You’ve started the Egg Ladder, things seem to be going well, and then your child develops a rash, has a change in their poo, vomits or simply doesn’t seem quite right.
Was it the egg?
Should you stop?
Can you go back to the previous step?
And how long should you wait before trying again?
These are some of the most common questions I hear from parents when reintroducing egg.
An Egg Ladder can be a really useful way of gradually reintroducing egg, but children do not all progress through it in exactly the same way. How you respond to a possible egg ladder reaction depends on the symptoms, your child’s previous allergy history, the form and amount of egg they ate and what they were already tolerating.
In this article, I’ll explain what to look out for and what the next step usually involves.
Before starting an Egg Ladder
An Egg Ladder should not simply be downloaded from the internet and started because your child has an egg allergy.
The North West Paediatric Allergy Network advises that egg reintroduction should be carried out alongside advice from a doctor or dietitian. Their guidance also says not to attempt home egg reintroduction if a child has previously had breathing difficulties or become floppy following egg.
BSACI similarly advises that children with a history of severe reactions or asthma should have egg reintroduction guided by a specialist.
Your child should also be well when progressing the ladder. The North West guidance advises against increasing egg exposure when a child is unwell or has recently been wheezy.
That’s important because illness, eczema flares and other symptoms can make it much harder to work out whether something you are seeing is actually related to egg.
What are the stages of the Egg Ladder?
There are different Egg Ladder resources in use, so always follow the version recommended for your child.
The current North West Paediatric Allergy Network ladder progresses through five types of egg:
Step 1 – Baked egg in a flour matrix
This is egg thoroughly baked into foods containing flour.
Step 2 – Baked egg in other foods
The egg is still cooked but is no longer necessarily within the same flour-based matrix.
Step 3 – Well-cooked whole egg
For example, well-cooked hard-boiled egg.
Step 4 – Lightly cooked egg
This includes forms such as scrambled egg, omelette or softer-cooked egg.
Step 5 – Undercooked or raw egg
This includes foods containing less-cooked or raw egg.
The ladder also uses a separate gradual increase in the amount eaten. Parents therefore need to consider both the form of egg and the amount their child is tolerating rather than assuming that moving to a new food means immediately giving a full portion.
What can an Egg Ladder reaction look like?
A reaction can range from mild to moderate to severe.
Possible symptoms can include:
- Hives or an itchy rash
- Swelling
- Vomiting
- Tummy pain
- Loose stools
- Coughing, wheezing or noisy breathing
- Becoming dizzy, floppy or very unwell
It is important that if any of these symptoms occur, you stop progressing the Egg Ladder and follow your child’s allergy management plan if they have one. Seek urgent medical help if symptoms are severe.
Some symptoms appear quickly, while others can be harder for parents to interpret.
For example, a loose poo several hours later may be much less clear cut than hives appearing shortly after eating a new form of egg.
This is where the timing, amount eaten, form of egg and whether the same pattern has happened before become really important.
My child has reacted on the Egg Ladder – what should I do?
If your child develops symptoms after moving up the ladder or increasing the amount of egg, do not keep increasing the new egg exposure while you try to work it out.
Guidance is to go back to the previously tolerated stage if a child reacts when the amount or frequency of egg is increased, and remain there until they have been reviewed by their healthcare professional.
Make sure you write down:
- Which egg food they ate
- Which ladder stage it was
- How much they ate
- What time they ate it
- When symptoms started
- Exactly what symptoms you noticed
- Whether your child was otherwise well that day
That information can make it much easier to decide what happened and what to do next.
Should I stop all egg if my child reacts?
Not necessarily.
This is a really important point.
If your child was already eating a previous stage of the ladder without symptoms, reacting to the next stage does not automatically mean that everything they were previously tolerating has to disappear from their diet.
Advice is to return to the previously tolerated stage rather than stopping egg completely when a reaction occurs following an increase.
But exactly what that means for your child depends on the reaction they have had.
If you are unsure whether to continue a previously tolerated egg food, this is something I would get individual advice about rather than guessing.
Was it definitely the egg?
Sometimes it is obvious.
Sometimes it really isn’t.
Your child may have been teething, developing a viral illness, having an eczema flare or simply have had a change in their poo that happened to occur on the same day as an Egg Ladder increase.
One isolated symptom does not always prove that the new egg step caused it, which is why the timing, amount eaten and whether the same pattern happens again are important.
On the other hand, repeated symptoms following the same exposure deserve attention.
I find this is often where parents get stuck: they don’t necessarily need another generic Egg Ladder sheet , they need someone to look at their child’s pattern and help them decide what it means.
How long should I wait before trying the Egg Ladder again?
There isn’t one answer that is right for every child.
BSACI guidance notes that after a reaction, children should return to their previously tolerated diet and further reintroduction may be considered after a period of time. The timing and appropriateness of egg reintroduction should be individually assessed.
The right timing for your child may depend on:
- What symptoms occurred
- How quickly they happened
- The amount eaten
- Which step caused the reaction
- Whether your child has asthma or eczema
- Previous reactions to egg
- What forms of egg they are already tolerating
What if my child keeps getting stuck on the same Egg Ladder step?
This is another situation where it is worth looking at the bigger picture.
Some children tolerate one form of egg comfortably but repeatedly develop symptoms when they move to a less-cooked form.
That does not necessarily mean the ladder has “failed”.
Egg allergy commonly resolves gradually, with tolerance to more extensively cooked forms often developing before less-cooked egg.
But repeated reactions are a good reason to stop trying to push through the same stage and get advice about what happens next.
When is an Egg Ladder reaction an emergency?
Seek urgent medical help if your child develops signs of a severe allergic reaction such as:
- Difficulty breathing
- Wheezing or significant persistent coughing
- Swelling involving the tongue or throat
- Becoming floppy, faint or very unwell
- Symptoms suggestive of anaphylaxis
Calling 999/911 for breathing problems or faintness if you suspect anaphylaxis.
If your child has an allergy management plan or has been prescribed emergency medication, follow the plan you have been given.
Do not restart an Egg Ladder after a severe reaction without specialist advice.
Feeling stuck with the Egg Ladder?
If you’ve had a reaction, it can suddenly make something that seemed quite straightforward feel very confusing.
Parents often come to me wondering:
- Was that actually an allergic reaction?
- Should I keep giving the previous egg step?
- Have we progressed too quickly?
- Which stage should we restart from?
- Does my child need further allergy assessment?
- Are they getting enough variety while egg is restricted?
Those questions cannot always be answered from an Egg Ladder chart alone.
I can look at your child’s reaction history, what they are already eating, the stage and amount of egg they reached and the symptoms you have seen, and help you work out the safest next step.
You may also find my guide to Egg Allergy in Babies: Symptoms, Reactions and What to Do Next useful if you want to understand more about egg allergy itself.
Hannah Whittaker RD is a specialist paediatric allergy dietitian with over 20 years’ experience in nutrition and 10 years as a Registered Dietitian. She specialises in food allergy in babies and children, including cow’s milk, egg, soya, wheat, peanut and tree nut allergy, food reintroduction and nutritional adequacy.
Hannah has worked in NHS paediatrics and now supports families with practical, evidence-based nutrition advice. She is also an experienced media spokesperson and has contributed to publications including The Sunday Times, The Independent and Huffington Post.
Credentials
Registered Dietitian
First Class Degree in Nutrition
Postgraduate qualification in Dietetics
Experience
Over 20 years’ experience in nutrition
10 years as a Registered Dietitian
NHS paediatric dietetics experience
Media spokesperson in the UK and internationally
Writer, committee member and researcher supporting the British Dietetic Association
