Advice Needed on Starting the Milk Ladder Challenge for 16-Month-Old with CMA

[WeeG123]

Hi everyone,

I’m looking for advice from parents who have gone through the milk ladder challenge with a child who has Cow’s Milk Allergy (CMA). Our 16-month-old son reacted to breast milk and Aptamil formula when he was about six weeks old, so we switched to Neocate formula and have been using it ever since.

Recently, we started testing the waters. He has been fine with milk biscuits, and my wife tried him with some Cheerios in cow’s milk, and he seemed okay with that too. But I’ll be honest, I (Dad) feel really nervous about trying anything more.

Here are some of the things I’m struggling with and would appreciate advice on:

1. When did you start the milk ladder with your child, and how did you approach it? I’m worried about pushing him too fast or too slow. If we wait too long, is there a risk he might not outgrow the allergy?
2. Bedtime milk: He still likes a bottle before bed, but he’s off bottles during the day. We’ve kept him on Neocate formula for this, as he doesn’t seem to enjoy soya milk or the like. Is it okay to keep using formula for his bedtime bottle, or should we be encouraging something else? I feel like people might judge us for still using formula when others his age are already on cow’s milk.
3. Introducing nuts and other allergens: We haven’t tried anything like nuts yet because of the CMA. How do we navigate that when we’re still not fully confident with dairy?

I’d really love to hear how others approached this, especially from anyone who’s been in a similar situation. It’s a lot to juggle, and I want to make sure we’re doing the right thing for him.

Thanks in advance for your advice!

A nervous dad

You need to search for a milk ladder IMAP do a 6 or 12 step ladder. My daughter uses the north west ladder but the portion size increases very slowly. You use this but start at 1/8 portion rather than size of a grain of rice

There's two parts to the ladders building up portion size and moving from baked to purer forms of dairy.
The various ladders vary but loosely you want to build up to a full portion in at least 3-4 stages. For example 1/8, 1/4, 1/2 then full.
They all start with heavily baked dairy in a flour matrix (biscuits) then less baked eg cakes/pancakes then move to baked dairy like the sauce in lasagne then cooked cheese then uncooked cheese then yoghurt and milk. Some ladders have very gradual increments in types of dairy (ie 12 steps of increasing dairy based foods) and others do less steps for the types of dairy but much slower in the portion size (north west ladder). What's right depends on the child. Sensitive children want to build up portion sizes slower but if they aren't sensitive any of the other ladders are probably ok.

I feel for you, things are tough with an allergy baby! We started around 18 months and were advised to follow the imap milk ladder, which has very detailed guidance.

gpifn.org.uk/wp-content/uploads/2019/10/imap_final_ladder-may_2017_original.pdf

If your little one tolerated cows milk on cereal, you have skipped right up to the top of the ladder! I would still suggest to go back and follow it from the bottom, but you can take that as a very positive sign!

With regard bedtime milk, just go with whatever works for your family and what your son likes. Ignore any external pressure or judgement, it really makes no difference. I breastfed my little girl until she was 2 and had someone ask why she wasn't on cows milk yet....Umm because she's not a baby cow?

Re other allergens, just make sure you test them one at a time in isolation (i.e. no other new foods at the same time) and watch carefully for symptoms. You may find it helpful to keep a food diary.

HTH, good luck!

Missed some of your other questions.

My daughter was on alfamino until 2 under dietician and paediatrician. She then went onto a beaker of oat milk. She wouldn't drink the oat milk until 20-22 months. Give it a bit more time

The advise now is to introduce the other allergens as early as possible to reduce the risk of allergies - even before weaning has fully started under 6 months. I would pick a good day when you aren't stressed and running around and go for it. Do it early in the day and on a weekday when it's easier to get advice if needed. You wouldn't want to be doing the milk ladder at the same time as testing other allergens so I would be introducing other allergens as priority over doing the milk ladder.

How is your relationship with your HV? It might be worth asking for done advice from them. They can also do dietician referrals if they seem it necessary.