Today I'm sharing a short guide to the milk ladder, based on my own experience and from talking to other CMPA mums online. Our first attempt at the milk ladder was when my daughter was 2, and was unsuccessful. We restarted the milk ladder in May 2017 when my daughter was 3. For a long time, we thought that she was ok with cooked milk. Unfortunately, after a while we discovered that she was getting silent reflux. So we took a break. Now in 2022, aged 8, she can tolerate baked milk, woohoo! Although persuading her to try the next step is a bit more tricky now she is older!
Please note: this post contains general information and does not substitute for healthcare advice. If you are in any doubt about what to do, please speak to a health professional.
What is the milk ladder?
The milk ladder is a step-by-step guide for reintroducing milk to a child's diet if they have been dairy free due to a confirmed allergy. It is suitable for mild to moderate, delayed (non-IgE) cow's milk protein allergy. You can follow the milk ladder if your health professional has advised you it is safe to do this at home.
It is not safe for anyone at risk of anaphylaxis. Children with severe allergies will need repeat allergy testing to find out if they have grown out of their allergies. If tests come back negative for food allergy, your doctor will most likely recommend a food challenge in hospital.
Which milk ladder to follow?
Follow the one your health professional gives you. If in any doubt, follow the 12 step milk ladder as this is the most gradual reintroduction. There are shorter versions available, but they are not suitable for everyone.
When to start
Make sure your child is well when you start - no fevers, colds, rashes or stomach upsets. They should not be taking regular antihistamines as this could mask an allergic reaction. Wait at least 6-12 months from their last allergic reaction to give the best chance of success.
Avoid times when your normal routine is disrupted e.g. starting nursery, potty training or going on holiday. This is partly because stress can make allergic reactions more likely, but also for your own sanity!
When you are first starting, choose a quiet day when you can stay at home and keep an eye on your child. You need to be able to watch them for a signs of reaction. You might like to snuggle on the sofa with a movie or do some special craft activities or baking together.
How long to spend on each step?
This depends on your child. If your child's allergy is very mild you can increase the amount of milk they are eating every three days. You might prefer to spend a week or two on each step. This gives you time to watch for delayed reactions and to see if they react to a build up of cow's milk protein in their bodies.
Try not to make a big deal about each new food you are testing. Keep it low key. It can be confusing for your little one if you make a big fuss about a new food, and then they have a reaction and you have to stop them eating it again. You might prefer not to tell them that they are eating dairy at all until you are confident that they can tolerate it. My little one was well aware of her allergies and when I gave her a new food she would often ask "Am I allowed this?" I would simply tell her, "Yes, you are allowed this biscuit." (or whatever).
How long does it take to complete the milk ladder?
It depends! But it might take longer than you think. In the 12-step ladder, some steps actually have two stages, making 20 stages altogether. If you raced through with no setbacks it could take about two and a half months in total. In reality it will usually take longer because children do get ill, and there will be times when you have other priorities.
Your child might refuse to eat the food the first time you offer it to them, which can also slow things down. It can be helpful to eat dairy-free versions of foods like yogurt, cheese, pancakes, shepherd's pie and so on as part of your normal routine, to make the transition easier. Some children may need to see you eating a new food a few times before they are willing to try it themselves. Don't put pressure on them, just keep offering the food. If they still refuse to eat the food, try an alternative that is at the same step of the ladder. Scroll to the bottom for a free download listing all the alternative foods for each stage!
What if my child has a reaction?
Sometimes it can be difficult to tell if your child has had a reaction or not. If they have very mild symptoms like wind or a slightly upset stomach, carry on for a few days to see whether it settles down. Your child may just need some time to get used to eating cow's milk again. However, you should stop if the symptoms continue or get worse.
If your child has a reaction at the first step, stop altogether and try again in 6-12 months.
If your child has a reaction further up the ladder, go back to the previous step that they were tolerating. Keep giving them foods from this step and all the steps below it regularly (at least 2-3 times a week). Then in 3-6 months time you can try to move up the ladder again.
You might have mixed feelings about starting the milk ladder. It's exciting to think of all the foods they might be able to eat again (or for the first time). But it can also be stressful because of the worry that your child might have a reaction. You may also feel frustrated because it is such a slow process, but don't be tempted to rush ahead. Remember that the milk ladder has been designed to give you the best chance of success by introducing dairy foods gradually.
It is disappointing if they have a reaction at any stage but hopefully it just means they need a bit more time to grow out of their allergy. Focus on the progress you have made, even if it is just to learn more about how they react! We failed our last attempt to move up the milk ladder. Surprisingly, it still felt positive, because my daughter's reaction was so much milder than I had feared. This has taken away a lot of my anxiety about cross contamination and accidental exposure.
Don't rush it, take your time, and good luck!
It's quite common to get 'stuck' on a particular step of the milk ladder for various reasons. Sometimes a child reacts to the next step up the ladder. When this happens, you have to go back to the previous step and stay there for a while until you are ready to try again. Or you may have other things going on like teething, illness, potty training, or starting nursery that mean it's not a good time to move up the ladder right now.
In this situation your child might, quite understandably, get fed up of having to eat the exact same thing every single day. So I've put together this cheat sheet to help you! It will show you all the alternative options (for some stages, there are lots!) to help give you some choices.
It might also come in handy if you have a fussy eater who doesn't want to eat the food suggested in the milk ladder.
Have you started the milk ladder with your child? How are you finding it? Leave a comment below!