Excessive Saliva/Spit-up causing waking every night

[gracecody]

I am really not sure if this is an eating issue or a sleeping issue or both, but it is affecting both very negatively.  I posted this question in both breastfeeding and here -- I hope no one minds.  I'm wondering if this is simply a phase or a sign of a problem that should be addressed.

I have a 10 wk old baby boy who is exclusively breast fed. Over the past three weeks he has quite suddenly moved from eating every 2 hours (during the day) to every 3+ hours. I follow his hunger cues so this is not a schedule I am imposing upon him. I just started with a loose EASY at about 8.5 weeks, after borrowing the most recent BW book from a friend. I guess my baby would be best described as 'spirited,' at least where sleep is concerned. He is generally tough to get to sleep but I will say that he has gotten a lot easier since about 9.5 weeks.

Anyway, I wanted to give a little background on his sleep issues to put the spit-up issue in context. We follow a loose 3-hour EASY all day and he takes his nap in the evening, 6-ish. Then when he wakes we feed and start the bedtime routine, which is a bath, change to jammies, swaddle and shhh-pat to sleep. It all goes fine (for the most part, he doesn't like to wind down usually) and then anywhere from 30 min to one hour after we put him down to sleep, he will spit up and usually cough, and wake himself up. This has happened every night for at least the past week. It doesn't seem to bother him (no pain and usually a tiny amount of spit-up produced) so I don't really think it's reflux. His bed is at an incline, we place him on his side supported by a rolled up blanket, and I have tried the infamous gas drops and none of these things has helped.

The last feed previous to going to sleep is usually 45 min to an hour prior, and I am always sure to burp him well afterward. The other thing that is very frustrating is that when we are doing the shhh-pat he is in a vertical position and when he is starting to relax, he will suddenly start making this gulping sound in his throat. This is saliva and not spit-up. It obviously interrupts the process and sometimes after doing this he will start fidgeting and then wake up enough to start resisting the sleep process and suddenly we have a screaming baby. For the past several nights the routine has been like this:

feed
bedtime routine
sleep
wake up spitting up
shhh-pat
wake up spitting up
shhh-pat, wide awake screaming baby
long wind down
shhh-pat
sleep

And by then it's pretty close to feeding time again, yes, sometimes it has been a 3+ hour deal. Not fun!!

The final thing, which has us completely baffled, is when he wakes up during the night to feed (usually once or twice) he feeds beautifully for about 30-35 min and goes right back to sleep, and has NEVER once spit-up and woke himself up. He does spit up on occasion but he manages to sleep through it then (probably because he is in a deeper state of sleep).

My husband and I have given this all our best efforts and haven't been able to crack this nut -- suggestions, please??!

[Katet]

I think this would probably be described as his unsettled period... the fact he sleeps pretty well the rest of the time & is only 10weeks old, I think it may just be that. All babies have an "immature" stomach muscle & all do to some degree have reflux... that is the spit up... it is just when it is moderate to severe that it is an issue. I would keep at the consistent routine & it should sort itself out in the next moth or so.
Sounds like otherwise things are going great... well done

[yeppers]

I hear ya!!  We've had very similar troubles with multiple spit-ups causing wakings.   There has been noticeable improvement when we went from exclusive pat/shhing to part gentle pu/pd and part gentle pat/shh.  Now, your baby is prolly still a little young for pu/pd, but it's something to note for the future; it can get better soon.  (quick fyi: Our little guy was born a couple months early, so we've had some gray area when it came to the official 3-month mark indicating pu/pd readiness...)

One other thing I've started doing that has helped my lo get back to sleep after his little "interruptions" is to put a bib on him when he's first put down to sleep.  That way, when (not if!) he spits up, it just gets on the bib rather than the collar of his sleeper; whisk off the bib and voila -- ready for sleep again with minimal fuss.

HTH & good luck!

[gracecody]

Well it happened again last night...his normal bedtime (if he even has one, since this has been going on for some time) is around 9pm and for the past two nights he has finally fallen asleep for good in the 12am hour!  When he wakes himself up coughing he is usually NOT easy to get back to sleep, especially if he has been asleep for a little while, then it's like a nap for him I think.  I am going bonkers here.  This time he slept for about 50 min before waking himself up, long enough for me to fall asleep too (frustrating!).  I heard him working up to it though and it was not spit up, it was the saliva or liquid pooled in his throat and I could not actually find any liquid on his bedding, swaddle or jammies, though I could hear him struggling with it before he coughed and woke.  I am just hoping that this has to do with the development of his salivary glands and is a phase that will pass.  Does this ring a bell with anyone?  In any case, it doesn't sound like there's any good solution and we'll just have to wait it out.  Ugh.  Thanks for your suggestions though!

PS, thinking about the 'unsettled period,' how long does it last -- 20 min or so?  Would it help for us to hold him until he's more deeply asleep, just while this saliva thing is going on?

[Mum to Ella Rose]

As Kate said most babies have a degree of reflux. It is the immature sphincter muscle between the esophagus and the stomach. It sounds like that is what's happening to me. Because that muscle is immature sometimes the stomach acid will come back up. It doesn't nessecarily have to be spit up per se...as it may not have had a chance to combine with food in the tummy. It's just the acid itself pooling in their throats. I'm sorry I don't have any solution for you... but most babies do outgrow it as they mature.

Sharon

[gracecody]

Thanks very much for your reply.  In light of this, do you think there is any particular feeding time that would work best, i.e., one hour before bedtime, 30 min. before bedtime, etc.?  Or will this happen regardless of how long it's been since he last ate?  Thanks!!

[yeppers]

I know this doesn't have much to do with BW stuff, but have you thought about a potential food intolerance?  I notice a difference in my lo when I eat a lot of dairy, if I eat beans or peanuts (DH is allergic to legumes), or if I can't get enough breastmilk pumped for him and he has to take formula. 

You might want to try eliminating any foods with which there is a familial allergy or intolerance.  You can also try eliminating dairy from your diet for a couple of weeks, then keep the change instilled for another couple of weeks before finalizing your assessment (to give the dairy proteins a chance to clear your baby's system).  Dairy is a tougher bird than most other foods in that it is a bit more persistant in your and your baby's systems.  Rarely does just a day- or two-long trial elimination help for anything but the most minor dairy protein intolerances.

And to answer your question, on those bad days/naps, yes, I hold him for what's left of his nap if he wakes up coughing & choking and I have to use the bulb syringe on him.  Accidental parenting it may very well be, but it just seems like he goes through so much & it helps me too to just hold him and comfort him during those times.  I don't know if it would help to go beyond a few minutes of quiet, still time before putting him down since you already make sure he has burped if he needs to.  You might try lightly thumping his back and rubbing in an upward direction (especially on his left side) to burp him instead of just patting.  Gently giving him a gentle, exaggerated rock or two (frontwards and backwards - as if you are almost putting him down in your lap and then back up to your shoulder) sometimes helps any gas bubbles make their way out too.  As I touched on in my previous post, sometimes my baby doesn't tolerate "thorough pattings" so well and alternatives to heavy patting have seemed to help him. 

My lo has reflux (in addition to his food intolerances) and we are working on getting the right meds and dosages to help him too.  Perhaps you can ask your pediatrician about it (and see a pediatric GI if the problem persists)?  Reflux is very common in babies, and most do grow out of it, but there are medicines that can make a world of difference for you guys in the meantime.
<<<<Hugs>>>> to you and your baby for going through this!!
 
Sorry this was so long! -- Keep us posted on how your babe's doing!

[gracecody]

I have definitely questioned whether or not something I'm eating may be contributing to all the spit-up.  I have a very healthy diet, but I do eat a lot of dairy and wheat (if I didn't eat those things I would probably starve to death because it seems like I never can get enough food). 

What changes did you notice when you cut dairy out of your diet?

PS, I think it is probably worth mentioning that my baby is huge (and my Dr. keeps saying that huge babies tend to spit up a lot).  He was 16 lbs, 7 oz at 2 mos. and 10 lb at birth.

PSS, we had a TERRIBLE night last night -- he woke up from his cat nap at 7:45pm, was terribly cranky by 8:15, so I fed him then and changed jammies, read a quick book and we had him asleep a little after 9.  He woke up as usual coughing around 9:45 and this time completely resisted any and all attempts to put him back to sleep.  I shhhh'ed him until I was hoarse and he was just screaming, the worst I have ever heard him scream.  It wasn't pain, just exhaustion on his part.  It got to be time to feed again so I did, only to have him wake coughing about 10 min later.  Ultimately we both went to sleep at 1:15am and now this morning he is again resisting the shhh/pat method completely.  It seems to make him furious as soon as I say the first shhhhhh.  So (this is terrible I know) I had to get him to sleep in the sling and then transfer him to the swaddle and put him down to sleep from there.  We are really regressing and I am so desperate, I don't know what to do.    I don't think that a 1am bedtime three nights in a row is a coincidence and I don't know how to break this pattern before it happens again tonight.  I am just sick over this.

[Katet]

Lets look at his whole day... how often do you feed him & how long is he awake for.
He's 2 mo right?

I am with you on big babies my #2 was 10lb 4oz at birth & now over 22lb... my first was smaller at birth but they have matched each other since 3mo...good milk I think

I cut back on the milk part of dairy & eat cheese & yogurt & that helps me + I eat a lot of corn & rice snacks rather than wheat...more habit than need... so maybe try cutting back on the unprocessed dairy & swapping other grains for wheat.

Anyway lets see if we can get to the bottom of this.

[gracecody]

Thanks so much, Kate.

As of yesterday, I cut out dairy.  You were the third person to suggest it so I think it's definitely worth a try.  I am substituting soy for dairy and hope that soy won't be a problem! 

He is 11 weeks tomorrow.

He eats about every three hours but the intervals get a bit shorter later in the day -- until 6 wks of age he ate religiously every two hours (or less during growth spurts!) and since about 9 weeks he has been eating less frequently.  So we're still transitioning, I just follow his hunger cues.  Usually his feed schedule looks something like this:

5:30am
9am
12pm
3pm
5:45pm
7:45 or 8:00pm
11:00pm

He is awake for about 1:15 after waking, and asleep by 1:30.  His naps vary in length a bit; the first of the day is almost always 1:30 - 1:45, the second tends to be :45 to 1:00, the third 1:15 - 1:30, and then the cat nap is a half hour.

Having a big baby is definitely a physical challenge! 

I feel like we had a bit of a breakthrough last night.  He woke up from his cat nap around 7:30.  He wasn't hungry (!) so we delayed the last feeding before bed.  We did the normal routine -- bath, jammies, read a book, fed a bottle of EBM (new thing) and walk to wind down.  Then swaddle and walk a bit more (shhh/pat is not working these days and we're trying different things, scold me if you want!).  He was asleep by 9 but woke at 9:45 absolutely SCREAMING.  The only thing I could figure is that he had had a nightmare, at least that's the impression I got.  It was very weird.  Anyway, it took us 'til 10:40 to get him back to sleep but then he didn't wake up again.  I heard him working the saliva as always but he managed to sleep through it.  We will see what happens tonight!