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Milk challenge guidance
- Follow this advice only if your child has been assessed by a doctor or dietitian and they have told you that it is safe for you to do a food challenge at home.
- Do not attempt a milk challenge if your child has a severe reaction to cow’s milk or milk products.
- Only follow the milk challenge under supervision of a healthcare professional.
About the milk challenge
- The milk challenge (also called a milk ladder) contains 6 steps. Each step usually takes 3 to 7 days.
- Each step increases the amount of milk protein you give to your child.
- The challenge also involves giving your child forms of protein that are less processed on every step of the ladder.
- Start with a small amount of the food on the first day. Gradually give a larger amount of the food each day, until your child takes a standard portion for their age.
- If your child can already tolerate some foods containing milk, start on ladder step which is closest to where your child is at the moment (rather than at the bottom).
- If your child reacts to one step, stop the challenge. Wait another month before you try to move up the ladder again.
- It is important that your child keeps eating any dairy foods that they already tolerate.
A note about calcium
| Babies under 1 year old | Aim to give 500 to 600ml infant formula per day (whether milk free or normal formula). |
| Toddlers who remain allergic to cow’s milk | Give them 300ml calcium fortified milk substitute (such as soya, oat, pea or coconut milk). This will meet their daily calcium requirements. |
| Toddlers who have outgrown their cow’s milk allergy |
Give them 300ml cow’s milk. This will meet their daily calcium requirements. If you prefer, you can swap 60g fromage frais or yogurt for 60ml milk and you can swap 30g cheddar cheese for 180ml milk. |
| For other age groups |
Follow the steps on the ‘milk ladder’ by finding out if your child tolerates these milk protein foods.
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Step 1: home-made biscuits (see recipe below) Or use the following: malted milk biscuits, garibaldi biscuits, bread that contains milk (such as milk roll or M&S sliced bread or naan bread). |
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Step 2: muffins (see recipe below) Or plain fairy cakes, croissants, brioche, waffles, or shop bought scotch pancakes. |
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Step 3: pancakes (see recipe below) Or use the following: dishes cooked in the oven for at least ½ hour at a temperature of at least 180C. These include shepherd’s pie with milk and cheese, fish pie with milk and cheese, lasagne, pizza etc. |
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Step 4: cheese Pick a hard cheese (such as cheddar or parmesan) and give it to your child uncooked. Aim to reach a 15g portion. |
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Step 5: yoghurtAim to reach a 125g pot. Once your child tolerates the steps above (1 to 5), you can try introducing the following foods:
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Step 6: milk If your child is under 1 year of age: ready made liquid formula milk or formula milk made up from powder. If your child is over 1 year of age: cow’s milk (including UHT or longlife milk). |
When do I start?
- Make sure your child is well and is not suffering from a cold, flu or any other childhood illness. If they have asthma or eczema, make sure their symptoms are under control.
- Choose to start when your family is relaxed and you have time to concentrate on the challenge and do it carefully.
- Do not introduce any new foods while you are doing the challenge.
Allergic reactions to look out for
Look out for the following allergic reactions.
Mild to moderate symptoms
- Tingling/itching sensation in the mouth
- Feeling hot or chilled
- Intense itching
- Rapid development of nettle rash or hives
- Swelling, particularly of the face
- Increased anxiety
- Nausea or vomiting
- Abdominal pain or diarrhoea
- Unusually pale appearance
- Mild wheeziness.
Treatment for mild to moderate symptoms
Give your child antihistamines and keep an eye on them to check that they recover.
If your child is wheezing, let them use their reliever (Salbutamol) inhaler, if they have one.
Follow your child’s personal paediatric allergy action plan.
If you are worried, call NHS111 or go to your nearest Emergency Department (A&E).
Severe symptoms
- Difficulty in breathing (wheezing or hoarseness or a croupy sound).
- A lower level of consciousness: faintness, pale complexion, floppy limbs, generally unresponsive
- Physical collapse.
Action required for severe symptoms
Call 999 and seek emergency help immediately if your child shows severe symptoms.
Milk challenge recipes
Tips
- Cool the dough in the fridge for 30 minutes. This makes it easier to handle.
- Add ¼ teaspoon of xanthan gum if you use wheat-free flour.
- If you want to use a small cookie cutter to make more attractive shapes, divide your dough in 20 balls. Squish each ball in the cookie cutter.
Sweet biscuit ingredients
- 125g plain flour
- 50g cold dairy free spread
- ¼ to ⅓ of a cup of grated apple or pear or pureed banana
- 1 teaspoon of skimmed milk powder
- A few drops of vanilla essence or a tiny pinch of cinnamon for flavour.
Sweet biscuits method
- Heat your oven to 180C (or 350F).
- Mix the flour (and xanthan gum if used) with the milk powder.
- Rub in the cold dairyfree spread.
- Mix in the grated fruit and your flavouring (vanilla or cinnamon). You may need to add a little bit more grated fruit if the mix is too dry.
- Roll out the dough and cut it into 20 finger sized strips.
- Bake for 10 to 15 minutes in the oven.
Savoury biscuit ingredients
- 125g plain flour
- 50g cold dairy free spread
- 40g grated dairy free cheese
- 1 teaspoon of skimmed milk powder
- 2 tablespoons of water.
Savoury biscuit method
- Heat your oven to 180C (or 350F).
- Mix the flour (and xanthan gum if used) and milk powder.
- Rub in the cold dairy free spread.
- Mix in the dairy free cheese. Add the water. Add a little more water if the dough seems dry.
- Roll out the dough and cut it into 20 finger sized strips.
- Bake for 10 to 15 min in the oven.
Tips
- Use a whisk and mix the milk and oil together to make the muffins lighter.
- These muffins are quite large. Make sure you use muffin moulds that are big enough.
- Add ½ teaspoon of xanthan gum if you use wheat free flour.
Sweet muffin ingredients
- 250g plain flour
- 2½ teaspoons (10g) of baking powder
- 2 level tablespoons (25g) of sugar. (If your child is over 2 years of age you can add 2 to 3 tablespoons)
- Pinch of salt
- 50ml sunflower oil
- 250ml milk
- 110g of finely chopped or mashed fruit (apple or pear or banana)
- A few drops of vanilla essence.
Sweet muffin method
- Heat your oven to 180 to 200C (350 to 400F).
- Mix flour (and xanthan gum if used), baking powder, sugar and salt.
- Mix the oil and milk together. Add the liquids to the dry ingredients.
- Add the chopped fruit and vanilla essence and mix through.
- Bake for 20 mins in the oven.
Savoury muffin ingredients
- 250g plain flour
- ½ teaspoons (10g) of baking powder
- Pinch of salt
- 50ml sunflower oil
- 250ml milk
- 60g of grated dairy free cheese
Savoury muffin method
- Heat your oven to 180 to 200C (350 to 400F).
- Mix the dry ingredients together: flour (and xanthan gum if used), baking powder and salt.
- Mix the oil and milk together and add to the dry ingredients.
- Add the cheese and mix through.
- Bake for 20 mins in the oven.
Tips
- You can flavour the pancake dough to taste. For example vanilla essence for a sweet pancake or fresh herbs for a savoury pancake.
- Each pancake is about the size of a small ladle of dough.
If your child dislikes cake or pancake textures, you can do the following:
- boil a small potato
- add 40 ml of milk and a little milk free spread
- cover with foil and bake in the oven for 40 minutes at 180C to 200C.
Pancake ingredients
- 125g plain flour
- 2½ teaspoons (10g) baking powder
- 1 pinch of salt
- 2 tablespoons of sunflower oil
- 250ml milk
- 50ml water
Pancake method
- Add all the ingredients to a mixing bowl and mix together.
- Fry in a hot pan.
More information
Contact information
Kingston Hospital Nutrition and Dietetics Administrator, Monday to Friday. Voicemails are checked daily.