Climbing the Milk Ladder: an Approach to adding Dairy after CMPI

If you have been dealing with a cow’s milk protein allergy or intolerance, you may be wondering how to introduce dairy to your kiddo once they start solid foods. That’s where the Milk Ladder comes in! This approach is an evidence-based way to introduce milk products gradually, in stages, starting with foods that contained small amounts of milk products, and then progress on.

Heat and processing often denatures the proteins in milk which cause the reaction to begin with. So it typically begins with well-cooked and highly processed foods and progress up to fresh liquid milk. Each stage, or “rung of the ladder,” allows parents to see what and how much dairy their child can safely tolerate before trying the next food. Many times, parents may try a food like cheese, yogurt or liquid milk, and the child has a reaction, so they assume the child can tolerate absolutely NO dairy products, which may or may not be the case. This slow approach allows you to discern exactly what is going on.

Please note: This is not advisable for children that have severe or immediate reactions to dairy sometimes called “IgE mediated” due to the immune response. Please work with your pediatrician and allergist closely! This is really for those children who experience a mild to moderate “non-IgE mediated” milk intolerance.

We recommend you wait until your child is at least 9 months old before starting this process. Remember, avoid fluid milk until 12 months old. We also advise to AVOID lactose-free products. Lactose-intolerance and milk protein intolerances and allergies are two very separate things, and you want to make sure you are honing in on the correct issue.

We recommend give yourself and your child about a week between steps to fully understand their reaction, if any, to the new food. Many of the symptoms of a reaction (reflux, vomiting, tummy upset, bloating, gas, diarrhea, constipation, eczema, other skin rashes) can be caused by many different factors. Did you try a new detergent? Did they catch a bug at daycare or the playground? So if you see any of these symptoms, wait a few days and try the food again to see if the same reaction occurs.

  1. Store-bought highly processed cracker, cookie, or biscuit containing milk powder

  2. Bakery-bought or homemade baked good containing butter or milk

  3. Foods containing cooked cheese or cooked milk as a major ingredient (macaroni and cheese, cream soups, foods containing chocolate

  4. Plain yogurt

  5. Uncooked cheese

  6. Pasteurized fluid milk

You will also want to start each step with a small amount of the food, and then, once tolerated, progressively give larger portions. You may start with 1/4 of a cracker or cookie, then increase to 1/2, then 3/4 to a whole piece, etc.

Start slow and keep a journal. Note the date, the food, the meal, and any other factors that may play a part. This will help keep your sanity and keep your days, foods, and any reactions straight!

We know you've got a lot going on, so we wanted to create a resource that would help you nourish your body while breastfeeding that precious babe. Click here to request our free download all about nutrition while nursing!

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