Cows Milk Allergy - The Milk Ladder - HealthSurgeon - Healthy Living and Fitness

Cow’s milk protein allergy is the most common food allergy in infants. It is an immune response to the proteins that are found in cow’s milk. Breastfed or formula fed babies can have this type of allergy. Symptoms can be mild to severe. Symptoms of the milk protein allergy are eczema, hives, redness, swelling, vomiting, diarrhea, constipation, blood or mucous in the stool, fussiness, abdominal pain, wheezing, coughing, difficulty breathing, irritability, or crying after feeding. Symptoms can be intermediate or delayed. Most children grow out of the cow’s milk protein allergy between the ages of 3 and 5 years old completely.

There is a process to reintroduce milk into your child’s diet. The milk ladder is a step by step approach to reintroduce cow’s milk. The ladder method gradually increases the amount and the type of milk containing foods. You increase the foods starting with baked goods and progressing to less processed forms of dairy like yogurt and cheese.

Week One

Week one or the bottom of the ladder you start with malted milk biscuits, sponge cake, or shortcake. These need to contain milk. Ready to buy items like this do not always have milk. You can make your own or look specifically in stores for ones that say they contain milk. When starting you will want to give them a bite of the biscuit or cake to start. Then as the week progresses you increase to the point that by day 7 your child is eating a full biscuit.

Week Two

Week two you add foods that contain milk products. This could be things like lasagna, meatloaf, pizza, scones, croissants, cheese omelets, or mashed potatoes. Start with 2 correct portion sized bites for your child increasing up to a full portion by day 7.

Week Three

Week three you will move onto hard cheeses or milk puddings. Including foods like custard, cheese on toast, cheese on crackers, or rice pudding. Start with a very thin piece of cheese or one spoonful of pudding. At the end of the week you should work up to 25 grams of cheese or 125 mL of pudding or custard.

Week Four

Week four you can try any flavor of yogurt or ice cream. Start with one spoon full and increase up to a small scoop of yogurt or ice cream by day 7.

Week Five

Week five is boiled milk. Milk that has been boiled on the stove top for at least 2 minutes then cooled down to room temperature. Start with 50mL of milk as a drink or over cereal and increase to 200 mL by day 7.

Week 6

Week six the final step of the ladder is straight milk from the carton. This can be drunk or poured over cereal. Start with 50mL and increase during the week to up to 200mL by day 7.

Each day of the week for each step you are on you should be increasing the amount of dairy you are giving your child. On day one portion size should be the size of a grain of rice. Day two pea sized portion. Day three a teaspoon. Day four a tablespoon. Day five a quarter sized portion. Day 6 half a standard portion. Day 7 a full portion. Portions should be appropriate for your child’s age.

It is important that you speak with your allergist or your pediatrician before starting the milk ladder. Do not start the milk ladder if your child has ever shown signs of difficulty breathing after having any type of dairy. Do not start the milk ladder if your child is sick or you are overly busy. The milk ladder can be used for children who have shown previous skin or gastrointestinal symptoms after digesting dairy. You should aim to feed your child foods from the milk ladder at least three times a week to make sure they are tolerated before you move on to the next step. Feeding your child their milk ladder foods is best at either breakfast or lunch. This allows you to have the majority of the day to monitor their behavior or if any symptoms arise.

Before moving onto the next step make sure your child is tolerating the step they are on. If your child shows any symptoms after being on a certain step do not stop the milk ladder entirely. Just move backwards and repeat a week then try again to move forward if they show no signs of distress. Some children may stay on a step for longer than seven days as their bodies learn to tolerate the milk proteins.

Symptoms to be on alert for when trying the milk ladder are red raised or itchy rashes, swelling of any part that the food comes in contact with, vomiting, diarrhea, noisy breathing, wheezing, persistent coughing, or floppiness. If your child has any of these, stop the challenge immediately. Talk with a healthcare provider before retrying the milk ladder. If your child shows any signs of floppiness or difficulty breathing you should take them to an urgent care immediately.

The milk ladder is a way to reintroduce cow’s milk to a child who has been previously diagnosed with a cow’s milk protein allergy. You start with foods that are highly processed milk to forms that are least processed like yogurt. If your child tolerates the introduction you move up the ladder until they are able to drink milk straight from the jug. Some children will take more time to climb the ladder. Most children who have a cow’s milk protein allergy will completely grow out of the allergy by ages three to five.