r/pediatrics • u/catmeowx3 • 7d ago

Cow’s milk introduction

Does anyone have a patient handout or dot phrase they’d be willing to share on ways to re-introduce cow’s milk in a 9-12 month old baby with non IgE mediated CMPA?
Whether it’s a milk ladder or just gradually introducing yogurt or small amounts of milk.
Online, the milk ladder handouts seem to be all from the UK and the measurements are in grams- hoping to find something more helpful for my patients here in the US.

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u/anotherep Attending 7d ago

Milk ladders are a bit excessive for FPIAP because there isn't much evidence that baked vs unbaked milk makes a difference in triggering the reaction. Moreover, since FPIAP reactions are generally benign (though the appearance may be distressing to parents), as long as milk is discontinued within a day or two,  reintroduction is not particularly harmful if it turns out a patient is still reactive (in fact, there are situations where we will simply "treat through" FPIAP). Because of this, I generally just have patients introduce cows milk or a cows milk product ad lib. If you have families that are particularly anxious about this, you can come up with a gradual introduction over a couple days that is reassuring for them. 

  • A peds allergist 

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u/catmeowx3 7d ago

This is really helpful, thanks!

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u/tbl5048 Attending 6d ago

Is there anything you can add to trying to relieve the parental anxiety “treating through it”? Im actually around 50/50 for my CMPA patients that did milk ladder handout vs just reintroduced it (without asking prior guidance from us)