Milk Ladder Experience

[RoseH36]

My 13 month old has been on SMA formula since she was a few weeks old after bringing up entire feeds on other formula.

Around the time of weaning we tried her with a malted milk biscuit, she was sick on and off for the next day and didn't touch dairy with her again.

I am lactose intolerant and my mom can't tolerate one of the proteins in milk.

Saw paediatrics earlier this week who said to start the milk ladder again.

Wednesday lunchtime she had just a corner of a malted milk. That night she threw up once in her sleep.

Thursday she was fine during the day but again threw up overnight. No dairy was consumed during the day.

Yesterday she continued to be sick when having any solids or her bottle in the morning. She was incredibly drowsy all day. Took her to the GP who seemed to think it was viral, GP was aware of starting the milk ladder.

Again today she's only been able to keep water down, was sick after some of her bottle and really sleepy and tearful.

I'm at a loss as to whether this is a bug or a reaction to the malted milk from Wednesday. Has anyone else had a reaction last this long? Just seems too coincidental to me.

It sounds like a reaction. There’s a milk ladder expert on instagram called the Lydia, The Milk Allergy Dietitian.

I would leave it a few weeks and try again if it happens again she’s not ready. Ds was 6 before we successfully completed the milk ladder and tbh he can’t have loads still

How much malted milk the last time?
We started with a corner then an 1/8th and progressed up to 1/4 , 1/2 and then a whole biscuit 1 over about 6 months.

The long reaction time doesnt chime for me we are done and dusted in 6 -12 hours.

In general - Liquid piriton is your friend (well...its mine)

I'd give it a few weeks and try and small corner again then see.... but given how prevalent the allergy is in your family your DC might not progress fully up the ladder.

Given your family history, your child is at higher risk of not growing out of this very early. It is recommended to wait between 3 and 6 months before retrying. Many children do not grow out of their allergies until they are 3 or 6 years old.

Outside of this incident, is she generally healthy? Is she growing? Is she getting sufficient nutrients?

She is still very young and food is very new for her.

My son took weeks to recover from exposure to allergens. I stopped trying, I kept his diet 'clean', he grew, he was not sick, we were all happy and not stressed. He is my third and most allergic child. I learnt from DC 1 and 2, that healthy and happy was better than the perceived benefits of successful reintroduction. Age 16, he is the most robust of our children in so so many ways.

100% agree with this! If you can live without the allergen, then don’t stress with the ladder until much older! Life is hard enough now.

While there is lots of evidence about the reintroduction, there is not much accessible research that I can find that compares the overall and long term of children that avoid allergens hit get adequate nutrition from other sources compared to those that reintroduce .. I would love to see this.. looking at skin, asthma, othe rgut problems, frequency of other illnesses. And what about health into adulthood.. if those who avoid dairy in childhood continue to avoid dairy in adulthood, do they develop the same chronic illnesses in middle and old age as those who reintroduce.

In many studies there is significant drop put rate, often reported as difficulty with compliance which sounds like a patient / parent issue.. but could be that parents decide they can not continue to put their children through this cycle of stress and recovery and decide that the benefits of increasing tolerance to a specific food do jot outweigh the risks of constantly putting the immune system under stress.

I remember a conversation with an immunologist which went something like... we really don't understand why we are seeing more and more children with allergies. The old advice was not reducing the problem so we are trying a different approach.

While there is some very compelling evidence for early introduction and maintained exposure, it relies on exposure from 4 months and vigilant maintenance and the exclusion rates and rates from the research where significant. We have to ask, what was missing from the picture when the results were analysed, why are we still seeing allergies increasing and what other factors should we be taking into account.

I don't have the answers, but when you are faced with the question as to whether to push forward with introduction, you should consider what is best for your child, at this moment and always consider what happens if you wait.

That sounds a lot like a bug that seems to do the rounds from time to time.

I’d wait for it to clear, give it a few weeks and try again (if you’ve decided to try the milkmladder).

If get same again then can put it down as a fail at step one and ignore the topic for months.

Sorry to keep coming back - and based on my own experience - if exposure to an allergen increased the likelihood that it was quickly followed by what looked like a virus or other illness, there is a likelihood that the exposure to the allergen was a part of the picture. It took me many many 'viruses', many doctor visits, many conversations with medical professionals who disputed this, who said it was normal, who implied that I was an anxious mother.. to work this out.

Thank you for all your replies. After a day yesterday of no sickness she brought her bottle up within 10 mins this morning (she's down to 2 a day). Took her to hospital who can't find any obvious reason for the sickness but just to keep an eye on her. She kept weetabix down at lunchtime. So I do now think it's unlikely to be from the biscuit, which was less than a quarter consumed. I will be leaving the milk ladder for this year and look to try again after Christmas. She's managing a good range of foods without dairy in, is happy, healthy and growing fine so no other issues.