How to use a milk ladder
Expert advice on how to safely test re-introducing milk to your child's diet
Tips on introducing (re-introducing) cow’s milk after an intolerance or allergy confirmation, and how to use a milk ladder.
By Offspring Health
An estimated 53%* of infants under the age of one have a serious cow’s milk allergy, which is one reason WHO recommends not introducing it as a drink until after 12 months of age. However, milk proteins also are present in a number of foods that your little one might eat once they start solids.
The number eventually starts dropping because most kids outgrow their intolerance.
It may feel scary to parents of tots with allergies but, if properly handled, most kids won’t suffer any lasting repercussions from cow’s milk protein intolerance.
Here, we outline the milk ladder, what it is and how to follow it.
What is a milk ladder?
A milk ladder is a way to introduce or reintroduce milk to the child’s diet, after a specialist has confirmed that they have cow’s milk protein intolerance or allergy (CMPI or CMPA). It is a gradual process, in which the child eats milk products with different fat content at different times, leading up to drinking whole milk.
The milk ladder is mainly used to establish whether your child’s allergies remain or if they have outgrown them. Many kids will outgrow their reaction to milk protein — mostly between the ages of one or three years.
The milk ladder approach, which in many cases will be introduced by your dietitian or doctor, is a way to test your child’s current reaction to milk. It will allow you to reintroduce cow’s milk into their diet.
Most kids can start this process between the ages of nine months and older — however, you should first consult with your child’s allergy specialist.
It’s essential to understand that there is still a small possibility that your child will react negatively to fresh cow’s milk, or different foods containing milk. As such it is highly recommended that you consider the following precautions before starting a milk allergy ladder.
Food intolerances can show themselves in tummy aches. (Image: Getty)
What to consider before starting a milk ladder
- Only start the milk ladder plan when your child is healthy. Make sure that they don’t exhibit any current allergy symptoms such as rashes, eczema, tummy ache or fever.
- Start once they have had a couple of months without any reaction to dairy products.
- If your child has had a chest infection or a cold, or any sort of illness, wait a bit before commencing with the milk ladder plan.
- Always try to start the plan in the morning or mid-day, around lunchtime. This ensures that you can monitor your child during the day and take notes on their reaction to milk.
- The milk ladder plan normally recommends foods that are highly processed — it’s important to make sure that your child can tolerate these foods before moving to the next rung.
Also, some kids may not react to processed foods with milk content – say cookies, cakes, biscuits, etc. This is because when foods are processed, by heating for example, the proteins might break up and won’t trigger an allergic reaction.
If your child gets allergic symptoms to fresh cow’s milk, take a break from the milk ladder and talk to your doctor or dietitian.
Your child, it’s important to note, isn’t allergic to milk — they are allergic to the proteins in it. There are two offending proteins: Whey protein and Casein, and your child might not be allergic to both.
The end goal of a milk ladder plan is to safely introduce dairy products into your child’s diet. Give them the vitamins and minerals those products have in abundance while also liberating you of the stress inherent to carefully planning your child’s meals — trying not to slip up and spark their allergies.
12 step MAP milk ladder
There are two official milk ladder recipes/processes, which are the 12 step MAP milk ladder, and the IMAP 6 step milk ladder.
In this article, we’re going to explain the 12 step program. What’s the main difference? The 6 step program is the newer version with condensed rungs. Most physicians still prescribe the 12 step version.
What is the milk ladder process?
Well, it’s simple. Each step takes into account a food, for example biscuits or pizza. You simply follow a carefully crafted food recipe and feed the result to your child. If they don’t encounter any issues with that food. Then you can move on to the next step.
What if the step triggers an allergic reaction?
In that case, keep allowing them to have foods from that step and previous ones, but wait three months until you try to progress to the next rung of the milk ladder.
How to use a milk ladder in 12 steps
Milk ladder recipes are readily available online but it’s perfectly fine to use shop-bought products following the relevant information below.
Step 1 – Malted milk biscuits
You can either buy malt biscuits or make your own. Homemade biscuits are better since you can avoid other allergens like soy or nuts. These biscuits mostly have powdered milk.
Step 2 – Digestive biscuits
Make sure you buy biscuits that contain milk during this stage. There are many recipes online in case you want to cook them yourself.
Step 3 – Muffins/cupcakes
Most kids who get stuck on the milk ladder challenge normally find their Achilles’ heel in this step.
Step 4 – Pancakes
Pancakes contain less milk than muffins BUT are baked or cooked for a much shorter time so the allergic proteins are more prevalent.
Step 5 – A portion of shepherd’s pie
A child’s bite-size portion of shepherd’s pie loaded with cheese and other dairy products.
Step 6 – Lasagne
Homemade child’s portion of lasagne. Preferable beef or chicken, not soy.
Step 7 – Cheese pizza
Preferably pizza that does not contain milk in its base. In other words, don’t buy cheese-stuffed crust.
Step 8 – Chocolate
Milk chocolates are high on the ladder not only because they contain dairy, but because they might also contain other allergens. It’s important that during this step you buy good quality processed chocolate. The fewer contaminants it has, the better.
Step 9 – Yoghurt
Try introducing them to whole yoghurts and look out for reactions.
Step 10 – Cheese
Most physicians recommend Cheddar or Gouda during this stage due to their fat content and how much milk they have during production.
Step 11 – Sterilised milk infant formula
During this stage start with 100ml and carefully increase to 200ml.
Step 12 – Milk
Start with pasteurised infant milk formula and gradually introduce, during this stage, cow’s milk.
How long does the milk ladder challenge take?
It’s important to be incredibly meticulous and take your time during the milk ladder challenge. To allow your child’s digestive system to get accustomed to new foods, new products, new tastes. You’re not just introducing dairy, but other foods into their body and they need time to acclimate themselves.
Each step of the milk ladder challenge takes one week. If you don’t encounter any allergic reactions, you should be finished by 12 weeks or three months.
*Christopher Warren of Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago, and colleagues wrote that cow’s milk allergy is the second most common food allergy among American children.
Offspring Health recognise each child has a unique nature with individual needs that can change with age.
