Inside: A guide to stage 4 of the milk ladder for children and adults with a milk allergy.
You’ve hopefully completed stage 1, stage 2, and stage 3 of the milk ladder already and are now looking at what is needed for stage 4. The same rules apply and so you just need to make sure you have the right food available to get the stage completed.
Stage 4 of the milk ladder involves gently introducing Scotch pancakes over the course of a few days in the hope that there won’t be an allergic reaction. If there is no immediate reaction or delayed reactions to the food each time then the stage is deemed complete.
This post will talk you through everything you need to know to complete the stage based on our own experience with two children with a cow’s milk protein allergy.
If you are dealing with severe allergies then speak to a health professional or the allergy team to make sure it is the right time to begin the process to avoid severe reactions.
What is the milk ladder?
The milk ladder is simply the name given to the process of introducing milk products back into a child’s diet (or indeed an adult where necessary) where they’ve previously avoided them due to a cow’s milk allergy or milk intolerance (lactose intolerance).
Those with an allergy are not able to process the milk proteins and can display a range of symptoms as a result. You can read more about CMPA allergies here if you want to find out more.
The milk ladder gently introduces dairy, starting with a tiny amount of dried milk powder, baked milk in biscuits and cakes, to processed dairy products such as cheese, until eventually drinking fresh milk itself.
An allergy sufferer may never reach the top of the ladder to be able to drink a glass of milk, but they will be able to reach a point of being able to eat a more varied selection of foods – eliminating the need to check every single food label everywhere they go.
Everyone goes at their own pace – there is absolutely no rush – and if a stage is not completed due to a reaction then you can always try again at a later date.
How much should I give?
The process is always the same when introducing new food into a diet. You should give one portion (in this case 1 pancake) on day 1 and then monitor for any reactions. If nothing is observed then you can repeat for day 2 and then again for day 3.
Three days will give you a real indication that the immune system has not rejected the food and initiated a delayed allergy response. So if after three days there is no issues at all, the stage is complete.
What if they fail a step?
It is quite common to reach a step that causes some form of reaction, even if it is a slight upset tummy. It is just the body’s way of saying that it isn’t ready to progress further.
The advice given by medical professionals is to wait 3 months before trying that stage again. But you are absolutely fine to continue giving the foods from the stages already completed.
So let’s say you’ve reached stage 3 without any issues at all but suddenly encounter a reaction at stage 4. Simply continue giving the foods from stages 1 – 3 over the next 3 months and try stage 4 again when you’re ready.
Stage 4 – Scotch pancakes
As with the previous step, if you aren’t dealing with any other food allergies then you can of course buy ready-made scotch pancakes from your local grocery store.
If however, you are dealing with a soya allergy (which often goes hand in hand with cmpa) then you will need to make your own for this step of the ladder.
Here is the recipe for 18 mini scotch pancakes:
Ingredients
120g self-raising flour
pinch of salt
30g caster sugar
1 egg
144ml milk
Method
Sift the flour into a bowl and add in the the salt.
Crack the egg into a separate bowl and add in the milk. Whisk together until the egg is fully mixed into the milk.
Gradually add the wet ingredients into the dry mix, whisking in between additions to avoid any lumps in the mixture.
Heat a pan and pour in a small amount of mixture to make a pancake 5-8cm in size. When the surface of the batter is covered in bubbles it is time to flip the pancake.
Allow to cool and serve.
The next step in your milk ladder journey is to attempt Stage 5 – Shepherd’s Pie. This will introduce heated dairy rather than baked or pan-fried as we’ve had up until now. It is the first stage that truly feels like progress as you’ll be able to enjoy a meal together.
Good luck!