A practical guide for reintroducing milk using the milk ladder

This practical guide has been developed to support Healthcare Professionals in advising families on the safe and effective reintroduction of cow’s milk using the six-step international milk ladder. It brings together expert clinical insight, evidence-based guidance and real-world considerations provided by specialist paediatric dietitians and parents.

The booklet is designed for use with children diagnosed with mild-to-moderate non-IgE-mediated cow’s milk allergy who have been assessed as ready to begin reintroduction. It outlines how to prepare families, identify readiness, select suitable starting points, and tailor progression through the ladder based on individual tolerance and response. It also provides practical advice on portion sizes, alternative food options, managing delayed reactions, and supporting families through common challenges such as fussy eating, illness, and differing care settings.

Healthcare Professionals can use this resource to:
• Offer consistent, structured guidance to families starting the milk ladder
• Support shared decision-making and individualised care planning
• Provide reassurance and evidence-based strategies to manage reactions and setbacks
• Empower parents and carers with clear, accessible information to build confidence at home

This guide is not a substitute for clinical assessment or personalised advice. It is intended to be used alongside your professional expertise to ensure safe, gradual reintroduction tailored to each child’s needs.