The MAP Milk Ladder
The gold standard for reintroduction of cows milk for mild to moderate non IgE CMPA is known as 'The MAP Milk Ladder'
The milk ladder may come in many different styles, but essentially they all follow the same process, slowly reintroducing cows milk protein (CMP) starting with milk cooked in products at high temperatures for a long time and slowly decreasing the amount of cooking whilst increasing the volume of CMP ingested as your child moves up the ladder.
This method is safe for children who have a mild-moderate non IgE allergy to cows milk, but may not be suitable for children with a severe non IgE allergy or an IgE or mixed non IgE/IgE allergy. These children will usually be offered a trial in a hospital setting to begin with,following a satisfactory allergy test result, and if this is successful they may then be advised to follow the milk ladder at home.
Always speak to your child's HCP before you embark on any reintroduction plan.
Reintroducing any allergen is an exciting but stressful time for parents, we worry that we could bring on our child's symptoms by giving them foods we have been avoiding for months or sometimes even years, yet at the same time we are excited to finally feed our children "normal" food and it is completely normal to have these mixed emotions when advised to follow the ladder.
Reintroduction is a unique experience for each child, some may pass the ladder on the first try at around 12 months, and others may fail repeatedly until school age, some may pass the first few steps and then fail a step, you will not know how your child's journey will play out until you begin.
There are lots of tools available to help you plan your child's journey up the ladder, including recipes to make home made items including gluten, wheat, egg and soya free items, should your child be avoiding other allergens at the time you are reintroducing milk.
CMPA Support for Reintroduction group on Facebook is another great resource providing practical advice and support from parents who are on the reintroduction journey and from parents who's children have completed the reintroduction ladder successfully, not only for reintroduction of CMP, but also for reintroduction of other common allergens.
Tips for reintroduction.
- Before starting the ladder and progressing on to the next steps, make sure your child is well and any gastrointestinal and eczema are settled.
- Most children will start on step 1, some may already eat one or more of the foods on the ladder. If that is the case, you need to be advised which step of the ladder your child should start from.
- Time spent on each step is individual to the child, some may only need one day whereas others may need much longer, this should be discussed with your child's HCP.
- If the food on any step of the ladder is tolerated, your child should continue to consume this in their normal diet (as we as all the food in the previous steps,) and then try the foods suggested on the next agreed step.