Carbohydrate Counting

Table of Contents

Carbohydrate counting might be required for children with dietary needs or chronic health conditions. It is important to review the needs of the individual child carefully, to include all health information provided by the parent and as shared by the school nurse. 

Carbohydrates are nutrients found in foods and are usually measured in grams per serving. Carbohydrates provide the body with glucose, which is converted to energy used to support bodily functions and physical activity.

The school nurse and the education team may meet with the family if there is a request for carbohydrate counting. Sometimes the child’s medical provider or licensed dietitian will want to be involved in the discussion.

Who does carbohydrate counting at school:

  • Sometimes the family will choose to be responsible for figuring out the carbohydrate counts of the meals the family provides to the child during the school day.
  • Sometimes the school nutrition program will calculate the carbohydrates from their standardized recipes, serving sizes, and labels required by the school nutrition program and place the carbohydrate counts next to each item on the menu (not only for the learner but also for the health and awareness of all of the school community).
  • School nutrition program personnel provide the planned menu, labels, and serving sizes of the school meals.
  • Most importantly, children (if developmentally able) can be encouraged to assist in carbohydrate counting to promote independence in managing their health needs.
  • Lastly, the school nurse or delegatee may assist.

Delegation Steps to Carbohydrate Counting:

The instructional steps assist the registered nurse working under the auspices of the school or program in professional judgement and accountability of delegation. Additional steps may be required depending on the learner’s health needs.

  1. Determine how the calculator of carbohydrates per meal will be provided.
  2. Have the student assist with this skill acquisition  (as much as developmentally able)
  3. Determine the number of grams in the food item by the serving size using the label.
  4. If the student was served a different portion than indicated on the label or did not eat the complete serving size, then a calculation for the difference may be needed.
  5. Self-serve items (i.e. salad bars) where students help themselves to fruits, salad condiments, and vegetables can sometimes make it difficult to calculate the carbohydrates eaten. (Check with the delegating school nurse for the best method to address this issue.)
  6. Calculate the total, document the calculated total in the student’s health record, and follow the next steps provided by the school nurse.