5 top tips from a dietitian when starting the milk ladder
The reintroduction of milk can feel daunting for most families especially in those early days where it may have been difficult to even obtain a diagnosis of CMPA. The thought of now introducing milk may fill you with worry that symptoms may return.
My name is Lydia Collins-Hussey and I am a specialist paediatric allergy dietitian and here are my top tips to support you with the ladder, but before we begin, let me cover the basics…
The milk ladder is a gradual step-by-step guide to introducing milk back into your child’s diet. It is intended for non IgE mediated milk allergy (delayed milk allergy), however, more recently it is also being used in IgE mediated allergy (immediate milk allergy) under strict guidance from an allergy team.
The ladder starts with baked milk (biscuit) as this is more likely to be tolerated compared to fresh milk because the milk protein is heated and mixed in a wheat matrix. As you increase up the ladder the milk protein becomes less baked or processed until fresh milk is reached.
My Top Tips
Seek advice
Make sure you are being supported by a health care professional that works in the field of allergy, I know this is easier said than done in the current NHS climate and waiting times. However, the milk ladder is only a guide and should be tailored to each individual.
You may need to start at a much slower pace depending on previous symptoms or you may go quicker as your little one has had accidental exposure to steps higher on the ladder and tolerated.
Not only is it important to seek advice initially, but to also communicate with your healthcare professional or team regularly. They can provide ongoing guidance, support and more importantly adjustments to your plan (surprisingly this happens more than you think).
Getting started
The one thing you need to ensure before starting…is that you feel 100% confident in what to do and what the ladder involves. If you’re not sure, reach out to your dietitian.
You will see from a simple google search that there is an array of different ladders which can make it confusing which one to choose. The 6 step is more commonly known and most up to date, but you will find that different allergy teams adapt ladders and have their own versions too.
Before getting started, ensure your child is well, there are no tummy symptoms, and their eczema is under control as this can make it harder to know if it is in relation to a reaction or not.
It’s not a race
Try not to compare to others that are on the ladder. Sure, there are some littles ones that fly up but for the majority it can take a lot longer, with research showing the average time to complete is around 15 months.
Delays in the ladder are common whether its due to illness, second guessing if it’s a reaction or not, or simply because you are starting with much smaller amounts (yes, there are cases where we start with a crumb). Remember slow progress is still progress.
Be patient
Your little one may not be progressing as you expected but please don’t rush the process. Usually, non IgE mediated allergy is outgrown quicker than IgE mediated with the majority by school age.
If your child is over 5, please don’t be disheartened as there is research that children go on to outgrow in later childhood too. Tolerating baked milk is a good sign that your little one will then go onto outgrow their milk allergy.
Take a step back
If it’s all getting too much, take a deep breath and pause. There is no harm pausing with where you are on the ladder and keeping in foods you know are being tolerated.
Reach out to your dietitian, that’s what they are there for, to support and provide you guidance.
Need further help with the ladder?
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MASTER THE MILK LADDER MASTERCLASS: 3 secret steps to success
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I’m an award winning, UK registered dietitian with over 10 year’s experience in the NHS and private practice. I support parents in helping manage their little one’s milk and/or multiple allergies from diagnosis, management and tolerance.