This page gives advice on introducing dairy into your child’s diet at home.
Follow this advice only if your child has been assessed by a doctor or dietitian and they have told you that it is safe for you to introduce cow’s milk and milk products (dairy) at home.
Do not attempt the milk ladder if your child has had a severe reaction to dairy or you have not received advice from a health professional.
The milk ladder is a step-by-step, practical way to introduce dairy products at home in children who have previously been diagnosed with a delayed onset (non-IgE) cow’s milk protein allergy.
There are various versions of the milk ladder. This ladder is adapted from the iMAP version and has 6 steps. Each step usually takes a minimum of 3-7 days to achieve a full portion.
The ladder starts with small amounts of broken-down forms of milk proteins that are easier to tolerate. As you move up the ladder, the milk proteins are less broken down, until you eventually reach intact cow’s milk proteins. Each step also increases the amount of milk proteins that you give to your child.
The milk ladder usually starts when your child is 9-12 months of age or has been dairy-free for a minimum of 6 months following a confirmed diagnosis of delayed-onset cow’s milk protein allergy by your GP/doctor/dietitian.
See our recipes and choose from:
OR
Choose a shop bought product. In that case, always check the label to ensure the product that you buy contains cow’s milk. Cow’s milk will be listed in bold or italic on the ingredients section on the food label.
IMPORTANT!
Only start to introduce cow’s milk into your child’s diet:
METHOD
1. Give your child a tiny amount of the food containing the baked milk to eat (e.g. a bite or a crumb) - Watch your child for symptoms for the next 2 hours
2. If no symptoms appear, the next day, give your child a larger amount of the food containing the baked milk: e.g. a quarter of a biscuit - and watch your child again for symptoms for 2 hours
3. If no symptoms occur, the next day, keep increasing the amount offered: e.g. offer half a biscuit – and watch your child for symptoms for 2 hours
4. Continue increasing the amount of the food containing cow’s milk that you offer every day, or on alternate days, until your child reaches a full portion for age (e.g. a couple of biscuits). You should allow at least 3 days to reach this but we usually recommend allowing about 7 days.
5. Keep offering the forms of dairy that your child tolerates at least 2-3 times per week. You may also try other foods that are on the same step of the ladder.
Note: You may progress at a slower pace if you feel that this works better for your child or for the family. For example, some families avoid progressing on the ladder on nursery days and prefer increasing portions at the weekend. Some families feel more comfortable starting with very small amounts, especially on the higher steps of the ladder (e.g. yogurt: tip of a teaspoon of yogurt, then to build to ¼ of a teaspoon, then ½ teaspoon, then full teaspoon, then tablespoon, then couple of tablespoons).
See example of a progression on step 1 of the ladder in the table below:
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Suggested amounts to offer |
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Day 1 |
A quarter of a biscuit |
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Day 2 |
Half a biscuit |
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Day 3 |
Half a biscuit |
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Day 4 |
A full biscuit |
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Day 5 |
A full biscuit |
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Day 6 |
A couple of biscuits |
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Day 7 |
A couple of biscuits (or 3 if baked at home as per recipes provided) |
Look out for the following symptoms (mild to moderate reactions):
Important
Severe allergic symptoms are unlikely to occur but if you notice any of the allergic reactions listed below, call 999 immediately. Follow your child's personal paediatric allergy action plan if you have one. If your child is wheezing, use their reliever (Salbutamol) inhaler if they have one.
Severe allergic symptoms:
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Ingredients |
Method |
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125g flour 50g cold dairy-free spread 40g grated dairy-free cheese 1 teaspoon of skimmed milk powder 2 tablespoons of water.
Tips
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1. Mix the flour (& xanthan gum if used) and milk powder. 2. Rub in the cold dairy free spread. 3. Mix in the dairy-free cheese. Add the water (you can add a little more water if the dough seems dry) 4. Roll out the dough and cut in 20 finger sized strips 5. Bake for 10 – 15 min in the oven at 180⁰C. |
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Ingredients |
Method |
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125g flour 50g cold dairy-free spread 40g grated dairy-free cheese 1 teaspoon of skimmed milk powder 2 tablespoons of water.
Tips
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1. Mix the flour (& xanthan gum if used) and milk powder. 2. Rub in the cold dairy free spread. 3. Mix in the dairy-free cheese. Add the water (you can add a little more water if the dough seems dry) 4. Roll out the dough and cut in 20 finger sized strips 5. Bake for 10 – 15 min in the oven at 180⁰C. |
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Ingredients |
Method |
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250g flour 2½ teaspoons (10g) of baking powder 2 level tablespoons (25g) of sugar (if you child is older you can add 2-3 tablespoons) Pinch of salt 50ml sunflower oil 250ml milk 110g of finely chopped/mashed fruit: apple/pear/banana Vanilla essence to taste.
Tips
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1. Mix flour (& xanthan gum if used), baking powder, sugar and salt 2. Mix oil and milk together. Add the liquids to the dry ingredients 3. Finally add in chopped fruit and vanilla (additional) and mix through 4. Bake for 20mins in the oven at 180-200⁰C. |
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Ingredients |
Method |
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250g flour ½ teaspoons (10g) of baking powder Pinch of salt 50ml sunflower oil 250ml milk 60g of grated dairy-free cheese.
Tips
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1. Mix the dry ingredients together: flour (& xanthan gum if used), baking powder and salt 2. Mix oil and milk together and then add to the dry ingredients 3. Finally add in the cheese and mix through. 4. Bake for 20 mins in the oven at 180-200⁰C.
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Ingredients |
Method |
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125g flour 2½ teaspoons (10g) baking flour 1 pinch of salt 2 tablespoons of sunflower oil 250ml milk 50ml water.
Tips
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1. Add all ingredients into a mixing bowl and mix together 2. Fry in a hot pan. |
Follow the steps on the Milk Ladder to find out if your child tolerates these foods.
You have two options for the Milk Ladder: using commercial products and/or using home-made recipes (see Recipes in section above). Some of the commercial products that are useful to introduce cow’s milk in your child’s diet may be highly processed or high in added sugar. If this worries you, please use the recipes provided, as these have no added sugar/offer savoury options, or talk to your dietitian/doctor.
Please note we do not endorse any particular brands or products. We have listed a few brands which contain cow’s milk protein on the ingredient list to help you select a suitable product more easily. However, manufacturers may change their recipes. If you are using ready-made commercial products, please ensure that the product that you choose contains cow’s milk in the list of ingredients.
Always check the food labels ingredients list of any shop-bought product used to do the ladder.
These products have a very small amount of milk. The cow’s milk proteins are broken down by the thorough baking and ‘trapped’ with the flour. Milk will be listed as one of the last ingredients on a food label.
Use the Ladder home-made biscuits (see recipe)
Start with 1 cookie/biscuit (equivalent to 1 ml of milk); increase to 2 and then 3 cookies/biscuits (equivalent to 3 ml of milk - if your child can manage a portion of 3 biscuits/cookies)
OR
Use the following: malted milk biscuits, Garibaldi biscuits, bread that contains milk such as milk roll, cake rusks, milk rusks or shop-bought naan bread (check ingredient lists). For example: Regal rusks, Jutrezenka Bebe biscuits, Toastea milk rusks, Warburton’s milk roll, Sharwood’s plain mini naans.
Those products contain more milk. The cow’s milk proteins are broken down by the thorough baking and ‘trapped’ with the flour and the other ingredients.
Use the Ladder home-made muffins (see recipe)
Start with half a muffin and then one muffin
OR
Use the following: plain fairy cakes, croissant, brioche, waffles, madeleines, paratha, Shokupan Japanese milk bread, Mochi cake, Szarlotka (Polish apple cake), Toto cake, short bread biscuits or scotch pancakes. Examples: Tesco brioche burger bun, Royal family red bean mochi cake, Le Petit Beurre biscuits, Bonne-Maman madeleines, Kozonac bread, Regal puff pastry biscuits, Nankhatai, Bakarkhani/bakarkhani roti.
Those products contain more milk. The cow’s milk proteins are broken down by the thorough baking and ‘trapped’ with the flour and the other ingredients.
Use the Ladder home-made muffins (see recipe)
Start with half pancake and then 1 pancake
OR
Use the following: dishes cooked in the oven for at least ½ hour at a temperature of at least 180⁰C. These include shepherd’s pie with milk and cheese, fish pie with milk and cheese, lasagna, moussaka, bazlama (Turkish bread containing yoghurt), home-made naan containing yoghurt, Duff pudding.
The cheese-making process (slight heating and fermentation) reduces how allergenic the milk proteins are. Milk is now the main ingredient.
Pick a hard, mature cheese such as Cheddar or Parmesan and give it to your child uncooked. Aim to reach a 15g portion (2 ½ flat tablespoons of grated cheese or a small matchbox portion).
Yogurt is fermented and heat-processed. This reduces how allergenic the milk proteins are. Milk is the main ingredient.
Aim to reach an age-appropriate portion: this could vary between a tablespoon to a full individual pot (125ml – equivalent to 4 heaped tablespoons of yogurt). We recommend using plain cow’s milk yogurt (will contain no added sugar).
IMPORTANT:
Once your child tolerates all the steps above (1 to 5), you can try introducing the following additional foods (See list below).
These products are lightly heat-processed, which slightly breaks-down the milk proteins. The overall amount of milk present in these foods is high. These foods may be cheese-based or yogurt-based but do not contain liquid, uncooked cow’s milk.
You are now introducing cow’s milk proteins that are pretty much intact (pasteurised only: heat treated at 57-68 C for 15-20 seconds) and present in larger amounts.
Aim at trying 100ml (full portion) to gradually build to 200ml (depending on your child’s age).
Ensure younger children get sufficient dietary calcium:
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Babies under age 1 year: |
If your baby is not breastfed, aim to give 500 to 600ml infant formula per day, whether milk-free or standard formula. |
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Toddlers (age 1-3 years) who remain allergic to cow’s milk: |
Give 300ml of calcium-fortified milk substitute such as soya, oat, pea or coconut ‘milks’. |
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Toddlers who have outgrown their cow’s milk allergy: |
Give 300ml cow’s milk - If you prefer you can swap 60g fromage frais or yogurt for 60ml milk and you can swap 15g cheddar for 90ml milk. |