Milk Ladders for cow’s milk re-challenging are designed to move from highly baked cow’s milk in a flour matrix e.g. biscuits and breads, to cow’s milk containing meals baked in an oven e.g. pizza, shepherds pie, lasagne. The ladder then moves onto products where the cow’s milk proteins are altered by other means, such as by fermentation in cheese and yogurts, before starting the final phase of introducing cow’s milk. This is often done by using UHT or sterilised milk first which has a higher level of heat treatment before using fresh, pasteurised milk.
Each stage should start with small amounts, gradually increasing to a normal portion before moving onto the next stage. Adding fresh milk to mashed potato could therefore be done as a first step in the final stage of the milk ladder. With the support of a dietitian through these stages can avoid confusion and enable smoother transitions.