EASY for a 5 month old with working parents

[heather8844]

Newbie here!
My LO is almost 3-1/2 months old. She has recently had some schedule and environment changes - MIL was her caregiver until a family emergency occurred. NOw LO will be in daycare 2 days a week and with MIL 3 days a week. As a new mom I of course have loads of questions and have been searching everywhere for answers. My best friend turned me to baby whisperer. I have been reading the book but have some questions reagrding working parents and EASY.
1) My daughter has terrible reflux (doctors say she is fine and she is definitely thriving) and she has to remain upright for at least 20 -30 mins after her meals (bottle - formula only) - how can I accomplish the activity portion of EASY if she has to remain as still as possible after her meals
2) most sample schedules I see are for babies who wake up @ 7 am... our days are soooo not like that. This is our typical work week day: I wake up @ 3 am - feed the dogs, get LO's bottle ready. Baby is being fed by 330 am. I take my shower and get ready for work @ 430 am. The husband is in the shower and getting ready by 5 am. We leave the house between 530 - 545 to drop LO of at either grandmas or daycare @ 6. We then drive an hour to work (there by 7 am). 4 pm we leave work and pick up LO. (daycare provides a worksheet of what LO does during the day - right now, naptimes, bottles, diaper activity. grandma eh not so much) we are then home between 530 - 6 pm. LO gets a bottle @ 630 - sometimes goes to sleep sometimes we get a storybook or two in. Naptime between 8 - 9. at 9 pm i wake LO up for a bath, bottle, and bed (not quite into crib but we will be working on that one soon - after a small vacation in two weeks). LO is asleep by 10 pm. on the weekends she will sometimes sleep until 5 am. she then goes to sleep until 730 - 8 am. the weekends are especially hard for schedule b/c that is the only time my husband and I can run errands but that being said we try to keep her on as normal a schedule as possible and are not usually away from the house for more than one meal for her. Night time schedule is always the same (until we try to move her to the crib I'm sure)... I just want to make sure she is getting the rest she needs and maybe some ideas for scheduling especially with grandma during the day to make sure she is getting everything she needs (tummy time, activites, sleep, etc)...
I guess I would just like to hear some ideas from working parents who have 12 hour days...

[goldmom]

Welcome to BW! Reading around the FAQ's have been very informative to me when first starting out.

I'm a working parent with kids at a babysitter all day, but we have managed to stay on an EASY routine as best we could. I usually wake at 6:30, one of my LO's woke around 6:15, the other at 6:45, so their days have started from there, not the "ideal" 7. If you are starting significantly earlier (5 am?) I would shift your routine to start then, and not at 7. The early months have been harder since it's not always easy to get to the sitter right before a nap, so we've had some bad morning naps, but eventually they can stay up long enough to manage to reach the sitter and be up for a few minutes before nap time starts.

You currently sound like you're doing a 7 hour night (10-5?). That's pretty short for the night time consolidated sleep. I would try to lengthen that to no shorter than 10.5 hours and ideally closer to 11-12 hours if possible. This is difficult when you're out all day and not around your LO, but to me it was worth it so that my LO's are getting their sleep needs  met. (In the early months I'd see my LO for 45 min in the AM then 1.5 hours in the PM which included a 30 min cat nap - But I have the weekends to be with them).

For your activity, at 3 months, holding her for the 20-30 minutes after a bottle and walking/talking would be considered an activity, even just sitting in a chair and looking around is enough. A time is just the awake time, not necessarily action time!

[jessmum46]

If your LO has reflux is she being medicated?  There is much much more to reflux than just whether a LO is thriving or not - babies who are growing brilliantly can still be in a lot of pain from acid .  I agree though that activity time doesn't have to be 'active' as such - any time awake will count.

Routine wise I'm a little confused about when exactly your LO sleeps?  As I read it...

WU 3-3.30am?
A/S? Does she go back to sleep here?
A time 5.30/45 leave the house
(Not sure what napping is like in the day)
A 5-6.30pm
S 6.30 (always?  For how long?)
A ?
S 8-9pm
A
S 10pm

It's really hard to advise on routine for you without knowing what typically happens but if you want to post a normal day then I'd be more than happy to take a look . I know the pressures of being a working parent and often do 13h days at work.  It's hard and I miss out on time with DD on those days, but I see her sleeping as a priority. 

With your early start I'd be aiming for a 6/6.30pm BT (asleep for the night by then).  Is that feasible?  What's the earliest you could realistically do?  I wondered about 6.30pm as you say she'll sometimes take a nap then so maybe if you went for a quick bath and bottle as soon as you get in you could settle her down for the night instead of treating it as a nap? 

I don't know your lifestyle or where you're based though so if that isn't really a workable suggestion then come back to us and we'll see what else we can suggest

[heather8844]

I have consulted with her pedi several times and so far the doc does not see the need to medicate. I have an another appt with the pedi next friday b/c gut feeling is that LO, even though thriving, needs more than the typical burp her and sit her up for 30 mins. Her "spitting up" is getting worse with age not better (when i would have expected the opposit to be true).

Typical day:

WU: 4 AM
4:15 - "breakfast"
typically stays awake until at least 5:00 - 5:30 am when we leave for daycare
sleeps from 5:30 - until we get to day care
at daycare: we are still figuring out that schedule but typically 2 - 3 naps that last anywhere from 30 mins to 2 hours thus far when we have picked her up from daycare @ 515 pm she has been asleep since between 4 - 430 (between 45 mins to 1 hours and 15 mins)
she sleeps on the drive home to about 630 pm
630 pm - "dinner"
then she sleeps from about 730 - 8 pm until 9 pm (when I am the one that is typically waking her up)
9 pm - bath
915 - last feed of the day (formula with rice cereal)
930 - we are in the keep her head elevated for 30 mins phase
10 pm - lay down for bed

the earliest i could honsetly see getting her down for the night is between 730 - 8 pm (b/c of the reflux) and to be honest I have not tried feeding @ 630 and having an earlier night b/c at this time i am not sure if i cut out the 915 feed if she would get enough to eat (she is taking 4 oz pretty much every 3 - 4 hours. I have tried upping that slowly to 5 oz every 4 hours but the min she has a smidge more than 4 oz she spits up). Again I am meeting with her pedi next friday to discuss b/c she is spitting up after every feeding - sometimes up to a hour after the meal. Also, I am trying to make sure LO is getting enough tummy time and am trying to add at least 5 - 10 mins after her bath but before her last bottle...

[jessmum46]

Unfortunately (speaking from experience here.....) many doctors are trained in the school of thought that says if a LO is thriving, their reflux does not require treatment.  Unfortunately as many, many mums here will tell you, reflux is so much more than just weight gain or not.  Poor sleep, crying, discomfort can all have a huge impact on the well-being of the whole family so make sure your pedi knows those concerns and addresses them.  If you need support or help in doing that the ladies on the reflux board are great and have all been through it with less-than-sympathetic health professionals

Ok, so the routine is going to be hard work with your work commitments, I definitely see that.  It's kind of like at the moment she is starting her day at 4am and not properly going to bed for the night until 10pm.  That only allows for 6h night sleep which is really, really short. I think you need to be aiming for a minimum of a 10h night otherwise you are really going to struggle, especially as she gets bigger  . Most LOs would actually need more than that, but I don't really know how to make that work for you.  Hopefully she will be able to make up some of the lost hours with long naps but I think realistically you do need to make some allowances for a longer night time.  It's hard when you're working, I do know that, it can feel like you never see LO, but babies do need their sleep.

Some ideas.....does she wake herself at 4am?  If not can you leave her sleeping until she you need to go out?  Or if she does wake, can you feed and immediately resettle her until you leave the house?  Then allow her to sleep (if she will) all the way to daycare too?  That would at least give you a 5.30am start to the day or perhaps 6.30am if she sleeps on the way to daycare. 

At the end of the day I would give serious consideration to doing bath, tummy time (perhaps while bath is running?) bottle and bed as soon as you get home.  Is her mattress in bed elevated?  That would help reduce the need to physically hold her upright post feed and buy you some extra minutes possibly?  And then you could either just wait for her to wake to feed at night (personally I would do this), or do her later evening feed as a dreamfeed around 3-4h after bedtime?  So don't wake her, just let her take the bottle while sleeping? 

That would give you potentially a 7.30pm to 5.30am night, still short but a whole lot better than 6h.  What do you think?  Is any of that workable/realistic?

[heather8844]

I am hoping that speaking directly with her pedi this friday instead of going through nurses will help in regards to the reflux. The hubby took a video to show LO's doc what the spit up looks like so that may help too.

Yes - I have a wedge in her crib. Granted that only works for so long since she is a squirmer and she moves off of it through the night but that being said she is on it long enough to start digesting the meal.

She wakes herself @ 4 - 415. there is a 50/50 chance of getting her back to sleep. I really try to each morning just some days she doesnt want to. She will wake up when we move her from her crib or rock and play to her car seat but usually goes to sleep pretty quickly once the car starts moving.

Last night we moved things around a little & gave her her bath @ 830, last bottle @ 9 pm, in crib by 930 --> it went so-so. she woke up @ 11 pm got her back to sleep by 1130. she woke up at 2 am & got her back to sleep by 230. (each of those times I think there was an external noise that woke her - we had a pretty strong rain storm & the rain on her window was fairly loud) then she woke up @ 4 am. didn't try to put her back to sleep until after her morning feed. Going to try the 830 again for a few nights & then move back a little each night (until 7 or 730). I just really hate not being able to spend more awake time with her  but i know it is best for her. and i do get to spend the time with her on the weekends.

And just between us (lol) I  am actually looking for a new job that is closer to home which would allow for less travel time to and from work which would mean a later start in the morning and an earlier arrival home.

[jessmum46]

How are you getting on?

[heather8844]

Doctor is still being very conservative in addressing the reflux. She did recommend starting solids and adding *some* rice cereal to bottles.

That being said we have had 3 good nights in a row. BG slept from 930 to 630 one night and last night from 930 to 530 (even after some very crazy times yesterday due to bad weather). today she was able to sleep longer b/c we had very bad weather and my boss told me to work from home.

[jessmum46]

Ugh and grrr to your doctor   Solids can help some babies with reflux, but for others it can really aggravate things.  Cereals especially can cause troubles with gas and putting them in the bottle is really not recommended any more.  If the intention is to thicken the milk there are plenty of commercially available thickeners which are safer and less likely to cause tummy troubles.  But even if you do start weaning with cereal (I'd personally choose something like pears instead) then I'd mix it in a bowl with some of LOs usual milk to a runny consistency and then spoon small amounts of it into LOs mouth.  Bear in mind almost universally solids are not recommended before 17 weeks of age, and even then that's quite early.  Your LO may still have a very active tongue-thrust reflex and may just not be ready for solids yet.  If your doctor can't come up with anything better I really would think about seeking another opinion from someone with a wider/more up to date knowledge of reflux treatments. 

Glad you had some better nights though . Yay for sleep!

[Lolly]

^^^^

I agree with everything posted above!!

I have 2 refluxers who were both thriving weight wise, he was 75th centile at this age and she was 91st. However both were unable to sleep well, struggled to feed comfortable and were very uncomfortable at times. They did much better when they had the right treatment.

We started DD on cereal at 17 week which did help but solids made my DS worse and that was at 5.5 months. Rice cereal is not recommended at all as it doesn't thicken evenly and can be a choking hazard in a bottle. You can get reflux formulas which can help if your LO is on a standard cow's milk formula (and a better option than adding anything really). Meds like ranitidine are safe for babies and are well tolerated with no side effects that we ever saw.

With the elevated mattress if you put a U of rolled towels under her sheet it will keep her in place. The towels need to run from armpit to armpit down around her feet and it makes a "nest" to stop her rolling or sliding sideways.

Reflux can go on a long time and the acid will be causing damage which can lead to food/milk refusal. I too would be looking for another opinion (I demanded a paed referral for both my babies). The other thing to question your Dr about if you can is would they leave reflux untreated in an adult - I rather doubt it.

{{HUGS}} reflux is really hard.

Laura

[Skadiver13]

Hi Hun, with out reading through the entire thread I did pick up some yes that was me moments. My doc DID NOT want to put him on meds said he was just a fussy eater and although he was thriving he was sleeping horribly, eating next to nothing and miserable. Even as a first time mom I knew something wasn't right. I immediately changed doctors and asked for a referral to a specialist Pediatric Gastro doctor. He immediately tested him for MSPI (blood in the stool) and put him on reflux meds. It took us a few weeks and two meds to figure out the right dose but life was soooo much better.  At some point I would just put your foot down. If you are convinced it is reflux and it sounds very much like it is. Rice cereal is not going to help in any but the most mild of cases (even if it helps then) then I woudl ether tell your doctor you want a referral or meds his choice. Or change doctors.

Lolly is right. Cereal made it much worse for my LO because he was also MSPI and at that age coudln't handle any solids. Also reflux can last a long time. My DS is 20months and we've tried 2 times to wean him off his meds and he still needs them. Teething makes his reflux flare ups really bad so we've been lucky to be able to control it with meds. 

Hope this helps.

[heather8844]

Can someone help me figue out what my EASY schedule would be? The LO is almost 5 months old (she is considered preemie - she was born @ 36 weeks 4 days) and has reflux. My husband and I both work about an hour and half away from home.
Our day looks like this currently:
420 am - wake up feed baby, hubby gets ready for work - try to get LO to go back to sleep until we are ready for work... if not she is awake until 545 (in the car)
500 am - i get ready for work
535 am - put little one in car seat (if she is sleeping, this wakes her up for a short time)
545 am - leave for daycare or grandma's house
600 - 615 am - drop LO off at daycare/grandma's house and say goodbye
615 am - 515 pm - LO is at daycare/grandmas - typically feeds happen every 3 - 4 hours; i have limited sleeping time to no more than 2 2-hr naps (this after daycare was letting her sleep 6 or more hours in a day and she was not sleeping at night). She typically starts her day @ between 630 am and 7 am
700 am - mom and dad at work
400 pm - mom and dad head to daycare/grandma's house
515 pm - pick up LO from daycare/grandma's house
530 pm - head home from daycare/grandma's house
600 pm - get home; LO is usually asleep from the car ride
630 pm - feed LO (she is starting solids so 1 -2 tablespoons of a veggie, and 1 tablespoon rice cereal mixed with formula and apples and if she is still hungry a 2 oz bottle)
700 pm - here is where it gets iffy for a while -- sometimes LO will take a nap from 7 pm - 845 pm; sometimes she does not
845 pm - no matter what we start bath time; bath, dry off, baby massage, 3 -5 mins of tummy time in crib while i get pjs ready, put pjs on (this is all in a dimly lit room - just a nite light, basically what she will see when she wakes up)
915 pm - bottle (4 - 5 oz w/tablespoon of rice cereal - she has reflux); i then have to hold her for 30 mins b/c of the reflux; she typically falls asleep during the bottle if not right after (lately she has taken to fussing for about 10 mins in my arms when i try to get her to sleep)
945 pm - 10 pm - lay LO down in her crib
10 pm - 1015 pm - mommy to bed
typically LO sleeps from approx 930 pm - 420 am

I just want to make sure the LO is getting enough rest and starts to have an actual routine. Just dont really know where to start when my husband and I have such long days b/c of work. 

[heather8844]

one more thing to note - yesterday she only had 1 45 min nap and 1 30 min nap. last night she slept from 530 pm to 230 am - in fact i had to wake her up for a 730 feeding. DF @ 830. she went back to sleep from 300 am - 400 am. Brought her into bed with mom and dad for 30 mins, then she slept until 530. was up for 15 mins and then went back to sleep until we got her to daycare @ 615 am.   

[creations]

Wow, you must all be utterly exhausted with such long days.

I see she's not yet 5 months and being early her adjusted age is, what? not yet 4 months??

I've given your situation some thought over night and really there is no easy or regular way to do this but here are my thoughts. This is not an ideal EASY, the A times are long for her age and I imagine you wouldn't be happy with the earlier BT as it means you see so little of her but here's my thoughts:
- she will be habitually waking and taking shorter sections of night sleep based on the current routine and will need to help her learn to sleep through by linking those sections together.  W2S, shush/pat and resettling in any way as quickly as possible will help with this so teach her to have a long night sleep (using APOP if needed)
- leave her to sleep or resettle using the methods mentioned above at all night wakings which I would class to be from 7pm to 6am (I'll show a sample EASY below)
- Night feeds should be in a dim room and possibly switched to dream feeds to help her link her night sleep. For instance the 4.20 NW is likely from hunger but a habit has formed where she is not always going back to sleep, because the following 1.5hrs is disturbed being moved.  I'm wondering if an earlier DF could help to eliminate this NW and teach her to sleep through until 6am (with a brief disturbance at the 5.30 ish move to the car seat) or alternatively that you don't give a feed at 9.30/10 before you go to bed but let her wake for her feed.
- Have her reflux attended to. At roughly this age I had to demand an appointment with a paediatrician as my DS's GP and HV both said there was no problem as my DS had continually gained weight since birth. Within 5 mins of being in the peds office she had diagnosed silent reflux and prescribed meds. His improvement was dramatic.  If you have not already looked at the long term risks associated with untreated reflux I suggest you look into it and give it your consideration as soon as possible. The thing that got me was the risk of long term damage to the oesophagus from repeated acid attacks.
- I would stop all solids until she is older, all research suggests at this age their gut is not yet mature enough to handle solids well and the nutritional/calorific value of milk is of much higher importance (small tummy can get full on solids and not leave enough room for milk meaning overall calorie intake drops instead of increases).  If she has the adjusted age of not yet 4 months this is super early for solids and in most cases not advised (although yes in some cases of reflux and MSPI some LOs do do better with some solids under 6 months).  If you do choose to continue with solids I would limit them to her day hours which I would class to be from 6am to 7pm.  In all cases of introducing solids it is advised to give solids in the morning and afternoon hours to reduce the risk of gas, discomfort and sleep disturbances. Even much older LOs tend to have 1.5hrs between their last solid meal and BT.  Based on the routine I suggest this would mean your child minders would give solids meals at appropriate times if that's what you choose.
- Based on average sleep needs for this age (15 to 18 hrs of sleep in a 24hr period) I would aim for at least 15 hrs and see how she does on that over time then tweak her routine as needed.

So here's a suggestion of a routine, like I said it is not ideal but somewhere to start.
This routine gives 2 naps of 2hrs each, a CN of 30 mins and a night sleep of 11hrs.  Total 15.5hrs in 24.

WU 6.00/6.30 on arrival to CM (the later time if she continues to sleep after drop off)
E 6.00/6.30
A 2 to 2.5hrs (if she must have solids then 7.30)
S 8.30 - 10.30 (2hr)
E 10.30
A 2.5hr (if she must have solids then 11.30)
S 1.00 - 3.00 (2hr)
E 3.00 (if she must have solids then 4.00)
A 2.5hr
S 5.30 in car following pick up from CM. CN 30 min
E 6.00 on arrival home
A BT routine begins - 6.00 milk, 6.30 bath, 6.45 top up milk and night time snuggles
S BT 7.00 (resettle any NWs) (11hr night with some disturbance for feeds and transfer to car)
DF 9.30/10.00 before you go to bed
Another option here would be to not dream feed but let her wake for a feed when she wants, this could help to shift the time of her feeds and eliminate/shift the 4.20 NW.
NF when needed
NW 4.20 feed if needed and resettle, better still eliminate this NW as she doesn't always sleep after it
5.30/40 transfer to car seat, set off for CM
WU 6.00/6.30 at CM

The 4.20 NW will need some work to stop so that she sleeps until the moment you transfer her to the car seat and goes straight back to sleep in the car.  I suggest you leave her undisturbed until you are both ready to leave the house for work and literally put her in the car seat and out the door to reduce the disturbance to as short a time as possible.  Letting her wake for a night feed is one way to shift the E pattern at night, another would be to do a W2S at say 3am.

Quite a few things there to think about, it's quite different to your current routine so let me know what you think.

Meanwhile I want to invite suggestions from the rest of the BW community.  My thoughts are just that, thoughts, if there are other thoughts out there please post them so we can all be supportive of this hard working, tired family.

[Sarah - Enfys' Mum]

That's great advice from creations. I'd agree that she really needs an earlier bedtime. I can sympathize, when I went back to work after dd1, I was out of the house from 8 till 6 and literally as soon as I picked her up I had to put her to bed.  It was tough. We did a very quick bath, book, bottle, bed. I tried to enjoy that hour as much as possible and looked forward to the weekends when I could see her in daylight. But I knew it was for her benefit as she really needed the sleep.
If you can get her to sleep through 4.20 even till you leave the house at 5.45 then it might work.  She's doing a good 7 hour stretch now (if I understand correctly) so if her bedtime feed is 7 pm then you're through till 2ish, and if you fed her then she should be okay till 6.