Written by Registered Dietitian Nishti
This guide is only suitable for children who have, or are growing out of a delayed (non-IgE mediated) allergy to milk, and have been advised by their Doctor or Dietitian that it is safe to start introducing milk at home. This blog post will explain everything you need to know to get started at home. There are also comprehensive videos on our Youtube channel. We have one video explaining what is the milk ladder and another video showing you how to bake your own biscuits for step number 1 of the milk ladder so make sure to check these out.
What is the Milk Ladder?
The Milk Ladder is an evidence-based, step-by-step approach to re-introducing dairy products back into the diet of young children with a confirmed allergy to dairy. It is only suitable in those children who have had a diagnosis of a non-IgE-mediated allergy. This is the delayed type of allergy. It is not safe for anyone at risk of anaphylaxis. Children with severe allergies will need to 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 the hospital.
Before you start:
- Ensure your child is well and that their eczema, asthma, or hay fever is under control.
- Choose a day when you have time to observe your child for at least 2 hours after they have eaten the food.
- Be mindful of not introducing any other food allergens at the same time (such as egg or peanut butter etc.).
What reaction to expect?
The type of delayed reaction varies from child to child and these symptoms can develop between 2 hours or up to 3 days after starting. Here is a list of common reactions seen in children:
- Tummy pain
- Loose stools/constipation
- Worsening of eczema/rash
It is unlikely that your child will suffer from an immediate allergy since you have been advised to start the milk ladder at home. However, for educational purposes, we have listed the symptoms below. These occur within minutes or up to 2 hours of having milk products:
- Red or itchy rash
- Swelling of face, eyes, lips.
- Difficulty breathing
Can I expect the same reaction as before?
Your child may show completely different symptoms to before they went dairy free. Meaning, don’t expect to see the same again when you start them on the milk ladder! Some children may have struggled with loose poo before going dairy free but as they start the milk ladder you may notice that their eczema flares up. Please watch this video on Youtube if you want to know more about this topic.
Milk Ladder – 6 or 12 steps?
The ladder consists of 6 steps (the previous version had 12 steps). Your doctor or dietitian will advice you on which ladder to follow. Don’t worry so much about which milk ladder to use as the most important thing is to just get started 🙂
Step 1, 2 and 3 of the milk ladder have an accompanying recipe. On our Youtube channel, we show you how to bake biscuits for step 1. Click here to watch.
What if my child won’t eat a biscuit?
If your child dislikes the taste or texture of step 1 (biscuit) there are a few alternatives to try:
- Crumble the biscuit into their usual breakfast cereal or yogurt.
- Add some of your child’s usual milk to the biscuit to make a paste and then stir it into the fruit puree.
- Use an alternative to step 1 (malted baby biscotti, shortcake, garibaldi biscuits, supermarkets’ own digestive biscuits, Belvita breakfast biscuits).
How much should I give?
The advice on quantity and amount is different from child to child. Please ask your dietitian or doctor for advice on this and concurrent steps as these must be individualised.
What if they react?
If your little one progressed without problems until they reached a certain stage of the ladder then please do not completely eliminate milk again from their diet. You may continue to keep the previous steps in the diet. For example, if they tolerated steps 1 and 2 without any issues but reacted to step 3 then please continue to keep steps 1 and 2 in their diet. This helps to build on tolerance for the next time you try step 3 again. Please allow 2-4 weeks for symptoms to settle before you start again.
Should I do the milk ladder through my breast milk?
Some parents choose to do the milk ladder themselves. This is an option but it isn’t ideal.
We do not know how much of the milk protein is transferred to your baby and it is therefore more difficult to establish whether they have had a reaction or not. However, if you are nervous and want to start through your own breastmilk then that’s absolutely fine. It may just take longer for you to complete the milk ladder.
Here at Nishti’s Choice we provide expert help and advice to families with an allergy baby. To book a no-obligation chat please visit the booking page.
Fox, A., Brown, T., Walsh, J. et al. An update to the Milk Allergy in Primary Care guideline. Clin Transl Allergy 9, 40 (2019). https://doi.org/10.1186/s13601-019-0281-8
National Institute for Clinical E. Diagnosis and assessment of food allergy in children and young people in primary care and community settings. 2011. http://www.nice.org.uk/CG116
Venter C, Brown T, Shah N, Walsh J, Fox AT. Diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy—a UK primary care practical guide. Clin Transl Allergy. 2013;3(1):23.