The Ultimate guide for mums by expert CMPA Dietitian
You’ve been told to start the milk ladder but you’re wondering what it’s all about. The Milk Ladder – Ultimate guide for mums by expert CMPA Dietitian (me) will definitely help!
Maybe you’ve been given a copy of the imap milk ladder like the one above and that was it, no explanation, no advice, you were just told to start with your baby when they’re ‘around’ 12 months old.
If this is you and you want to find out more about the milk ladder then keep reading, you are definitely in the right place!
This blog is based on evidence and written by me – Hannah – Expert CMPA Dietitian. It also contains the real answers to the questions I receive from mums just like you.
What is the milk ladder?
The milk ladder is a specific way to reintroduce cows milk protein back into your babies diet after they have been avoiding cows milk for a period of time.
If your baby has been diagnosed with a milk allergy you will have likely been told to avoid cows milk contained products in their diet for at least 6 months and after this stage you will be advised to start the milk ladder.
It is advised to be used with babies with non-IgE or delayed cows’ milk protein allergy. You must speak with your doctor or contact me first if your baby has an IgE milk allergy. Don’t start the milk ladder with your baby if they do.
When age to start the milk ladder
You should start around 6 months after your baby has been on a cows milk free diet. This is likely to be when your baby is around 12 months old. You might start the milk ladder a little earlier, at 9-10 months, or later, when your baby is around 18 months old. This will all be dependent on when your baby was diagnosed with a milk allergy.
Don’t start the milk ladder if…
Only start the milk ladder when your baby is well.
This can be a little tricky as your baby always seems to have a cold (runny/snotty nose), a cough, or be teething (red cheeks and runny poop). All these symptoms are completely normal as your baby’s immune system is developing. If symptoms are mild then you can start the ladder. If you find your baby is struggling with these symptoms then don’t start until they are well as you won’t be able to tell if symptoms are due to milk protein or other illnesses.
You should definitely not start the milk ladder if your baby has;
- A high temperature/fever
- Very loose stools – tummy bug
- Recently been prescribed medication such as antibiotics
- A rash or flare up of eczema
- A chest infection or bronchiolitis
- Taken antihistamines in the last 5 days
Use your mummy intuition and start the ladder when you feel that your baby is free from symptoms and is well.
I’m breastfeeding, do I do the milk ladder or does my baby?
I’m going to give you the pros and cons on this one.
Doing the milk ladder with your baby first
- You know how much milk protein your baby can tolerate
- You know when you last gave your baby food with milk contained. No confusion if it was something you ate and how much milk came through your breastmilk
- If a reaction occurs you can stop the food immediately and go back to the last step that your baby could tolerate.
- You have to wait until your baby has been on a cow’s milk protein free diet for 6 months. This can be tricky if your baby has their diagnosis at an older age.
- It can be difficult to get a younger baby to eat the whole portions of foods recommended on the ladder.
Doing the milk ladder as a breastfeeding mum
- The volume of milk protein your baby receives is probably less than that if they were to eat the food themselves. This can be helpful if you are a little anxious about starting the milk ladder with your baby.
- Your baby might be able to tolerate milk protein through your breastmilk which means you don’t have to avoid milk anymore
- It might be easier to start the milk ladder through your milk before 9-10 months if your baby has been milk free for 6 months.
- You don’t always know what it was that you ate that your baby reacted to, especially if the reaction is delayed. We don’t know quite yet how quickly or slowly milk protein moves through your breastmilk – research is continuing on this one.
So what’s my advice
I’d say to start the milk ladder with your baby before you reintroduce milk back into your diet. I think this is the easiest way to see your baby’s tolerance level of cow’s milk protein and stops any confusion. But, honestly, the choice is up to you. I would always say to monitor each step and my milk ladder food diary can help with this.
Should we do the 6 step or 12 step ladder?
I advise the 6 step. You can find a copy at the top of the page and also in my MILK LADDER FREEBIES below
Breaking it down a little
- Step 1 is a biscuit. In a biscuit the milk is baked and can be found lower down the ingredients list.
- Step 2 is cake, again with milk baked in the cake and found in the ingredients list
- Step 3 is a pancake, again with baked/cooked milk.
As you move up the milk ladder you get to steps 4, 5 & 6. These includes cheese, yogurt and cows milk.
Why is it a ladder?
When milk is baked in a food the likelihood of this milk causing an allergic reaction is reduced as the milk is heated. As you move up the milk ladder then the milk protein is exposed to less heat.
If you then add in flour (biscuit, cake or pancakes) in steps 1, 2 & 3 of the milk ladder, this again reduces how allergenic the food is.
Allergenic means how likely a food is to cause an allergic reaction.
The higher up the ladder you go the more milk protein is in the food and the more allergenic the food is.
How to do the milk ladder
Download my milk ladder daily planner here. This gives you a day by day plan on how to progress with the milk ladder.
I have put together two different versions.
- Reintroduction is completed each day
- Reintroduction is completed every few days.
You can have a little break between the steps if you like, just keep the foods that your baby can tolerate in their diet whilst having this break.
How long should I spend on each step of the milk ladder?
Again check out my milk ladder daily planner but…
Each step of the ladder is different and each baby is different when it comes to their tolerance of cow’s milk protein. I would always say to be guided by your baby and their symptoms.
If your baby has a reaction on a certain step, stop where they can tolerate it. You need to then give 2-4 weeks for symptoms to settle (as this is generally how long the body takes to recover from symptoms), and then restart the milk ladder from the step your baby was able to tolerate. To give you an example;
My nephew was able to tolerate step 1 – biscuits, and step 2 – cake, but when he was given pancakes he started to have loose stools and a raised rash. We stopped giving pancakes but kept biscuits and cakes in his diet (baked milk) and then after 2-4 weeks restarted again at step 3 – pancake. You don’t have to go back to the bottom of the ladder.
Mild to moderate vs severe milk allergy – does it matter?
If your baby has a mild-moderate cow’s milk protein allergy then you may find that they will progress a little quicker up the milk ladder as they are less sensitive to cow’s milk protein but this is not always the case.
If your baby has a moderate – severe allergy then you may want to go a little slower with the milk ladder, starting off with smaller portions on each step.
Use my allergy food diary to help you with tracking progress with the milk ladder. You can find it here.
How do I know if my baby’s symptoms are due to the milk ladder?
Common symptoms that indicate a reaction in a baby with a delayed cow’s milk protein allergy are;
- Loose stools – mucous may be present
- Tummy upset
- Raised red, itchy rash
- Sounding chesty
If your baby starts with their original symptoms then you should stop the milk ladder on the step that they are able to tolerate.
Should my baby stay on their hypoallergenic formula when they’re doing the milk ladder?
This is all dependent on their age.
Under 12 months
Yes they should continue on their hypoallergenic formula. If your baby gets to 12 months and can’t tolerate cow’s milk to drink then you can start to move them to fortified plant milk. See my post on Instagram here on the best ones out there.
Your baby is fine to continue with their hypoallergenic formula up until around 18 months. After 18 months, I’d advise you to move them to fortified plant milk if they still can’t tolerate whole cows milk to drink.
Your baby is also fine to switch to fortified plant milk at 12 months old as long as there are no worries about their growth and they are having a well balanced weaning diet.
Does my baby need a multivitamin if they take hypoallergenic formula?
If your baby is having less than 500mls (16oz) of hypoallergenic formula then yes they will need a multivitamin containing Vitamins A, C & D. If they are having more than this then they don’t need a multivitamin as their formula is providing all that they need. Have a look at my free multivitamin guide here for more information on this.
My baby isn’t progressing with the milk ladder, what can I do?
Firstly don’t worry, each baby goes at their own pace.
If you find that your baby keeps showing symptoms on a certain step and you have tried 3 times on that same step then take a break.
As I mentioned above, if a reaction occurs take 2-4 weeks, however if you can’t get past a certain step then instead take 3-4 months break and then again retrial at the step that your baby wasn’t able to tolerate. Remember to make sure that during this time that you keep all the cow’s milk protein contained foods in your baby’s diet that they can tolerate.
How long will it take for my baby to complete the milk ladder and drink cows milk?
This is individual and every baby is different. Some babies don’t have any reactions and others take a little longer.
Try not to worry as your baby is going at their own pace. Remember that if they are having a balanced diet alongside their formula, breastmilk or fortified plant based milk then there are likely no concerns with nutritional balance or growth.
The stats show that 80% of babies grow out of their milk allergy between 3-5 years
Where does chocolate come on the milk ladder?
This is a common question and to answer this, chocolate comes between steps 4 & 5 so between cheese and yogurt. Once your baby can tolerate cheese without symptoms then you can try with a little piece of chocolate. Remember, chocolate shouldn’t be given all the time to younger children but a small piece now and again is fine.
All of the answers on this blog have come from evidence base and questions I get asked frequently, however if you have your own questions then sign up for my MILK FREE MASTERCLASS and come along to learn more about the milk ladder and ask your question.
Here is the link to join the waiting list
Bump2baby nutrition LTD accepts no responsibility for any adverse reactions that occur from following the milk ladder. The milk ladder should not be completed without the support of a registered dietitian.