4.5 mo old with nursing and sleeping issues

[SukieCat]

Hi All,

I've posted to various boards about my spirited 4.5 month old DS who is having issues with napping.  More recently I've realized a lot of our problems are probably more about nursing so I thought I'd pop over here to see what you ladies think.

Background: DS has always been a "sleepy" nurser.  He was jaundiced as a newborn and he's just always loved comfort nursing.  This was okay until about a month ago, when he started not being able to sleep at all without nursing.  He's never fallen asleep on his own, we've always rocked him or nursed him to sleep.  At the same time, he was having issues gaining weight, so I didn't want to not nurse him when he seemed to want to nurse, even though I knew a lot of it was comfort nursing.  I've never really been able to read his different cues.  So we really got into the habit of nursing to sleep.

Because he was having weight issues, we started him on a formula supplement.  He gets about 8 oz of formula per day.  We also started him on a bit of rice cereal.  Since we started those two things, he's been gassier and he's been going longer between poops.  He also shows a lot of signs of reflux so we've had him on Zantac for two weeks which seems to be helping, although it doesn't improve the gassiness.  The supplements are improving his weight though, thankfully.

Up until two days ago, DS was a very good night sleeper, only getting up once to feed at 4am-ish (we don't do a DF).  However, on Friday he went to the doctor and got a couple of vaccinations, and that night was awful.  He was up 4 times, very hard to settle.  Last night was better, but he was still up probably 3 times.  Whenever he gets up, I nurse him back to sleep.  Sometimes he'll just nurse a little and fall asleep but sometimes he'll take a full feed.  I'm really not sure when to feed him in the night, and he doesn't like pacifiers so it's not like I can offer one and see if he'll go back to sleep.  I'm afraid that by feeding him so much at night, he's eating less in the day which will cause him to get up even more at night.

I haven't been able to get him on a good EASY because nursing to sleep throws off the E times.  Even when I get him to sleep, he doesn't settle well and often wakes up after only a few minutes.  I think he is OT.  I don't know what the best way to get him to sleep without nursing is.  And I don't know if we can start to get on an EASY while he's still dependent on nursing to sleep.

So I guess my questions boil down to when should I feed him when he gets up at night? What's the best way to teach him to sleep without nursing?  Should we try to get onto some kind of EASY even if he still has to nurse to sleep?  Or would it be better to try to space out feedings so he's hungrier and will hopefully eat more when I offer?  Could his gassiness be impairing his sleeping?

Any advice would be greatly appreciated!  Thanks!

[Fiver]

Ok, when you say weight issues, can you expand on that for me, please?

Did your Dr/paed suggest you start rice cereal or have you been advised somewhere to do that?  There are fewer calories in rice cereal than breastmilk and causes constipation in some babies (which could explain the digestive issues/gassiness you've been experiencing with him)

Has he had his 4 month growth spurt?

[willowsmummy]

if he has gone 4 or more hours then i would nurse him!! otherwise keep everything dark/quiet and calm. i used to shhh by DD as she didnt respond well to pat (she wanted to play) x

[SukieCat]

When DS was about 2.5 months he wasn't gaining weight adequately.  I talked to some LCs and tried to modify how I was feeding him (incorporating breast compression, trying to keep him on longer).  We did a lot of weight checks and he was gaining weight after a couple of weeks.  Then he developed napping issues, and I lost some of my focus on feeding while dealing with sleeping.  By his 4 month appointment (2 weeks ago) he was back to not having gained enough weight.  Here's some numbers so you can see what I mean:

Birth weight: 10 lbs 10 oz
Lowest weight: 9 lbs 6 oz
Two months: 11 lbs 13 oz
3 months: 12 lbs 3 oz
3 months two weeks: 13 lbs
4 months: 13 lbs 6 oz

We started the rice and formula at this point (per the ped's recommendation), and at 4 months 2 weeks he's now up to 15 lbs.

I have no idea if he's hit his growth spurt.  Because of our napping/nursing issues I am sometimes feeding him every hour anyway, so growth spurts aren't super obvious to me.  Since he's been gaining a lot more weight recently, I'd guess he might be having it now or had it last week.

Literally nothing I have tried can calm him once he's up from a nap or from night sleep.  I've tried just leaving him, I've tried sh, pat, sh-pat, I've tried rocking, I've tried gentle pressure on his back or tummy... nothing.  Everything I do either excites him (wants to play) or irritates him (ends up screaming his head off).  So we end up nursing a lot and the habit becomes ever harder to break.

[anna*]

OK I know this sounds trite but... honestly the only way to stop nursing to sleep is to stop doing it. Yes there will be a lot of crying - but if you take that as your cue to nurse again, you're not going to break the habit. At night, as per pps suggestion, I'd set a time limit and settle him without feeding if he wakes up before that time. So say the limit is 4hrs, if he wakes up at 3.25hrs you'll settle him without feeding even if it takes an hour. You can feed at the next waking.

With naps, you can start by feeding a little earlier so that you have 10 mins after nursing to make sure he is fully awake before starting your wind down. Then make it 20 mins before nap etc.

[Fiver]

For what it's worth, it's not unusual for BF babies to gain weight more slowly than FF ones, also some will gain more quickly than others.  He does seem to be having a steady (if not massive) weight increase (as my DD did).

As for the sleeping, for the naps, personally I never bothered much trying to extend DD's naps - once she's awake, she's awake during the day.  And in all honesty, at 4.5m, I just fed at night, even if that meant she fed to sleep.

Admittedly, she's a fairly laid back personality so has phased out any of the feed to sleeps herself and it does seem to differ by personality type.

[SukieCat]

I guess part of my concern with stopping the nursing to sleep is I'm afraid he won't be eating enough.  I don't want to cause more weight issues.  I know BF babies can grow more slowly but he was falling off the WHO growth chart and we felt we needed to do something more for him.  I will try cutting the rice cereal to see if that helps the gassy.  That was more for fun/learning than nutrition anyway.

I know there will be screaming if we stop nursing to sleep cold turkey.  There is no other way I've gotten him to fall asleep.  I've tried every contraption and every prop and nothing works except nursing.  Occasionally DH can rock him to sleep but it's rare.  DS is a spirited nap fighter, I imagine he could stay up all day if he put his mind to it.  I've never seen him crash.  One of the ladies on the spirited babies support thread mentioned using gradual removal to teach him to sleep on his own.  Do you think that could work for us?

[anna*]

I'm not suggesting cutting the feeds (although if he fed less often it's opssible he would take more at each feed), just moving them so he is going down for his naps awake. It's not at all unusual for a whole day of naps to be skipped when you're sleep training. My son did it when we were weaning the dummy, same age. But he WILL sleep eventually.

Gradual removal is a possibility, definitely worth a try. Personally I never managed to make it work - don't know whether I had the technique wrong, or just lacked patience, it just ended up with a frustrated baby and a frustrated mummy, and we got nowhere.

[Fiver]

Are you still doing the breast compressions?  That will help with getting some more of the fattier milk into him.  Did the LCs say anything about why they thought you seem to be having issues with milk transfer apart from suggesting breast compressions?

[SukieCat]

I'm not quite as good about remembering to do the breast compressions now that we've got him on formula supplement and his weight is doing better.  But yeah, the LCs said exactly what you did, that it would help get the fattier milk to him.  Once he started having napping issues (about a month ago now) I just wanted him to sleep so badly that I wouldn't push him to keep eating and I think that's part of our problem too.  I actually visited the LCs twice and they measured how much milk he was able to transfer, and both times he was getting plenty (I don't remember the numbers).  That was when he was 11 days old and at 6 weeks.  I'm not sure if something happened between then and now with my milk or if it's the naps or what.  The last time I talked to the LCs they didn't say anything about why they thought he wasn't getting enough, just that it sounded like he wasn't getting enough hindmilk.  He also started having more greenish poops back then, which improved when I did breast compressions religiously. 

So I think I could probably have kept EBFing and he would have been okay, but it got to the point where we were both sleep deprived and I was stressing about his naps and just felt like we'd benefit from a formula supplement.  I did resist for a month and did lots of weight checks, but it took everything I had to keep him on track and as soon as I let up a little his weight started flat-lining.  I always have him nurse first and then give him formula afterwards twice a day.  He loves the bottles, always guzzles them right down, which makes me feel like I'm starving him, you know?  I just want to make sure he's getting enough calories every day to thrive.

[Fiver]

You're not starving him!   Often LOs don't get the "full" signal so soon when they're feeding from a bottle as there's a constant flow and they don't pause in the same way they would when BF.  So they then tend to consume more, which can make the BF mum think that LO was REALLY hungry.  Sometimes LO will then be sick, bringing back some of the excess that they've consumed.

[eva026]

Sometimes LO will then be sick, bringing back some of the excess that they've consumed.

Yup, that's what mine does. If we give a bottle of BM we have to only give a certain amount because if we let her have as much as she wants she pukes after.

I've recently weaned rocking as a prop and the gentle removal plan only got us so far, in the end we had to drop it cold turkey and just survive the few days of yelling. I think it started with 20-30min of DD screaming and me shh/patting till she cried herself to sleep.
DD also had nap issues for ages and could easily go the whole day with 30min of sleep total. Like you I was frantic and so afraid to wean the prop in case she got no naps at all and could see myself rocking a 2yo to sleep in the future. Finally around 5mo she just grew out of the short napping and everything got so much easier.
I'm not writing to give you any specific advice, just to give you some encouragement that it can be done:)

[SukieCat]

Thanks for the encouragement!  I need all I can get!

Yeah, mine did that too after the first couple of bottles.  Now I don't offer as much each time.  He usually cries when he is done with a bottle, like he wants more, but if I burp him and distract him then he is fine.  I think he wants to just keep comfort sucking on the bottle like he sucks on me, haha.  Too bad I can't get him to suck on an actual paci!

I've actually had some success today getting him to sleep without nursing... however, he still required rocking.  So I'm just transferring props at the moment.  At least DH can help with rocking to sleep.  It seems like if I can remove nursing as a prop, even if it means using another prop in its place for a little bit, then I can get his eating figured out and get him on an EASY routine.  Then we can wean the next prop.  Somehow that seems easier than trying to do it all at once.  Or maybe I'm just setting myself up for more frustration, I don't know.

[willowsmummy]

atleast with rOcking you get a much needed break!! and It may even help with the NW if he isnt getting nursed to sleep keep up the good work. also i rocked/nursed to sleep and one day i had enough so i swaddled her and put her down and to my surprise she fell to sleep!! Lol xx