Inside: The Milk Ladder & Reintroduction of Dairy for Children.
I am so glad you have found this post in amongst all of the confusing information that is out there. I’ve been where you are right now and I know how you feel. It gets better, I absolutely promise you but if you need to talk it through with someone then please reach out – either in the comments or by messaging me on Instagram.
And if you are at the very beginning of your cow’s milk allergy journey, check out my other posts that will hopefully help you through.
When your child is ready, you can begin to reintroduce dairy into their diet. This process of slowly adding more dairy to their food is known as the Milk Ladder and will take you from zero dairy all the way up to drinking a glass of milk.
But what is the process? When do you start it? What happens if it doesn’t work?
I will answer all of these questions within this post but as I said above, please feel free to ask me anything else that you might think of or if you simply need some reassurance. I am always always happy to help and of course you should speak to your healthcare provider if you need medical assistance.
What is The Milk Ladder?
At some stage in your child’s life, you cut dairy products out of their diet. They may have a severe allergic reaction such as swelling and sickness that made them very unwell. They may have had a milder allergy, one with delayed reactions such as mucous in their poop and a bloated tummy that made them cry out in pain.
Whatever the reaction, it is never nice to see you child in distress and I hope that you were able to get the medical advice and help you needed from an allergy specialist or other health professional.
When you are ready to reintroduce dairy back into your child’s diet (and I’ll talk about when this might be below) then you will need to work through the Milk Ladder. Simply put, it is a series of steps that gradually increases the amount of dairy present in foods given to your child.
If you tried to give your child a glass of cow’s milk after months or years of avoiding it, it would make them react in those very same ways as they did as babies. So, we need to almost trick the body into accepting it by starting off with super small doses – small steps to get to the end.
What age should you start The Milk Ladder?
When I first removed dairy from my children’s diets (I had two with CMPA and one with lactose intolerance) I desperately wanted to know when I could work my way up the ladder. All I wanted was for her to be “normal” and make everything ok again.
Now, our dietician told us to wait until 6 months of age (this was back in 2014 so advice may be different now) and so I had to get used to life with an “allergy baby” in the meantime.
The thing is, a baby only drinks milk in the beginning, so there is just no need to worry about The Milk Ladder at that point. You either give up dairy yourself if they are having breast milk or you give them a specialist infant formula if they are having bottles. It is only when they start to wean onto solids that you start to face any difficulties.
When I say difficulties, I mean having to read food labels, ask for allergy info in restaurants etc… but honestly you just sort of get used to it. You get into the habit of buying oat milk, you know which biscuits to buy, life carries on nicely in the routine you create for yourself.
But, at some point you will want to try and reintroduce dairy. Maybe it will be at 6 months, maybe it will be at 12 months when there is a good chance they have outgrown their allergy, maybe it will be later. It isn’t up to the doctors, it is up to you as their parent. You are the one who gets to decide and that’s ok.
What is The Milk Ladder process?
The idea is to start off with small amounts of heavily processed dairy and work your way up to the purest form – fresh milk. The reason being that it is the cow’s milk protein that causes the immune system to reject and react to milk products, so by using a heavily processed form you break down those proteins and allow the body to adjust to them in their gentlest forms.
Step 1 – Malted milk biscuit
Step 2 – Digestive biscuits
Step 3 – Muffin
Step 4 – Scotch pancake
Step 5 – Shepherd’s Pie
Step 6 – Lasagne
Step 7 – Pizza
Step 8 – Chocolate Buttons
Step 9 – Yoghurt
Step 10 – Cheese (hard cheese such as Cheddar)
Step 11 – Sterilised milk
Step 12 – Pasteurised Milk
Twelve steps may look a lot but actually once you make it past lasagne you are on the home straight. I have to say, my own children never made it past cheese but that was through choice – they cannot stand the taste of milk at all!
If you are feeling a bit overwhelmed, I understand. At this stage it looks like a mountain to climb but you just need to focus on one stage at a time and take it from there. If you want to see how we got on, you can follow my Milk Ladder series here.
I share recipes and more detailed information about each of those early stages where it all feels very precarious and daunting.
How long does the process take?
This is another “everyone is different” answer I am afraid. It is important not to rush through as you risk them reacting unnecessarily. Slow and steady wins the race here and as I said, you will be used to your normal dariy-free diet so need to view this as an added extra until you reach the end.
However, as a rough guide, each stage should take 3 days if you follow the advice of health care professionals. In my own experience, this was indeed the case but I chose to stay longer at each stage because I was worried sick of even a mild allergic reaction happening.
An example would be:
Day 1: 1/4 of a malted biscuit
Day 2: 1/2 of a malted biscuit
Day 3: Whole malted biscuit
I chose to do a few days for each instead of trying to fit it all in 3 days and it worked fine. Go at the rate that works for you.
Once you’ve cleared a stage, you can move onto the next stage straight away. Again, I was extra cautious and would spend a week or so on the final part of the step (whole biscuit as an example) before feeling happy enough to move onto the next food.
What if there is a reaction?
It is such a worry giving your child a food that you know has caused them so much distress in the past. I held my breath at each stage and barely slept for worrying that they’d cry out in pain in the night.
If they do react to one of the stages then do not panic.
– Stop the current stage of the ladder
– go back to the previous step
– Try again in 3 months time
And it goes without saying that in a medical emergency you must contact the emergency services.
Example:
Let’s say you made it to Scotch pancakes no problem and they are now able to enjoy biscuits, muffins and pancakes as part of their diet. You move on to Shepherd’s Pie, which involves making the mashed potato using milk and butter to cream. Unlike the previous steps that were part of the baked milk challenge stages, the rest of the stages simply incorporate dairy into the food.
So, you give them a portion of Shepherd’s Pie and a few hours later they have a tummy ache.
It means that their stomach is not quite ready to progress any further at this stage. That’s ok. They can still carry on with the other foods that they’ve successfully eaten and in 3 months time you can try again. And you can always adjust the recipe to use less dairy for day 1 to ease them in further.
Why 3 months? It takes that long for the gut lining to heal. It may heal in a shorter time than this but always better to allow as long as possible in these cases.
Does The Milk Ladder work?
In my own experiences of using the process I was able to successfully introduce dairy foods back into my children’s diets. As mentioned above, none made it past the cheese stage as they refused to drink milk, however they all happily have cream on their hot chocolate and eat huge amounts of ice cream in the summer. They never suffered with any allergic symptoms and can eat anything they want without worry.
In my opinion, the longer you can leave it the better. Most children outgrow a cow’s milk protein allergy by the age of one year old and their stomach is more able to process foods and successfully complete the Milk Ladder challenge.
For reference, I worked through the challenge when my daughter was 11 months old and then again with my son when he was 3 – purely because I was so used to giving a dairy-free diet that I forgot! Both progressed well and both happily manage dairy now.
If your child has a dairy allergy and you are wondering whether now is the right time to start the challenge then I hope this post has been useful. Any questions, just let me know.
Sara
Thursday 11th of July 2024
Hello! Do you have the recipes you followed for steps 6 and up? I could only find through the Shepard’s pie on your blog!
Katy
Monday 15th of July 2024
Of course: https://www.whatkatysaid.com/our-journey-up-the-milk-ladder-04/ After lasagne you simply switch to shop-bought for the remaining steps. Or if you want to make your own pizza for example then just normal mozzarella on top is fine because at this stage the melting of the cheese is all that is needed. Good luck!