Baked milk home reintroduction

Introduction

Please read the whole of this information sheet before starting a home reintroduction of baked milk.

Most children with cow’s milk allergy grow out of it in early life. As the allergy resolves with time, many children will initially tolerate well cooked (baked) milk products before they can eat lightly cooked or uncooked fresh milk. It is appropriate to try reintroduction of milk at home in some children where there have only been mild reactions to milk (for example hives, mild swellings, gastro-oesophageal reflux.)

Children who have had more severe symptoms (such as breathing difficulties or collapse) may need to have a reintroduction performed under hospital supervision. This protocol informs parents how to perform the milk reintroduction at home. Use the following information only as a guide. There may be variations for individual children, which your dietitian or doctor will explain.

Guidance notes

You will be introducing baked milk over a period of weeks, rather than over one day as you may have seen happening in hospital. The protocol below will guide you how to do this.

For the reintroduction you will need a malted milk biscuit containing less than 1g of baked cow’s milk powder or protein (do not use a biscuit with any type of undercooked cow’s milk, such as a cream filling). You may stay at each stage for longer than as shown below, but do not increase to the next ‘dose’ of biscuit more quickly.

Try to give the dose every day. If you miss several days (for example, if your child is unwell), give a smaller dose when you restart and build up.

Do not increase the dose if your child is unwell. Keep them at the same dose that they have already been tolerating. Symptoms of a reaction can usually occur up to 2 hours after the last dose (worsening of eczema usually occurs after some hours, or the next day).

Week 1

1. Postpone starting reintroduction of baked milk if your child is unwell.
2. Have child’s usual antihistamine medicine ready and available.
3. Begin by giving your child a small crumb of biscuit to eat. Observe carefully for any sign of allergic reaction.
4. Give a small crumb of biscuit every day for a week.

Week 2

1. Large crumb to be eaten daily (for 2 days)
2. One sixteenth of a biscuit to be eaten daily (for 2 days)
3. One eighth of a biscuit to be eaten daily (for 3 days)

Week 3

• A quarter of a biscuit to be eaten daily (for 7 days)

Week 4

• Half a biscuit to be eaten daily (for 7 days)

Week 5

• 1 whole biscuit to be eaten daily (for 7 days)

After your child has successfully completed the baked milk challenge

Do not allow other foods containing milk until 1 whole milk containing biscuit is tolerated for a week, or you have spoken to your dietitian, doctor or nurse.

Please see the information resource ‘Introducing baked milk‘ for advice about which foods are suitable for a child who can tolerate baked milk. This will guide you to choose appropriate foods after your child has completed this home baked milk introduction and is eating the malted milk biscuits without a problem. Do not worry if your child does not like to initially eat milk products. This is quite common.