Irregular night wakings (4 month old)

[jedibarrister]

My 4 month old boy (w/ reflux) has a completely inconsistent night waking pattern.  At this stage, I'm on the lookout for eliminating a feed by looking at pattern wake-ups (no) and diminished intake (varies) and I'm at a loss.

Night one, he'll sleep from 8:30 to 5, night two he'll wake up every 2 hours, night three, he's up once, night four, he's up twice and so on.  Just about the only wake up that I can predict is the one around 5 am.  He used to be a 2:00 and 5:30 wake up but since his double ear infection, he's fallen out of that predictable routine.  Hubby took the 2 am feed w/ a bottle and I nursed at the 5:30 feed.  While ill, he'd reject the bottle outright so I was nursing the whole time.  He's been infection free now for 2 weeks but has started picking up the arch-back-push-me-around-with-heels skill.  In the last two weeks, he'll take the bottle until he's not starving, then reject it and cry until I come to nurse him.  Then he'll sleep.  So (a) he's playing daddy for the boob and (b) the boob is slowly becoming a prop to sleep too.  I'm trying to answer all the FAQ questions so forgive the ramble.  But feeding at daycare is by bottle.  He gets 6 oz a feed (cereal w/ milk, and A.R. Lipil formula).  I nurse him at 6:30 pm (2 sides about 15 minutes total) and before bed (8:00) I bathe, read a book and either nurse or bottle or both so he's full (cluster).  I have supply issues later in the day so the bottle is usually needed for about 4 oz for this last feed. Oh and the pediatrician thinks he's teething.  As for comfort items, it's his fingers.  No toy yet.  He's also not 100% in control of his arms so we still swaddle to sleep but he pulls out within the 20 minutes and is fine until the wee hours. 

With this ramble, can anyone tell me how to get predictability back so I can slowly move him off the 2 am feed?  Is it the skill? The teething? The recent illness? 

[Colin Macs Mom]

How is the reflux treated, what medicine? Could it be possible that he needs a dosage adjustment? My little refluxer used to do the same thing when it was time to up the dosage on his medicine.

Night feeds are a very touchy thing with a reflux baby as a feed often soothes the pain, so making sure that all is well in the pain department is critical before you make any changes.

What time are you doing the feed with cereal and milk? Can you post your full routine?

[jedibarrister]

The routine used to be 2:00 am A.R. Lipil (6-8 oz) and 5 a.m. nurse.  He nurses in the morning before "school" and gets the milk w/ cereal by his noon feed.  Then it's A.R. Lipil thereafter until he's picked up.  He's on Axid 1 tsp twice a day (he hated the taste of Zantac).  I haven't had him back to the GI but his pediatrician wondered if his dosage should go up.  He didn't, however, increase the dosage at the 4 month check up which is weird now that I think about it.

[Colin Macs Mom]

My advice to you then is first thing, get the dosage increased. When Colin was that age we were needing to  increase fairly regularly because they grow so fast, and that med family bases the dosage on weight.

You also might consider doing the cereal in the morning - is it possible it's causing some gas? We also did a bit of cereal very early on because it helped the reflux. Only problem is that it's so early for them to digest something like that.

[jedibarrister]

He does only get the cereal in the morning (11 am) feed.  I have an appointment with the GI next week.  Let's see how that settles things down.  Thanks.

[Colin Macs Mom]

Ok let me know 

[jedibarrister]

Well we had his Axid dosage increased to match his weight.  But the night wakings continued.  He's 5 months old now and teething.  The pediatrician thought that might be it (since we had some early nights of uncontrolable crying).  So he prescribed Tylenol 3 but we don't want to give him that every night.  So on codeine nights, he sleeps from 8ish until about 2ish, feeds and well, and then sleeps until 6ish.  On motrin nights (regular tylenol is sugar water it seems), he goes to bed at 8ish, is up at 10ish, then midnight, then 2ish, 5ish, and 8ish.  When he wakes, he won't be calmed absent breast or bottle and he's clearly not hungry since he'll take in 1 oz or a couple of minutes before going to sleep.  I've tried introducing a binky as an alternative or water instead of formula but he balks, squirms and screams.  I think I can likely wrestle him out of the squirm and eventually calm him down and maybe rock him to sleep but (a) that'll wake the whole house and (b) replace my rocking for my breast as the crutch to go back to sleep not to mention (c) he's nearly 19 lbs and my body can't handle the rocking, swaying, jiggling for too long.  At this point, my gut tells me that these are cyclical wakes, i.e. he's waking up in the sleep cycle and not going down again alone like he used to as opposed to pain or hunger wakes but how can I be sure about the no pain? 

Long and short of it is that I don't want to drug my kid for sleep but I'd also like him and the rest of us to get some.

[Colin Macs Mom]

oh my     Do you have one end of the mattress elevated? Sorry if I already asked that.

How long did you give the water and binky? It's definitely going to take some time to straighten things out and it won't be a lot of fun.

[jedibarrister]

We had a reflux wedge but he's moving around so much (butt scooting on his back) that he'd wake up in an uncomfortable position, half on and half off.  For these reasons, we didn't elevate the mattress as he'd end up with his feet higher than his head anyway.

Last night, I tried PU/PD at midnight (!).  He bucks like a bronco to get to the breast.  I allowed him to latch on for one minute and then slipped in a binky and put him down.  He fussed, then babbled, then fussed, the cried.  After about an hour of PU/PD (only at crying and I'd always be outside of his room after PD) he fell asleep only to wake up an hour later.  Hubby fed him (4 oz is all he took) and he fell asleep only to wake up 2 hours later.  So I took this one and the binky switch wasn't working.  So I allowed him 2 oz from the bottle before the binky switch, then PU/PD for 15 minutes and he fell asleep only to wake up 2.5 hours later, he babbled for 15 minutes, and then went to sleep for 3 hours and didn't need food for another half hour after that. 

So here's what I'm doing w/ the nanny during the day:

PU/PD to nap
logging all food and naps to see if he's not getting enough calories causing him to need to tank up.  he seems find after 4:30 a.m.
adding one nap in the day (3 instead of 2) in the hopes that he's not getting enough sleep during the day so he's (a) not eating well due to fatigue and (b) well the more they sleep the more they sleep.

What do you think?

[Colin Macs Mom]

The logging is definitely a good idea - a lot of times that's the only way to get a clear picture of what's really happening.

It does sound like there's a feed-to-sleep thing going on for sure. I'd keep going with the PU/PD and if the logging shows that the daytime intake is good, then wean those night snacks very slowly.