Overcoming our fears as we start the milk ladder

If you are following the blog you will have seen in a few previous posts that Millie, now almost 11 months old, has a dairy allergy (cows milk protein allergy, CMPA for short) along with a couple of other food allergies. It has meant that the weaning process has been both restrictive and quite complex, slowly trying new foods to make sure there are no other allergies. So far we know she has CMPA, soya and possibly a cod allergy.

As she’s approaching her first birthday and will be starting nursery in a few weeks I have decided to start her on the milk ladder, giving us a couple of weeks at home to take the first few steps with her. The milk ladder is a way of challenging and reintroducing dairy very slowly into an allergy sufferers diet. Each step of the ladder trials milk in different forms, starting with cooked milk leading right up to rung 12 which is tolerating milk in its pure form to drink.

Below is a link to the milk ladder we have been given to follow, there are other alternatives around, some of which differ greatly but offer more flexibility at each stage.  I may look into using a different ladder further along the way as I’m not particularly keen on giving Millie shepherds pie every day for a full week!

Milk-Ladder-2013-MAP

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We had an appointment with a dietician a few months ago to talk through the process and to get all of the relevant information we needed. Quite frankly the appointment was a waste of time! Since then I have done a lot of reading about how to go about a milk challenge and the best ways of following the milk ladder. But for some reason I have still been feeling incredibly nervous! Im guessing its quite common to feel this was as its a fear of the unknown, wondering what symptoms or reactions your baby will have, not wanting to cause them any pain, worrying that they will fail the challenge! So I thought I’d write a list of some of the really valuable advice I’ve read and things to remember along the way:

– Take all the time you need – although the recommendations are to try each step for a week and if no reaction move on to the next step, if you don’t feel ready or are unsure if there has been a reaction then there is no need to move on just because the week is up. My health visitor suggested to try each step for two weeks initially for Millie as she had only ever been exposed to dairy through breast milk so we were unsure of her reaction symptoms.

– Talk to others who are also starting the ladder – this has been crucial for me. I think because we didn’t have a very positive experience with our dietician I have called upon various support groups whenever I have had a question. I also regularly look through previous posts in the groups as there is more than likely someone out there who has already asked the exact same question that is worrying you. (this group on facebook has been invaluable for us CMPA Support For Weaning)

– Familiarise yourself with possible signs of a reaction – for us Millie’s reactions had always been fairly sudden and severe vomiting, explosive nappies and a swollen tummy. It wasn’t until I started reading a bit more that I discovered things like puffy eyes, coughing and wheezing, dark circles under their eyes, constipation and even blood in their stools can be a sign of a reaction. Because these had never happened to us I wouldn’t have know to watch out for them.

– Make others aware – this may seem obvious but in our case I intend to fully brief Millie’s nursery of the stage we are at on the ladder before she starts and also give them full details of things to look out for in case she starts showing a reaction while she is in their care. Thankfully it doesn’t seem like Millie has any IgE reactions to cows milk (things such as breathing difficulties, swelling of the lips and tongue, loss of consciousness etc) but I still think it’s crucial to keep updated anyone who is caring for your child as you never know how well aware they are of allergies.

– Be prepared – if you plan to cook everything for each stage of the ladder yourself make sure you have all of the recipes to hand ready for moving on. Alternatively if you are using shop bought products make sure to check the ingredients to ensure they include the right form of diary ie malted milk biscuits for stage 1 should include milk powder not whey powder.

– Don’t panic – if your little one does react the best advice I have been given is to not panic. You need to stop all dairy for at least a month, or longer if symptoms still haven’t cleared, and then restart again from stage 1.  Some children take a good few years to grow out of their allergies and only a few manage to complete the ladder first time round.

We are now on day five of stage 1, Millie has been eating a full malted milk biscuit everyday for five days without any severe reactions but I will do a full update at the end of each week which will also include any recipes we have used.

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