Michelle Staples-Horne, MD, MPH, CCHP; Barbara Wakeen, MA, RDN, CCHP; and Paula Braverman, MD
Providing adequate nutrition to youth in custody can be a challenge. Consider the broad picture of food inequity outside the walls. Many young people come from situations where fast food, food deserts, and strong food preferences—“pickiness”—make it difficult for them to get the nutrition they need. They may be accustomed to determining their own food choices and have limited exposure to healthy options.
In a juvenile detention or confinement setting, the conflict is even stronger. Among many other choices that have been removed from their control, youth who are detained have limited food choices, if any at all. This dynamic frequently creates situations where it is difficult to provide food that is both appropriately nutritious and agreeable to them.
A healthy diet is a balanced diet: adequate nutrients and calories based on age, gender, and activity levels. Youth require more calories, protein, calcium, phosphorus, iron, zinc, folate, and vitamin D than most adults. Assuming a common age of 16 years and an average daily activity level of an hour or less of moderate-intensity exercise, the target goal for youth in correctional facilities is between 2,600 and 3,000 calories a day.
The Vital Role of the RDN
In custodial settings, a registered dietitian nutritionist works with the facility or governing agency food services staff to produce menus that should be both nutritious and relevant to the demographics of the population. The RDN may be on staff or work in a consulting capacity and is a direct liaison to the facility food services department or staff.
RDNs write and approve menus based on many considerations, including population, state standards, accreditation standards, facility policy, contracts, and other guidelines such as the USDA Child Nutrition Programs. Youth should also be surveyed to provide input into creation of the menus.
In building these nutrition programs, it’s critical for RDNs to consider states’ varying definitions of “youth.” Typically, “youth” means younger than 18 years old, but in some states, it can be as young as 16 or as old as 24. Those housed in adult facilities should be served the adult menus augmented with milk and one or two snacks per day.
Honoring Specific Dietary Requirements
Some youth require special diets due to allergies; medical, dental, or behavioral health needs; or religious practices. Diets are ordered by the appropriate health authority — clinician, nurse practitioner, or authorized medical personnel — or religious authority based on governing agency policies. In most settings, diets ordered due to religious practices are approved through the chaplaincy service, planned and/or reviewed by the RDN, and then provided to food services staff for compliance.
Other special dietary needs include soft diets to accommodate dental appliances such as braces; autistic youth who may require food that is more, less, or differently textured; youth on suicide precautions requiring finger foods; and youth who are pregnant requiring more calories and nutrients.
All medical diets are created by the RDN with appropriate preparation by food services staff. Typically, correctional facilities have a standardized medical diet program that encompasses common medical diagnoses. For diet needs outside of the standard diets, the RDN should be contacted for guidance.
Facilities should have a protocol in place for youth reporting food allergies, although sometimes an “allergy” is actually a dislike of that food or a gang restriction to not eat that type of food. If a youth arrives stating a food allergy, the health staff — or health-trained custody staff if no health staff is on duty — should notify food services immediately via phone and written communication so food services can provide a meal avoiding the allergen. Food services should notify the RDN for guidance as needed.
Then, as soon as possible, the parent or guardian should be contacted to verify the food allergy. Many times, the parent or guardian will explain that the youth is not in fact allergic to the food item. This information should be documented in the medical record and the diet order rescinded.
If the parent or guardian does attest to the food allergy, health records may be requested from the young person’s primary care physician or a blood test can be ordered to confirm the patient’s reaction to the food when ingested. If the test is positive and/or correlates with the history, the diet can be continued. This information should be provided to the RDN to create a diet eliminating the food allergen. Once the diet is created, food services staff should prepare the meals as directed, and custody staff should ensure the youth receives and eats only the diet meal prepared.
Incorporating Behavioral Health Care
Further evaluation may be indicated for youth presenting to the facility with restrictive diets unrelated to food availability or culturally sanctioned practices to assess for an eating disorder such as anorexia nervosa or avoidant/restrictive food intake disorder.
Both disorders place youth at risk for significant malnutrition and require close medical monitoring as well as intervention by a behavioral health professional. Unlike anorexia nervosa, which involves purposeful food restriction related to distorted body image and fear of gaining weight, individuals with ARFID do not have a disturbed body image. Rather, ARFID can present with a lack of interest in eating or food avoidance based on sensory issues or concern about potential negative consequences associated with eating such as choking or abdominal pain. There is a strong correlation between ARFID and autism. A 2025 article in the International Journal of Eating Disorders reported significant rates of co-occurrence between autism and ARFID.
Complying With Policy
The Child Nutrition and WIC Reauthorization Act of 2004 requires educational agencies and correctional facilities in the Child Nutrition Program to establish a school wellness policy for all youth.
To meet the requirements, juvenile correctional facilities can offer education or educational materials via classes, handouts, or one-on-one counseling during the time the federally funded after-school snack is provided. Most often, this education is provided by medical or educational staff. It is a golden opportunity to provide health and wellness education that might be new to the audience. Incorporating daily physical activity and/or structured exercise can also offer positive results for some kids at risk.
Taking the Next Bites
There are immediate steps juvenile facilities can take to improve their nutrition programs:
- There should be policy for youth participating in hunger strikes. Close monitoring by all staff is required to accurately monitor and document food and fluid intake.
- Behavioral and medical staff should have clear procedures in place for young people on strike, including counseling and medical monitoring. Youth have the right to refuse food until the refusal becomes life-threatening, requiring medical intervention.
- Most juvenile facilities do not offer commissary or have vending machines available. However, if there is a commissary or vending machines, items should be reviewed and selected for food quality and allergens with input from the RDN.
- Just like at home, food can be a source of comfort and support in appropriate types and amounts. Youth populations can be offered food to celebrate positive behaviors. These treats should be vetted by the RDN for nutritional value. A party with a veggie pizza will be appreciated as much as one with a meat lover’s special.
- Deter well-meaning community organizations that want to bring in food as gifts. The quality, safety, and nutritional content of items from outside is unknown and may be prohibited.
Nutrition plays a critical role in the health and development of youth in custody. With careful planning, professional guidance, and coordinated policies, facilities can ensure that meals support both immediate health needs and long-term well-being.
Michelle Staples-Horne, MD, MPH, CCHP, is medical director with the Georgia Department of Juvenile Justice.
Barbara Wakeen, MA, RDN, CCHP, is a correctional dietitian consultant with Correctional Nutrition Consultants, Ltd.
Paula Braverman, MD, is chief of adolescent medicine at Baystate Medical Center. The authors are members of NCCHC’s Juvenile Health Committee.
Relevant NCCHC Standards
NCCHC Standards for Health Services in Juvenile Detention and Confinement Facilities, 2022
Standard Y-B-01 Healthy Lifestyle Promotion: Health care policies, procedures, and practices emphasize health promotion, wellness, and recovery.
Standard Y-D-05 Medical Diets: Medical diets are provided that enhance patients’ health.
