Habitual NW at 6 weeks - possible? If not, what's going on??!

[Mackjack]

So DS is 6 weeks old, 12lb and BF. He has silent reflux and is on Ranitidine. He is on a 3 hr EASY which works pretty well during the day (although his naps are a bit hit and miss at the moment). My issue is - he wakes at the same times every night and doesn't necessarily take a really big feed and then after about 3/4am we have a very fussy period and he doesn't really go back to sleep which ultimately leaves him OT for the day thus many 45min naps. Could he be waking habitually? Or is he too young to be doing that? Also, he doesn't seem particularly hungry at the 3hr mark during the day - he doesn't take much and my breasts always feel soft which tells me he's not taking enough so I'm going to try 3.5hr feeds.

But this is a typical 3hr EASY for now:

E 6.30am
S 7.30 am settles himself - this nap is usually 45mins though I often can shh pat him back to sleep and he can do 1.5/2hrs
E9.30am
S 10.45 anything from 45mins - 2hrs
E12.30am
S as above
E 15.30
S 16.45 this nap in particular he fights - if he does go to sleep it's very fitful and he usually wakes after 30mins/45mins
E 18.00 usually end up feeding early here as he's not slept well beforehand. Also, we used to let him have A time after this E but we found he would really really fight bedtime so now when he's woken from the nap before, we just feed him in the bedroom in the dark and put him back to bed and he seems to settle well.
BT 19.00
E 23.30 always seems to wake at this time, doesn't necessarily have a big feed
S 00.00/15
E 02.30 again, always wakes, has a small feed
S 3.00/15
E 4.00am this is when he always wakes and starts fussing, I sometimes feed him (though I know he can't be hungry) - he'll take a few sucks for about 10mins and then go to sleep but wakes about an hour later and then he's just fussing for as long as I can stand it until I get him up and feed him!!

Am I missing something here?! I think the first two NF seem ok-ish but I really feel he should be able to sleep longer from the 2nd NW until 6 or 7. Or maybe they're all habitual wakings - should I WTS? If I extend to 3.5hr feeds, should I still give him that fifth feed or try to get him to bed after the fourth feed and see what time he wakes for a feed?

[Mackjack]

Actually, he's waking at 45mins pretty much every nap - we have to ssh pat him to try to get him back to sleep - doesn't always work....

[Mackjack]

....well I was  going to try doing 3.5hr today but he's just had a 45min nap which i couldn't resettle him for and it'll be too long til his next feed so that's not going to work....

[PuppyLuf]

I'm not an expert, but by fussing, do you mean screaming / crying, or just grunting and making noises?  I'm asking only because my LO has reflux and he grunts and groans in patches throughout the night as he goes in and out of sleep cycles.  I kept him in my room for the first 5 weeks and finally moved him to his own room because he made so much noise that I couldn't sleep. I now keep a baby monitor in my room turned on low so I can only hear the loudest noises.

When do you give him Ranitidine?  If he is crying and then refusing food, it may be that his reflux is not being treated correctly.  Babies need 2-3 doses of it a day, they become tolerant of it very quickly, and it is related to their weight, so the baby must be frequently weighed and re-prescribed by the pediatrician.  Here is a page I go visit all the time:

http://www.refluxrebels.com/Acid_reflux/Acid_reflux_medication.html  The whole site is a good one, but this page explains the different medications.

My LO started on an H2 medication and moved to a PPI.  If your pediatrician suggests you move to a PPI, do NOT let them talk you into using a compounded liquid form or a solution.  Most of these, even the kits, go bad after 2 weeks, making you think it isn't working when LO gets symptoms at night.

It took me a while to learn my baby's different cries.  We had a LOT of acid-reflux cries at night.  They usually included a monotone crying in his sleep that would peak with a kind of high-pitched pain squeal.  Babies with reflux tend to want to soothe themselves with a little bit of milk to get the reflux burn down.

My pediatrician ok'ed my baby sleeping on his stomach (I did buy LO a breath monitor because of increased SIDS risk).  Babies have a deeper sleep on their stomachs, and as the physician's assistant told me, "The kindest thing you can do for a refluxing baby is get him off his back and onto his belly at night."  It's not for everyone, and one should definitely discuss with pediatrician about this.

Also, reflux babies may refuse to eat if they associate certain feed times with pain.

My child is adopted, so I am not familiar with the logistics of breast-feeding, but could it be your milk supply is lower at night?  Perhaps he needs a bit more?  (this is absolutely a guess, as I really don't know)

I hope you get some answers and some sleep!

[Mackjack]

Hi there. I mean grunting and making noises while being wide awake. This eventually escalates to a cry. I don't think he's not taking good feeds at night because he's in pain - he just either falls asleep during the feed (and I just cannot wake him no matter what I do!!) or he just seems a bit disinterested and doesn't take much. Yes, we were having some reflux cries which were much more "urgent" and squealy and usually accompanied by choking/throat clearing/swallowing but at the moment, we're not getting these.

[becj86]

You may find that it's actually related to having lots more milk in the first feed post-midnight. This is a feed that often can cause issues for the most settled of babies because mum has more milk - peak time for making milk because you're resting - and they actually get more milk faster at that feed. That can cause gas and general digestive discomfort even in A baby without reflux.

You could try lying back to feed him for that feed.

Do you change his nappy/diaper before a night feed? That often helps wake them a little to get a bit more milk in.

From reading a lot of reflux stories over the years, I know things settle once on meds, then the grunting comes followed within a fairly short time by the reflux screaming again. It's definitely worth chatting to you doc about increasing meds to keep up with weight gain. Most kids seem to need an increase every 500g or so.

[Mackjack]

I will try the laying back to feed - yes I do a nappy change to try to wake him but doesn't always work. Any thoughts on whether these wakings are habitual?

[becj86]

Not at this age, it's almost certainly discomfort. It's the hallmark time for discomfort to disrupt night time sleep.

[Mackjack]

Ok quick update - last night he woke for feeds at 12.15 and 3am (bedtime was 7.30). he didnt take massive feeds. Then he woke at 5.45 - I was pretty confident that he couldnt be hungry so waited a little while to see if he would settle then I shhpatted him - he settled pretty quickly and slept til 6.50am. I then got him up for the start of the day.

He still had fairly short naps today - I put him down for his 1st nap after just short of an hr A timeai thought he would be OT from the night as he usually is but he fussed in his cot for 40 mins before having a 45min nap so I think I misjudged that and he was actually UT. Next 2 naps he woke at 45  mins (why?!) but went back to sleep and these ended up being 1hr 10 naps. Final nap before bed was a disaster as usual (he just laya there and whines/cries every 10 mins til I give in and get him up).

I'm wondering if that 2nd night feed is actually a hunger waking as its v close to the first night   feed and he doesnt take much?  waking as its v closs to the first night feed abd

[Mackjack]

Sorry about the gobbledygook at the end - hard to do this from my phone while feeding! X

[Mackjack]

Sigh...last night bt was 7.30, woke at 11.15pm, didn't take a massive feed, then woke again at 2.40am and only took one breast. Think he nodded off for a bit but was awake from about 4am - not upset just waving his arms and being noisy. Tbh he sounded ut - but how could he be after not having great sleep during the day? Started to sound like it would build to a cry so managed to ssh pat and he fell asleep wuite quickly 5-5.45. Tried to shh pat again at this point but didn't work and have now got him up for the day and am feeding. Whats going on? I can't take much more of this . I'm sick of having to analyse every single move he makes, its,so exhausting.

[becj86]

If you're getting stretches over 3hr at night at this age, you're actually doing well.

Waking at 45min is likely just his sleep cycle, that's when he gets into lighter sleep and he needs to learn how to get through to sleep a longer nap. This is something you can do with shush pat.

[Mackjack]

Hi Bec. Thank you for your response. He can go back to sleep after 45 mins - he's done it loads - I was wondering if the 45 min naps during the day are because he's OT from the night. And with regards to the 4am wakeup last night - I know he does well to sleep from 19.30-23.15 and then not wake again until 2.40am but what was the 4am party about?!?

With regards to our EASY which I posted at the top of this thread, do you think that 4th nap of the day is causing some sort of problem? He always fights this one and seems to fall in and out of sleep -  I usually end up giving up and getting him out of his cot for a feed earlier than the 3 hr mark. As I mentioned, after this nap, we don't have A time as such, I usually just feed him in the bedroom in the dark and put him back to bed (awake) for BT as we found that giving him A time after this nap resulted in a massive OT screaming fit at BT. Am I doing wrong by doing BT like this? Honestly, I feel like we're in a right mess at the moment and I cannot see the woods for the trees!

[Mackjack]

...or could the 4am party be because he's OT from rubbish naps throughout the day? I just thought an OT wakeup would be more 'upset'?

[becj86]

Ok, at 6 weeks, these rules aren't always as accurate for prediction...

Having said that, a 45 min nap with no resettle is more likely UT than OT. You could try giving another 5 min A time. A happy waking in the early hours of the morning is also related to UT more often than not.

It could also simply be that his night is shifted, actually going from the beginning of that 4th nap and that's why he's waking at 4am.

Something like this may work:
6 wake
7:10 nap
8:40 wake
9:50 nap
11:20 wake
12:30 nap
2 wake
3:10 nap
4:40 wake
5:50 BT

You can push it all an hour later than that for more sociable times... Just stuffed it and fixed the easier bit as on iPad.

If he's anything like my boy was, he'd almost be ok on 3hr EASY now but that's unusual, just depends when they 'wake up' from the sleepy newborn phase.