Background Cows’ milk allergy is common, occurring in up to 2% of infants. To facilitate oral tolerance, the reintroduction of baked milk initially, followed by progressively “rawer” forms is recommended. Many “Milk Ladders” exist guiding clinicians in this including: the St Bartholomew’s (Bart’s), BSACI (British Society of Allergy and Clinical Immunology), Cardiff (REACH Team), and MAP (Milk Allergy in Primary care) ones.
Aim To compare parents’ views and preferences on four milk ladders.
Methods A pilot questionnaire was devised and tried for clarity; minor revisions were made. The final version had 9 questions: the first seven questions assessed aspects including layout and practicality through questions such as, ‘How clear do you think the language and layout is?’, and ‘How clear is it when to progress to the next step of the ladder?’. All of these 7 questions were scored by the parents out of a possible high score of 5, giving a possible total score of 35. Two further questions assessed parental understanding in using the ladder, through questions that asked at which stage of ladder items such as yoghurt and milk would be on. The questionnaire was distributed to Parents/Guardians of children of any age on the Wards and Outpatients Departments; each participant was given two randomly allocated ladders to assess. SPSS was used for data analysis.
Results 150 questionnaires were distributed and 123 returned with 11 non-responders and 16 incomplete. Participants reviewed 252 Milk Ladders.
A one-way Welch ANOVA assessed the mean questionnaire scores with these being statistically significantly different (p < 0.0005) between the groups. The BSACI ladder scored worse than the other three ladders, whilst Cardiff scored higher than the Bart’s ladder.
Conclusion Parents found all milk ladders helpful, preferring aspects such as a boxed layout and fewer stages. Overall the Cardiff Milk Ladder was found easiest to use. This preliminary study has highlighted the need for further research on Milk Ladders.
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