This ladder is to provide guidance for the reintroduction of cow’s milk in your child’s diet. This ladder is designed for those children with Non–IgE mediated milk allergy. This guideline is not to be used by children experiencing anaphylaxis, facial swelling or respiratory symptoms upon consumption of milk.
If your child has multiple food allergies it is important to ensure that the foods you are introducing are free from these other food allergens so only one allergen is introduced at a time.
The following guidance should help you to understand how to use this ladder
Before starting the reintroduction ladder, make sure your child is well and that any bowel / tummy symptoms or eczema are settled. If your child usually has antihistamine to treat a reaction make sure you have some available in case they have a reaction.
Most children start at Step 1. Some children already eat one or more of the foods on this ladder. If this is the case, you will be advised which step to start from.
For each new milk containing food, start with a quarter portion initially then gradually build up to half a portion,three-quarters of a portion and finally a full portion for your child’s age. This information is to be used as a guide and for some children a larger / smaller portion may be appropriate.
If the food is tolerated, your child should continue to eat this food on a regular basis, along with foods from previous steps and continue to progress through the ladder. It is advised to wait 48 hours before increasing portion sizes of each new food or introducing a new food. Once your child is regularly consuming a variety of foods in each step of the ladder, you can move on to the next step.
If your child does not tolerate a particular food, go back to the previous step. Wait 3 months before continuing the ladder. You may find that your child tolerates a small portion but has symptoms with increased portion sizes.
It is important to only introduce 1 new food at a time so that if a reaction occurs it is clear what triggered this.
Step 1
Garibaldi, Digestive, Malted milk biscuits not chocolate covered or cream filled), ice biscuits.
Step 2
Pancakes, muffin, waffle, fairy cakes, pastries
Croissants, Teacakes, Brioche, malt loa
Processed meats containing dairy e.g. chicken nuggets, deli meats, sausage. Potato products e.g. potato waffles. Cheese flavoured crisps e.g. quavers, watsits. Savoury breadsticks e.g. cheese twists and savoury
Step 3
Milk chocolate, chocolate biscuits.
Pizza, lasagne, fish pie, paneer curry or shepherd’s pie, cheese on toast, fish or chicken in batter.
Custard, Asian Sweets, Rice pudding
n Bought cream of soups, pasta bake.
Step 4
Hard cheese e.g. cheddar and parmesan, margarine/butter, white sauces, ice cream
Yoghurt, lassi, fromage frais, cream cakes.
Step 5
Sterilised milk, infant formula premade carton and boiled cow’s milk.
Step 6
Pasteurised milk /infant formula powder.
Milk Ladder Recipes
Please click on the arrows below to see our recipes
Preheat oven to 180°C (160°C for fan ovens), or gas mark 4.
In a large bowl, cream the butter and sugar and evaporated milk until pale.
Sift the flour in to a bowl and mix it in to form a stiff dough. Add a small amount of water if it’s too dry.
Divide dough into quarters.
Divide each quarter into 10 small, roughly equal balls.
Place the balls on a baking tray lined with greased baking paper.
Flatten balls with the back of a spoon.
Bake for 15 minutes, or until golden at the edges but still a little soft.
Cool the biscuits on a wire rack.
Any unused dough can be wrapped in cling film and frozen. Cooked biscuits can also be frozen.
Milk Ladder Recipes - Step 2 - Mini Muffins
Mini Muffins
Makes 8 muffins
Ingredients
130g flour
40g Cocoa powder
1½ tsp Baking powder
¾ tsp Bicarbonate of soda
100g Soft brown sugar
40ml Any oil
70 ml Prune juice/Apple Puree
200ml Milk
½ tsp Vanilla extract
Method
Preheat oven to 180°C (160°C for fan ovens), or gas mark 4.
In a mixing bowl, combine all of the dry ingredients.
In a separate bowl, combine the oil, apple puree/prune juice, milk and vanilla extract.
Add the wet ingredients to the dry ingredients and lightly mix.
Spoon the mix into a muffin tin lined with muffin papers.
Bake at 180°C (160°C for fan ovens), or gas mark 4 for 20 minutes.
Milk Ladder Recipes - Step 2 - Scotch Pancakes
Scotch Pancakes
Makes 18 pancakes
Ingredients
120g self-raising flour
Pinch of salt
30g caster sugar
1 egg
145 ml milk
Method
Sift the flour into a bowl, add the pinch of salt and the sugar.
Pour the milk into a separate bowl or jug, then crack the egg into the milk, and whisk.
Pour the egg and milk liquid into the dry ingredients, and mix to form a smooth batter.
Heat butter in a frying pan. Test that the pan is hot enough by putting a teaspoon of batter onto it.
Use a tablespoon to drop the batter onto the pan.
When the surface of the batter has become covered in bubbles get ready to flip them over using a spatula.
When cooked remove the pancakes from the pan and serve.
Milk Ladder Recipes - Step 3 - Shepherd's Pie or Cottage Pie
Shepherd’s Pie or Cottage Pie
Serves 4
Ingredients
500g lamb mince or beef mince
1 tbsp. vegetable oil
1 large onion, finely chopped
600ml vegetable stock
½ tsp mixed herbs
1 tbsp. tomato purée
2 carrots, chopped
Sea salt and freshly ground black pepper
900g potatoes, peeled and chopped
55g butter
100mls milk
5g skimmed milk powder (dissolved into milk)
40g grated cheddar cheese
Method
Heat the oil in a medium saucepan, then soften the onion and carrots for a few minutes.
When soft, turn up the heat, add the mince and brown, tipping out any excess fat.
Add the tomato purée, salt and pepper and mixed herbs along with the vegetable stock, cover and cook for around 40 minutes, uncovering halfway.
In the meantime, preheat the oven to 180°C (160°C for fan ovens), or gas mark 4.
Wash, peel and boil the potatoes for around 20 minutes.
Drain the potatoes and mash with the milk, butter and cheese.
Put the mince into an ovenproof dish, top with the mash and ruffle with a fork. Bake for 20 - 25 minutes until the top is starting to colour and the mince is bubbling through at the edges.
Milk Ladder Recipes - Step 3 - Lasagne
Lasagne
Serves 4
Ingredients
Oil, to fry
500g lean beef mince
1 onion, finely chopped
1 red pepper, and 1 green pepper, seeds removed, finely chopped
150g mushrooms, sliced
2 tablespoons tomato purée
2 x 400g tin chopped tomatoes
3 tsp dried mixed herbs
salt and freshly ground pepper
350g lasagne sheets
For the white sauce—20g butter, 20g plain flour and 330ml milk
Topping—40g grated mature Cheddar cheese
Method
Preheat oven to moderate 180°C (160°C for fan ovens), or gas mark 4.
Place mince, onion, peppers and mushrooms in a pan and fry, stirring until the beef is browned.
Add the tomatoes, tomato purée, herbs, salt and pepper.
Bring to the boil and simmer for 30 minutes, stirring occasionally.
To make the white sauce, melt the butter gently in a separate pan, once melted stir in the flour. Gradually whisk in the milk until you have a smooth sauce.
In an ovenproof dish, layer the meat mixture, lasagne sheets and sauce ending with the sauce and sprinkle the top with the cheese.
Cook in preheated oven for 30-40 minutes.
Food for Life Bradford Dietitians
Bradford Nutrition & Dietetic Service is located within Bradford Teaching Hospitals NHS Foundation Trust Telephone: 01274 365108 (8.30am – 4.30pm) Answerphone available outside office hours. Website: Bradfordhospitals.nhs.uk/dietetics E-mail: Dietitians.Office@bthft.nhs.uk
Code: MF-3-2-22Author: Bradford Dietitians
Published by Dietetics Department, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ.
