Cow’s Milk Protein Allergy, the next steps…

Welcome to the final part of the four part overview of how to not just survive but thrive with Cow’s Milk Protein Allergy. I really hope this series has helped and has answered most of your questions.

  1. Cow’s Milk Protein Allergy, the basics
  2. Management of Cow’s Milk Protein Allergy
  3. Cow’s Milk Protein Allergy and Complementary Feeding
  4. Cow’s Milk Protein Allergy, the next steps…

As your infant with a cow’s milk allergy is getting older you may be starting to think about what happens next. You may also be wondering when you are able to reintroduce cow’s milk (unless you are vegan or avoid dairy for other reasons). The avergae age for children to grow out of their milk allergy is 18 months, however this is an average so it could mean your child will grow out of it sooner or later.

It is recommended that children with a milk allergy continue being breast fed or given a hypoallergenic formula until the age of 2.

Plant based alternative milks which are fortified with calcium can be used in your child’s diet in cooking and cereal from 6 months.  It may be possible to switch to calcium-enriched alternative milks as a main drink from the age of 1 if your child is monitored by an appropriate health professional such as a paediatric dietitian or paediatrician. This is because plant based alternative milks do not have the same amount of fat and protein as full cream milk. It is important that we ensure that children are growing well and have these nutrients replaced by other means.

Remember also that rice milk is not suitable for a main drink up to the age of 5 due to the high arsenic content.


Calcium is an important factor in all children and toddler diets whether they have a milk allergy or not. I have outlined the daily requirements below and as you can see requirements drop significantly over the age of 1.

Age Calcium requirements per day
Under 1 525mg
1-3 350mg
4-6 450mg
7-10 550mg
11-18 800mg (girls) 1000mg (boys)
Adults 700mg
Breastfeeding mums 1250mg

Here are a few foods below with their calcium values next to them. I’ve put regular cow’s milk at the top for reference.

Food Portion Calcium
Cow’s milk 100ml 120mg
Calcium enriched alternative milk (soya/coconut/hemp/almond/oat etc…) 100ml 120mg
Cheese 30g (matchbox size) 220mg
Yoghurt 120g 200mg
Calcium fortified soya yoghurt/dessert/custard 125g 150mg
Calcium fortified breakfast cereal 30g 137mg
Calcium-fortified bread 1 slice (40g) 191mg
Sardines (with bones) ½ tin (60g) 258mg

For more sources of calcium and more information in general look at the BDA Calcium Food Fact Sheet

Remember that children need to be taking a Vitamin D supplement of 10ug per day in order for them to absorb the calcium they are consuming.


The other nutrient that I feel gets neglected is iron, please see the table of requirements below.

Age Iron Requirements
7-12 months 7.8mg
1-3 years 6.9mg
4-6 years 6.1mg
7-10 years 8.7mg

Red meat is the best source of iron followed by other meat. Good sources also include: fortified breakfast cereal, beans, nuts, dried fruit and wholegrains. Further information on meat free sources of iron can be found here on a fellow Paediatric Dietitian’s blog: Five Perfect Iron-rich Plant Foods.

If you are concerned that your child is not getting enough of any nutrients contact me or your GP.

Reintroduction of cow’s milk proteins

It is common to attempt reintroduction of the cow’s milk proteins from the age of 1. Or at least 6 months after diagnosis if the child was diagnosed very early on. Often children are accidentally exposed to cow’s milk by older siblings or in public. This can often be a blessing as parents and carers rarely like to do it on purpose. These reactions can be monitored, it’s useful to report back to the health professional who is overseeing your child’s treatment if an accident occurs, no matter what the outcome.

Starting reintroduction can be a really scary prospect, nobody wants to intentionally make their child unwell. Remember that any accidents or a failed reintroduction will not harm your child, they may have unpleasant symptoms for a short time but it does not affect them in the long term.

If your child has a severe non-IgE allergy or an IgE mediated allergy speak to your Dietitian or Paediatrician about reintroduction. If you’re not sure what kind of allergy they have check with your GP or Health Visitor or feel free to contact me .

The MAP Milk Ladder

The Milk Allergy in Primary Care (MAP) milk ladder is a fantastic resource that enables families to introduce cow’s milk protein back into a child’s diet systematically and gradually. It is only suitable for infants and toddlers with a mild-to moderate non-IgE allergy.

The MAP milk ladder is based on the idea that the more you process milk proteins, the more they are denatured (broken down). It also makes a difference what they are processed with, for example wheat creates a matrix around the milk proteins.

Click here for the MAP Milk Ladder . It is good to talk to your GP, dietitian or Paediatrician before starting the milk ladder and there are instructions on the back.

*I have heard that there will be an updated milk ladder coming soon called the iMAP ladder, when this comes out I will update this post.


I really hope that you have found this series on cow’s milk allergy useful, it is a real passion of mine after I have lived through it myself. It feels like the worst thing in the world especially if your baby is tiny when diagnosed but I hope I have given you lots of information and practical tips to make the journey a bit easier. Please contact me if you have any questions or comments. I love to hear from you!

If you are at all concerned with your child’s intake have a look below at my new service:

Nutritional analysis-4
Click here to check your child is getting everything they need for growth and development.

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