at least two snacks are provided when children are in care for six hours or more

And

• Children who are in care for six hours or more are observed to receive at least two snacks

Or

• Staff verbally confirm that children who are in care for six hours or more are provided at least two snacks.
• Drinking water is readily available to the children (for example, water bottles for each child, disposable cups and running water, etc.)

Or

• Children are observed to be given drinking water on request.
• Children are observed to receive a meal or snack that contains a variety of food groups in accordance with Health Canada documents, “Canada’s Food Guide”, “Canada’s Food Guide – First Nations, Inuit and Métis” or “Nutrition for Healthy Term Infants”.

Or

• Staff confirm that children receive a meal or snack that contains a variety of food groups in accordance with Health Canada documents, “Canada’s Food Guide”, “Canada’s Food Guide – First Nations, Inuit and Métis” or “Nutrition for Healthy Term Infants”.

Part 6.4 Menus

Ontario Regulation 137/15 s. 43

Intent

Subsection 43(1) is in place to make sure that parents know what their children are going to be eating at the child care centre so they can plan what to serve and how much food to serve the child at home. Being able to see the menu will also tell the parent whether there is anything on the menu that will trigger a child’s allergy.

If the parent sees something that their child cannot eat, they can send an alternative from home. For these same reasons, substitutions need to be noted on the posted menu.

Subsection 43(2) is in place so licensees can keep track of what foods are being served. Menus must be kept for 30 days so the planning of the current week’s menu can take into account what was served during the previous week; this helps to make sure children are eating a variety of food from week-to-week.

Clarifying guidance

If there is more than one copy of the weekly menu posted throughout the centre (for example, there is one on the parent information board, one in the kitchen and one in each room), food substitutions being made to a menu must be noted on every posted copy of the menu.

Cross-reference: licensees must follow any direction provided by the local medical officer of health around anything that has to do with the health and well-being of children in the centre. See subsection 32(1).

Important information

In some areas of the province, local public health units require a dietitian to review a licensee’s menus before the licensee can go ahead with offering that menu. Licensees and applicants for a licence should check with their local public health unit to see what requirements they have, if any, around reviewing menus.

Helpful information

To make sure children are getting the nutrition they need and are eating a variety of different foods, menu planning must be done carefully.

The federal government’s Canada's food guide website has helpful information about nutrition. Local public health units may also have resources about nutrition that are tailored for child care centres.

In addition, the Ontario Dietitians in Public Health group has free, publicly available child care resources including guides, tools and online learning modules. These resources were developed with the requirements around food/drink in Ontario Regulation 137/15 in mind.

Best practices

Some child care centres may want to use a set menu rotation, with standard posted menus that remain the same month to month. These menus may include general categories of food (seasonal fruit or pasta) instead of specific food choices (apples and pears or vegetarian lasagna).

It is best practice to note specific food choices on the posted menu as soon as possible so that parents can plan accordingly, particularly if a child is allergic to a specific item or ingredient and a parent will be providing an alternative.

Licensees can note menu substitutions and specific food choices on standard posted menus using post-it notes, dry erase markers or anything else that will not leave a permanent note of the menu. However, licensees need to make sure that they have a version or copy of the menu with all of the substitutions noted because the menus that must be kept for 30 days per subsection 43(2) must contain the substitutions that were made. One way to make sure that there is a record of every week’s menu, including substitutions, is to take a photo of the posted menu before it is taken down off the wall.

Compliance Indicators

• Planned menus for the current and following week are posted in a conspicuous place accessible to parents

And

• Any substitutions are noted on the menus posted for parents' reference at time of substitution

And

• Meals and snacks correspond with the posted menu, including any posted substitutions

Or

• The staff responsible for serving food to the children confirm that menus accurately reflect food served to children
• Menus that were posted for parents' reference, including any substitutions, are kept on file for a minimum of 30 days.

Part 6.5 Allergies and Food Restrictions

Ontario Regulation 137/15 ss. 43(3)

Intent

Subsection 43(3) is in place to protect children’s health and well-being; everyone who interacts with and/or prepares food for children needs to know about any allergies and what causes the allergies so these things can be avoided.

What children eat/drink may be limited for reasons other than allergies. To respect these restrictions and ensure children do not accidentally eat/drink something they are not supposed to, food restriction lists are also required and must be posted in certain areas of the centre.

Clarifying guidance

Things that trigger an allergic reaction are called allergens. Children can be allergic to things other than food such as a bee sting or latex, which may be serious or life-threatening in the case of anaphylactic allergies. This is why allergy lists need to be posted in areas other than kitchens and dining areas.

All allergies, including allergies to food, medication and other substances that can cause an allergic reaction must be included on the allergy list.

Food restrictions can refer to:

• food intolerances (for example, a child may not be allergic to a food but has a hard time digesting it)
• family dietary choices (such as a vegetarian diet)
• diet that are followed because of religious observance (for example, some families only eat foods that are kosher or halal)
• a combination of these things

Information about allergies and food restrictions must also be posted in the areas in the centre where food is made and where food is eaten, in all play areas or play rooms, and available and accessible in any other area in which children may be present (for example, in the gymnasium, library and more) to ensure that children receive the correct meals and snacks.

The information included on required allergy lists that are posted throughout the centre must match the information contained in an individualized plan for children with an anaphylactic allergy or the child’s individualized plan for a child with medical needs (where the allergy is not anaphylactic).

Lists of children’s allergies and food restrictions must be kept up-to-date and reflect the most current information available.

Important information

• allergy lists posted throughout a centre must include all of the names of all of the children with allergies or food restrictions in the entire centre/program because there are times when children may be moving in and out of different rooms for short periods of time.
• licensees must meet the requirements in subsection 43(3) even if their menus already make a note or address an allergy a child has. For example, the posted menu always says “this is a peanut-free centre”. The licensee must still have the name of the child with the peanut allergy who attends the program listed on the allergy/food restriction list required under subsection 43(3).

Example

XYZ Child Care Centre has a toddler group, a preschool group and a kindergarten group. Marco in the preschool room eats a vegetarian diet and three other children in the centre have allergies: Noah in the toddler room, Amira in the preschool room, and Sophia in the kindergarten room.

The allergy and food restriction list posted in each of the three rooms (“play area” or “play room”) and the other locations required by clauses 43(3)(a) and 43(3)(c) needs to list all 4 children’s names and what their allergies and/or food restrictions are. In this centre, the allergy list (using the template on CCLS) would look like:

Table summarizing children’s allergies and food restrictions. The table is organized in columns that include the program room, the child’s name, type of allergy, specific allergens and food restrictions.

Cross-references:

The regulation has a set of requirements to address anaphylactic allergies. See section 39.

The regulation has requirements around children’s records, including a requirement that a child’s record includes any individualized plan required under the regulation, such as those for children with anaphylactic allergies. See paragraph 72(1)(9.1)

The regulation has requirements around licensees maintaining a daily written record that includes a summary of any incident affecting the health, safety or well-being of a child. Any symptoms in a child that look like a possible allergic reaction need to be noted in the daily written record. See section 37.

Best practices

Licensees should:

• remind parents to provide them with updates on their child’s allergies and restrictions
• let parents know as soon as possible if it looks like a child had an allergic reaction to something that the child is unknown to be allergic

Compliance Indicators

• Where applicable, a list is posted in each cooking and serving area that includes the following:
  • name of each child receiving child care in the child care centre with allergies and their respective allergens
  • name of each child receiving child care in the child care centre with food restrictions and their respective restrictions.

• Where applicable, a list is posted in each play area or play room that includes the following:
  • name of each child receiving child care in the child care centre with allergies and their respective allergens
  • Name of each child receiving child care in the child care centre with food restrictions and their respective restrictions.

• Where applicable, a list is available and accessible in any other area in which children may be present (for example, playground, gym, etc.) that includes the following:
  • name of each child receiving child care in the child care centre with allergies and their respective allergens
  • name of each child receiving child care in the child care centre with food restrictions and their respective restrictions.

Part 6.6 Special Dietary and Feeding Arrangements

Ontario Regulation 137/15 ss. 44

Intent

Section 44 is in place to acknowledge that the requirements for nutrition in other parts of the regulation may not be appropriate for some children, including those with medical or special needs.

Clarifying guidance

Parents of a child who has a special dietary and feeding arrangement must provide written instructions about how the child needs to be fed and/or what they can/cannot eat and drink.

Important information: When children who are 44 months or older bring in a snack or a meal (such as a brown bag lunch) this is not a considered a “special dietary and feeding arrangement” because it is the default for all children this age.

Best practices

Where a child requires special foods and/or feeding arrangements at meal times and/or snack times, it is important that the expectations and responsibilities of both the licensee and the parent are clearly explained in writing.

Tips for developing special dietary and feeding arrangements

When asking parents for the written instructions for the child’s special dietary and feeding arrangements, licensees should ask the parents to include the following information:

• what food and drinks the parent will provide: for some children, it may only be the main meal being sent from home so the child will eat the snacks that other children are eating. Anytime a parent does not plan to bring all meals, snacks and drinks, the instructions need to note this
• if the arrangement results in the child eating different food and/or at different times than other children, how to make sure the child can still participate in meal times and snack time (if safe to do so) with other children so the child with the arrangement feels included
• what the child can or cannot eat or drink at special activities/events that serve food (for example, cake served as part of a birthday celebration)
• what happens when children are on a field trip and there is no refrigeration available or nowhere to safely prepare food
• what should happen if the child is still hungry after eating a meal from home and,
• what would be the back-up plan if food/drink from home was forgotten or lost.

Licensees may also want to ask parents for an ingredient list of food/drink being brought in from home to check to see if an ingredient could trigger an allergic reaction in another child in the centre.

If the parents need to change the written instructions, they need to let the child care centre know right away.

Licensees should consider having policies that require the parent-provided lunch to meet the nutritional requirements set out in the Canada’s Food Guides as well as the licensee’s anaphylactic policy.

Licensees must ensure that meals and snacks that are brought from home for children who are 44 months and older are labelled and comply with the centre’s anaphylactic policy.

Cross-references:

The regulation requires licensees to make sure that food or drink being sent to the centre from home is labelled. See subparagraph 42(1)(b).

Any special dietary and feeding arrangements in place for a child must be included in the child’s record. See subclause 72(1)(11).

The regulation requires licensees to have an anaphylactic policy which includes, amongst other things, rules that parents have to follow when sending food into the child care centre from home. See subparagraph 39(1)(1).

Compliance Indicators

• For each child identified as having special feeding or dietary arrangements, written instructions from a parent of the child are kept in the child's records.

And

• The child is observed to be fed according to the written instructions.

Or

• Staff confirm that written instructions are followed.