The Milk Ladder - A Simple Guide For Parents

By Registered Dietitian Nishti

This guide is for children who have been diagnosed with a delayed (non-IgE-mediated) allergy to milk and have been told by their doctor or dietitian that it's now safe to start reintroducing milk at home.

We’ll walk you through what the Milk Ladder is, how to get started, and what to look out for. 

What is the Milk Ladder?

The Milk Ladder is a gentle, step-by-step way to bring dairy back into your child’s diet. It’s only for children with the delayed type of milk allergy (non-IgE mediated) – not for those at risk of anaphylaxis or who have had immediate reactions to milk.

If your child has had severe reactions in the past, they’ll need allergy tests first. If tests come back negative, a hospital food challenge may be advised.

Before You Begin

• Make sure your child is well (no coughs, colds, or tummy bugs).

• Their eczema, asthma, and hay fever should be under control.

• Choose a calm day when you’ll be home to watch them for at least 2 hours after eating.

• Don’t introduce any other new foods at the same time (like egg or peanut butter).

What Reactions Should I Expect?

Delayed reactions (can take 2 hours to 3 days to show):

• Tummy ache

• Loose stools or constipation

• Bloating or wind

• Blocked nose

• Flare-up of eczema or rash

Immediate reactions are rare in these cases, but just in case:

• Hives or itchy rash

• Swelling of lips, face, or eyes

• Difficulty breathing

If you’re worried or unsure, speak to your healthcare professional.

Will It Be the Same Reaction as Before?

Not necessarily. Your child may react differently now. For example, they may have had loose stools before going dairy-free, but this time you might notice eczema instead. It’s all part of how the immune system changes.

Which Milk Ladder Should I Follow – 6 or 12 Steps?

There’s a newer 6-step version, but don’t worry too much about which one you’re using. Your doctor or dietitian will guide you. The key is just to start.

Steps 1, 2, and 3 have easy recipes to try – including our biscuit recipe video for step 1.

What If My Child Won’t Eat the Biscuit?

That’s OK! You can try:

• Crumbling it into cereal or dairy-free yogurt

• Mixing with a bit of milk and stirring into fruit puree

• Trying other biscuits like malted milk, baby biscotti, shortcake, Garibaldi, digestives, or Belvita

How Much Should I Give?

This depends on your child’s age and history. Please ask your doctor or dietitian for the right amounts for each step.

What If My Child Reacts?

If your child reacts at a certain step, don’t go back to avoiding all dairy. Keep the steps they were fine with in their diet.

For example, if step 1 and 2 were fine but step 3 caused symptoms, keep giving steps 1 and 2 regularly. This helps build tolerance.

Wait 2–4 weeks for symptoms to settle before trying that step again.

Can I Do the Ladder Through Breastfeeding?

You can, but it’s harder to track how much milk protein your baby is getting. Some parents prefer to do it this way if they’re nervous – and that’s completely okay. Just know it may take longer to see results.

References:

Fox, A., Brown, T., Walsh, J. et al. An update to the Milk Allergy in Primary Care guideline. Clin Transl Allergy 9, 40 (2019). https://doi.org/10.1186/s13601-019-0281-8 National Institute for Clinical E. Diagnosis and assessment of food allergy in children and young people in primary care and community settings. 2011. 

Venter C, Brown T, Shah N, Walsh J, Fox AT. Diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy—a UK primary care practical guide. Clin Transl Allergy. 2013;3(1):23.