Re-introducing dairy to my child - The milk ladder

Many babies/children with a delayed (non IgE mediated) CMPA (cow’s milk protein allergy) will outgrow this type of allergy between the ages of 1 and 3 years. Your Dietitian or doctor will decide when you should try to reintroduce cow’s milk into your child’s diet. This is usually 6 months after elimination of dairy.

Re introduction can be done by using a step by step process, often called the ‘Milk Ladder’. Although most children will outgrow their cow’s milk protein allergy, there is still a chance that your child will react to cow’s milk or foods containing cow’s milk.

What are the steps of the milk ladder?

STEP 1: Biscuits containing milk

(eg) malted milk biscuit, shortcake biscuits.

STEP 2: Baked products

(eg) plain cakes or plain muffins, scones, milk loaf, croissants, brioche

STEP 3: Baked products cooked for less time

(eg) scotch pancakes, cheese powder flavourings e.g. quavers, wot-sits

STEP 4: Foods containing cheese or milk

(eg) cream or cheese - on toast, macaroni cheese, pizza, lasagne, pasta bake, chocolate, shepherd’s pie/mash with butter, milk in sauces, soups or meals/purees containing milk, rice pudding/custards

STEP 5: Less processed milk

(eg) yoghurt, fromage frais, soft cheese, butter

STEP 6: Milk/formula (can be mixed with milk alternatives to taste)

(eg) infant formula or fresh milk

When do I start the milk ladder?

For non-IGE mediated CMPA its best to seek medical advice from your child's dietician or doctor. However, it usually begins:

1. Around 9-12 months of age.

2. When your child has been symptom free for 6 months following a milk-free diet.

3. Your child is very well. (ie eczema under control no gut or stomach problems)

How long is each step?

• When you are confident your child can tolerate the certain food at that stage of milk ladder.

• Your child has consumed the food on multiple occasions.

• You have waited 2-3 days between trying the food again and again incase there is a delayed reaction.

What if they react?

1. Stop giving your child the foods on the current step of the ladder.

2. Don’t stop any milk containing foods your child can tolerate. For example, if your child was on stage 4 of the milk ladder but failed at stage 5, keep giving them up too and stage 4 regularly. This will keep up their tolerance.

3. Check in with your child's dietitian to inform them of the reaction and depending on the severity they will advise when to begin the next stage of the milk ladder again.

Its very normal to feel anxious about beginning the milk ladder and the re-introduction of milk especially if your child previously has had a bad reaction. However, in the long run it can benefit you and your child to understand their tolerance.

In order to put your mind at ease, we recommend booking a 1-1 consultation

with one of our children dietitians who can give you and your child individualised advice.

We also have a CMPA allergy group webinars where other parents are there to discuss problems you may be experiencing which can make you not feel alone.