Milk allergy occurs in around 3 – 5% of children, but most outgrow their allergy between 3 and 6 years of age. Children with less severe reactions often outgrow their allergy more quickly.
- If your child has had a severe reaction (chest tightness, swelling, wheeziness, or bad asthma), their milk challenge should take place in a hospital setting.
- If symptoms were less severe, you can proceed with a home challenge as outlined below.
- Discuss with your Dietitian, GP, or Health Visitor if you are unsure where your child should be challenged.
Some children may develop tolerance to certain amounts of milk products but not large amounts (e.g., some can manage baked milk products but not cow’s milk as a drink).
Milk Reintroduction Video
Before Starting a Milk Challenge
- Ensure your child is well.
- Ensure no recent accidental exposure to milk products that caused a reaction.
- If prescribed an anti-histamine (e.g., Piriton), have it available in case of reaction.
- Wait at least 2 weeks after immunisations (including MMR) before starting.
- Choose a suitable time to monitor your child for reactions or changes in behaviour.
- Consider keeping a food and symptom diary (note changes in sleeping, irritability, skin, or bowels).
- Start the challenge in the morning, not evening, as delayed reactions may occur.
A milk challenge is usually advised around 1 year old OR approximately 6 months after starting a milk-free diet.
Stages of Milk Reintroduction
Below is a table detailing the stages for reintroducing cow’s milk products:
| Stage | Foods to Introduce |
|---|---|
| Stage 1: Baked Milk Products | Biscuits containing milk (e.g., Malted Milk, Heinz biscotti), bakery goods (brioche, milk roll, naan bread, croissants, pastry, baked Yorkshire puddings), plain cakes (pancake, scone, sponge, waffle), crackers/breadsticks with milk/cheese powder, crisps with milk/cheese powder (Quavers, cheese puffs), cold meat, sausages, fish fingers in batter/breadcrumbs with milk. |
| Stage 2: Boiled Milk Products | Custard made from instant powder and boiled milk, ready-made custard, rice pudding, main meals with boiled milk (shepherd’s pie, fish pie), small amounts of boiled milk in meals, UHT/long life milk in meals/cereal, tinned soup with cream or milk. |
| Stage 3: Dairy Products | Butter, yoghurt or fromage frais, cooked cheese on toast/pizza, grilled halloumi, dishes with cooked cheese (lasagne, baked pasta). |
| Stage 4 | Uncooked cheese (sandwiches, crackers, snack), fresh cream, chocolate, uncooked non-yogurt desserts (cheesecake, mousse, ice cream, cream cakes). |
| Stage 5 | Cow’s milk as a drink. |
Guidance Notes for Food Introduction at Each Stage
- If your child reacts at any stage, do not progress further. Continue to offer foods from previous tolerated stages and re-challenge every 3 months.
- Stage 1: Start with a small bite of biscuit, double the amount daily until a full portion is tolerated. Continue daily for 5 days, then offer other foods from stage 1 for about a month before moving to stage 2.
- Stage 2: Choose a food from the list, start with 1 teaspoon, double daily until a normal portion is tolerated. Continue stage 1 and 2 foods for a month before progressing.
- Stage 3: Start with a bite of toast with butter, double daily until a normal portion is tolerated. Repeat with yoghurt/fromage frais and melted cheese on toast. Continue stage 1, 2, and 3 foods for a month before progressing.
- Stage 4: Start with ½ teaspoon of grated cheese or cheese cube, double daily for 5 days. Continue stage 1 – 4 foods for a month before progressing.
- Stage 5: When stages 1 – 4 are tolerated, introduce uncooked cow’s milk. Start with 1 tablespoon in cereal or food, double daily until around 150mls is included daily. Then offer as a drink, starting with 50:50 cow’s milk to milk alternative or formula, gradually increasing until fully tolerated.
Post Reintroduction Advice
- Monitor your child’s symptoms closely during and after reintroduction. New symptoms may appear over time.
- Watch for: food refusal, picky eating, weight loss, poor sleeping, irritability, altered bowels, rash or eczema flare-ups.
- If you suspect a reaction, trial a milk exclusion diet for ~1 month and see if symptoms improve.
- For queries or concerns, contact your local Dietitian:
Forth Valley Royal Hospital, 01324 566626
Additional Information
- Between ages 1 – 5, your child should take a Vitamin D supplement of 10 micrograms daily. Health visitors can provide Vitamin D drops free until age 3.
- Always check ingredient lists for cow’s milk protein, especially in ready-made products. Manufacturers may change recipes.
- We do not endorse any particular brands or products.