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Reintroducing cow's milk protein after milk free weaning
Most children will grow out of their cow's milk allergy. If your baby has a delayed cow's milk allergy (non-IgE mediated), you can start the iMAP milk ladder when they are 9 to 12 months old.
The milk ladder is a step by step process of reintroducing cow’s milk and dairy products into the diet. By introducing milk protein gradually, you will be able to find out your baby's level of tolerance.
Do not try the iMAP milk ladder at home if your child has an immediate (IgE mediated) allergy, unless advised by a health professional.
Explore the topics on this page:
Understanding the iMAP milk ladder
Monitoring your baby's symptoms
Understanding the iMAP milk ladder
The iMAP milk ladder helps you slowly add cow's milk products back into your baby's diet. The milk ladder contains 6 steps. It starts with baked foods that contain a small amount of cow's milk protein. It then moves onto foods like yoghurt and cheese. Finally, you can try giving your baby cow's milk on its own.
You should stay on each step for around 7 days but you can stay on a step for longer than 7 days if you prefer to move more slowly through the ladder.
When to start the milk ladder:
- Try to start the milk ladder in the morning or at an early lunch so you can monitor for any symptoms during the day.
- Do not start the milk ladder if your child is unwell, teething or has had immunisations in the last few days.
- Do not start the milk ladder if you are very busy or have somewhere you need to be immediately after.
The iMAP 6 step milk ladder
- Step 1 - malted milk biscuit
(alternatives include another plain biscuit containing milk powder, not whey powder)
- Step 2 - mini muffin
(alternatives include a plain muffin, plain brioche, milk loaf, scone, croissant. Or try frozen Yorkshire puddings or recipes containing butter, for example, pastry or roast potatoes) - Step 3 - pancake
(alternatives include shop-bought pancakes, crepes or scotch pancakes. Or a dish cooked in the oven for at least 30 minutes, for example, lasagne, pizza, shepherd's pie or fish pie made with milk or cheese) - Step 4 - cheese
- Step 5 - yoghurt
- Step 6 - infant formula for under 1 year old, or whole cow's milk if over 1 year old
There are recipes available for steps 1, 2 and 3. These recipes contain egg and wheat-free alternatives. You can use shop-bought products if you prefer.
Monitoring your baby's symptoms
If your baby shows any symptoms on step 1, stop and try again in 2 to 3 months' time.
With each step you progress to, if your baby shows symptoms, stop giving the foods on that particular step. You can continue giving foods on the previous step(s) that you had successfully introduced. Offer these foods at least 2 to 3 times per week to maintain their tolerance. You can try the next step again in 2 to 3 months' time.
Do not increase food portions or introduce new foods if your child is unwell.
Your child may not react to milk in the same way that they did when they were first diagnosed with a cow’s milk allergy. Symptoms of an allergic reaction can include:
- reflux or vomiting
- tummy pain or bloating
- diarrhoea or constipation
- eczema or other skin rashes
- wheezing
- swelling of the lips or face
- irritation to the eyes or nose
It's normal to want to watch your baby closely when starting the milk ladder or progressing to the next step. You may notice mild symptoms like a small change in bowel habit or a little more wind, but this is not a reason to stop the milk ladder. Not all changes will be due to the introduction of new foods.
If you are unsure whether your baby is having an allergic reaction, wait 1 or 2 days and then re-try the same food. If it is an allergic reaction to the cow's milk protein, then the same symptoms should appear.
If the symptoms are very mild, you may continue with the milk ladder. These symptoms often go away after a few days.
Moving up the milk ladder
Some children will move up the milk ladder quickly without delay. For other children, progress may be a little slower due to:
- illness
- teething
- immunisations
- change of circumstances
- separation anxiety
In these situations, continue to give your child the foods on any previous step of the milk ladder that were successfully introduced. When they feel well again or the situation has improved, you can try the next step.
Some children can take longer than others to outgrow a cow's milk allergy. A very small number of children may remain sensitive to cow's milk into adulthood.
Children over 3 years old should try step 1 of the milk ladder every 6 months. Try to avoid starting the milk ladder more often than this.
If your child remains on a strict cow's milk free diet, it is important that they are meeting their calcium requirement to help them grow. Read more about calcium.
