The milk ladder and CMPA

The milk ladder is ONLY recommended for children with mild to moderate non-IgE or delayed type CMPA. It is NOT appropriate to reintroduce milk into a child’s diet at home if they have an immediate type allergy (unless advised to do so by your allergy clinic). This would usually be done in a hospital setting. It is also important that your child is well and that any tummy/bowel symptoms or eczema are settled.

The milk ladder is a stepwise, systematic way of reintroducing cow’s milk protein back into a child’s diet after a period of avoidance. The concept of the milk ladder is based on the fact that research shows that the more ‘baked’ cow’s milk protein is, usually the less allergenic it is.

Therefore the first step of the ladder begins with a very well baked milk protein and then the further steps are examples of gradually less well-baked milk protein products.

The ladder consists of 6 steps (previous version had 12 steps) but this may be adjusted by your HCP. The time spent on each step will also vary from one child to another depending on the type of CMPA and individual symptoms.

A recipe accompanies each of the early steps of the ladder and all options on the milk ladder are also soya free. There are also wheat and egg free options available, if required.

If you child does not tolerate the food in a particular step, simply go back to the previous step. Your HCP will advise you when that step can be tried again. The amounts of each food to be offered vary and your HCP may advise smaller / larger quantities, depending on individual circumstances.

STEP 1: Biscuit*
STEP 2: Muffin*
STEP 3: Pancake*
STEP 4: Cheese
STEP 5: Yoghurt
STEP 6: Milk / suitable formula (depending on the age of your child)

*has an accompanying recipe

A link to the milk ladder can be found here but please discuss the ladder with your Dietitian or Doctor before considering to start your child.


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