Naptime Troubles

[Angela Michelle]

Hello!  My 12 week old DS is driving us all crazy with naptime troubles.  Adam is a very good tempered little guy - I'd say Textbook bordering on Angel.  His nights are good, but it is almost impossible to get him to nap during the day. 

Adam was born one month early by Cesarean due to my health concerns.  He was 7 lbs 7 oz at birth and is currently approximately 15 pounds ( a big boy!)  Adam had some difficulties breast feeding when he was born so he had to spend approximately 2 weeks in hospital and was tube fed.  We gradually increased his nursing sessions until he was able to nurse successfully all the time.  When he came home from the hospital he was on a nice 3 hour schedule and had no trouble napping.

I would love to give you a run down of his daily schedule, but I can't seem to get him into one.  Every day is so different.  The one thing that is consistent right now is that he usually has his last feeding of the day at about 9 pm and is usually asleep by 10 or 11 pm.  This week he has been sleeping until about 5:30 or 6:30 am.  Then he feeds again and is usually right back asleep for another 1 to 1.5 hours.  Then he feeds again anywhere from 8-9 am and is often awake until the early afternoon.  If I am lucky, he will nap at about 1 or 2 pm.  Sometimes the nap lasts 3 minutes, sometimes 2 hours.  This week, he napped on Monday afternoon for a couple of hours.  For the rest of the week - no naps longer than 10 - 30 minutes with me having to go into him to get him back to sleep at 3-10 minute intervals.  As I attempt to write this message Adam had a "nap" for one hour.  During that hour I had to go into him about 6 times.  I am going nuts!

Methods I have tried:  I always swaddle him to prepare him for nap time.  I have tried the shush/pat - it just seemed to irritate him.  I have tried to put him down drowsy, completely asleep and alert.  I have tried staying with him to help him through to the deep sleep stage - after 10 minutes he opened his eyes, saw me and it was "game over".  He seems to need us to carry him around on our shoulder and pat his back while gently bouncing him as we walk until he is completely asleep and then put him in his crib.  This used to result in a nap, but now it often does not.  I have tried a paci - he doesn't care for it that much but will use it on occasion.  If he has it, he will not stay asleep once it falls out.  At best, he will nap 30 minutes with a paci with frequent interventions on our part to put it back in his mouth so he will fall back asleep. 

Usually our day progresses with Adam becoming increasingly over-tired and hard to settle.  He then begins to have a lot of trouble eating properly and soon becomes too tired to eat and too hungry to sleep.

I have tried to have a consistent wind down routine.  This is extremely hard to continue with because, in addition to Adam, I also have a 2 1/2 year old who also needs my attention.  I have found out the hard way how quickly my oldest can get into things and have also noticed his increasing frustration at getting hardly any attention from Mommy.  Often, when it is time for Adam to have a nap, my oldest needs to be fed or is in desperate need of a diaper change or getting into things again.  This is another big factor in the "nap time wars"!

I am not sure if this has anything to do with it, but Adam takes an hour to complete one session of nursing.  If I can't get him to nap after A, then he wants to eat every 2 hours, sometimes every 1 1/2 hours.  I try to watch for sleep signals, but he is frequently yawning during nursing and is often almost asleep while he's eating.  After eating he perks up and will be quite content during activity time.  I really haven't been able to observe any sleep signals at this point.  Soon, he is tired and I can't get him to sleep except for a little dozing for a few minutes.  Then we're at the two hour mark since his last feeding and he wants to eat again.  We then get into the cycle I mention about him not being able to eat well and then can't sleep well either.  I have tried giving him breast milk by bottle hoping that the shorter feeding time will enable him to get in a nap, but it doesn't work.  He also spits up quite frequently and I have occasionally noticed spit up in his crib when I have had to go into him.  Today, when I was observing him during his attempt at a morning nap, he started to move his tongue around in his mouth and made a face like he'd tasted something unpleasant.  I suspect something came up into his mouth a bit. 

I am sorry this is so long.  I really don't know what exactly to do here, so I am giving you all the information I can think of.  I have both of Tracy's books and find that the information in them makes so much sense, but I can't seem to figure out where I should be starting with my own situation.  I often do not even have time to eat a proper meal, let alone have any "sanity breaks" and my DS is pretty pooped out a lot of the time.  Please help! 

Sincerely,

Angela

[Taylor's Mommy]

Hi Angela, 
I am so sorry you are having a tough time with ds's naps.  I know how hard it is with just one so can't imagine yet dealing with a toddler and infant nap troubles.

Let me first ask a couple of questions to get a little better sense of your ds and his routine:
1. Is there a reason why he goes to bed so late?  Is he hard to get to sleep any earlier?  I think he may be gettign to bed a bit too late, so not getting enough sleep, therefore making him overtired at the start of the day.  Can you try and put him to sleep earlier?

2. After he is up at 8-9 am, when is the next time you try to put him down for a nap?  At this age the typical awake time is about 1.5 hours.  So you would want to aim to put him down for a nap between 9:30-10:30 am.

3. When you say he will sleep off and on, where exactly is he sleeping?  In his own room in a crib?  Is the room darkened and do you use any white noise?

4. Does he have reflux?  The reason I ask is when you describe him spitting up and seemign to have a bad taste in his mouth, as well as the long nursing sessions, those are some symptoms of reflux. 

If he doesn't have any medical issues like reflux, I think you need to start by getting him onto some sort of stable routine.  I know, easier said than done right?  Since he is close to 3 months, and pat/shush seems to irritate him, you may want to start with PU/PD in the next couple of weeks (it's only supposed to be used on babies at least 3 months old).  You will use PU/PD to help teach him to fall asleep independently without the use of any props.  This will help him get on a better routine so he is eating and sleeping better. 
Please answer the Q's above and we can go on from there.

Thanks and hang in there 

[Angela Michelle]

Hi!  It is so good to hear from you!  You must be a fast reader to get through my windy message!

Here are my answers to your questions:

(1) Adam goes to bed so late because I can't seem to get him to sleep any sooner.  I would love to do the dream feed routine suggested in the books as I know a couple of girls with babies younger than Adam who have found great success with this method.  So far, any attempts to get him to sleep any earlier at best will result in a half hour nap with many interventions from myself or my dh.  Any suggestions to getting him to sleep earlier?  I would have thought that being up in the evening would be a good way to start - unfortunately, he's already awake in the evening.  What is a typical night for a baby this age?

(2) At this point, I try to put Adam down for a nap around 12 - 1 pm.  He used to fall asleep after that feeding a short time after when he was younger.  Actually, because he was premature his E & A were kind of combined because he was very hard to keep awake for a feeding since it tired him out a little bit more than a typical newborn.  That was one of the reasons for his extended stay in the NICU because he couldn't handle a full nursing session at all for the first week as he was not strong enough.  (Hard to believe since he was over 7 lbs at birth!)  I have been wondering if this is part of our napping problem - he's used to falling asleep at the breast? 

(3)  Adam is sleeping in his crib.  I don't like to let him sleep anywhere else.  I darken the room (we have a black-out roller blind on his window so it's nice and dark).  I run our furnace fan for white noise as it gives a nice low hum in his room (the furnace room is beneath his) and it also cuts down on other noises in the house - especially from my 2 year old.

(4) You know - I've occasionally wondered about reflux.  I have not mentioned this to his doctor because I have been assuming that spitting up is "normal".  Maybe his frequent spit ups are more than usual.  I also was not aware that long nursing sessions are related.  Do you know why a reflux baby would nurse longer?  I remember reading on this in Tracy's latest book, but I currently cannot find my copy to reread that section.  Do you know of another information source online that I could log into to see if this may be an issue?

Here's how our day has gone today, to give you an idea of what is currently going on:

Last night - feeding at 9 pm
To sleep at 10:30 pm
Awake and fed at 3:00 am
Asleep by 4:00 am (immediately after nursing)
Awake at 6:30 am
Feeding for one hour
Asleep at 7:30 am
10:00 am - awake
Nursing until 11:20 am (one hour and a quarter)
Asleep in my arms at 12:20 pm
Laid him in his crib at 12:30
He made it for 45 minutes on his own with no interruptions.
Feeding at 1:20 pm
Currently awake (2:40 pm) and smiling at me from his baby seat.  So far does not seem sleepy.

Today is a little better, but I have found that he usually has at least one or two days (sometimes more as in the case of this week) with no napping and then has a "catch up" day where he will nap.  Then the cycle repeats.

One thing I was thinking about since my first email:  When Adam was about one month of age, I tried to help him learn to sleep on his own.  (I had more help at home on a daily basis due to holidays and my recovery from Cesearean).  I tried to have a consistent wind down routine and then put him in his crib sleepy.  The first attempt resulted in a nap of about 45 minutes.  The remainder of the day resulted in no napping - I had to frequently intervene.  By the end of the day, he was so tired that his ability to nurse was extremely poor and he was very overtired.  I was concerned about his inability to nurse as this was an major issue when he was born and I abandonded further attempts at the time because I was afraid I'd affect his ability to eat and he'd wind up back in the hospital. 

Thanks so much for helping me through this.  I really appreciate it!

[Taylor's Mommy]

Hi again,

Okay, one very important thing I missed with your ds is that he is 4 weeks premature, so really is he 8 weeks adjusted???
that changes things quite a lot because this early in the game the difference between a 8 week old and a 12 week old are very big.

Also, does he typically go back to sleep around 7:30ish after his first feeding upon waking?  If so, this is counting as a nap for him so then the one he had at 12:30 is his second nap.  He should then be getting at least one more nap in there. 

What is a typical night for a baby this age?

once I get it firmed up if he is 8 weeks or 12 weeks adjusted, I will elaborate on that.

Do you know why a reflux baby would nurse longer?

I beieve it has to do with them having difficulty swallowing because it bothers them, therefore they eat slower.  Does he bob off and on and sometimes cry or fuss during nursing sessions?
We actually have a reflux board on here that is a great resource.  I would def. visit there and see if he shows any more signs.

Please let me know about the 8 vs. 12 week question though before I go further.

thanks

[Angela Michelle]

Hi again!  Here are the answers to your questions:

(1) Yes, Adam is 12 weeks since birth, but technically only 8 weeks developmentally because he was 4 weeks premature. 

(2) Adam does have fussy feeding sessions.  They don't always occur, but what happens when they do is he arches his whole body and pulls quite roughly on my breast.  It is actually quite uncomfortable for the both of us.  I have a couple of other feeding issues that have appeared to be the cause of this that I will mention here:  I have a very large milk supply and have also got a VERY fast let down.  I can actually spray milk about 4 feet.  This fast let down has been an issue for Adam as it overwhelms his tummy.  I usually only feed on one side per feeding and have been using a pump to control the let down at the beginning of each feeding so that Adam's tummy can keep up, which has definitely helped.  I do notice that he begins to show frustration later on in the feeding when my milk slows down as I am pretty sure that he thinks the milk should always come out in a big gush.  This is when he begins to pull and yank on my breast (I can hardly wait until he has teeth!)  To test this theory out, I put him on the other breast when he begins to pull and yank and he will usually settle.  But, Adam has had feedings where his whole body is arching, jerking, and he pulls on my breast even when the milk is still coming out at a good pace.  Sometimes it is because he has to burp, other times I can't figure out what the problem is.  Maybe it is reflux.  I will definitely check the reflux board.  I've finally found my copy of Tracy's latest book and have looked up reflux.  Some things definitely sound like Adam (ie: spitting up watery cottage cheese like substance), but I definitely do not see any issues of the pain and discomfort that the book talks about.  He also sleeps quite well at night, which I am not sure why he'd be able to do.  I am going to take him to his doctor this week if I can get an appointment to check into this more.

This weekend, Adam has slept from 10 pm to 6:30 am on Saturday am. and  from 10 pm last night until 7 am this morning.  He slept for another 1 1/4 after his 7 am feeding.  Friday, I was able to get three 45 minute naps out of him.  Saturday - very short naps.  I am currently trying to get more of a routine as a starting point as I realize that the lack of structure must be a major issue here.

I am trying to watch his sleep cues, but what is confusing is he is already yawning during his nursing sessions.  He doesn't yawn during his activity time after and seems to go right into being overtired without further yawning.  Yet, if I try to settle him for a nap right after eating, he is not ready.  I try to keep activity time to about 1/2 hour and then settle him, but so far this isn't too successful.  What do you make of this? 

I will look more into the reflux issue and will let you know what happens after I see his doctor.  Thanks again! 

[Taylor's Mommy]

Okay, now that I know he is technically 8 weeks old, a lot of his behavior sounds very typical of newborn behavior, including the late bed time, short naps, and going from sleepy to overtired very shortly.  I think what you are doing so far is great.  Unfortunately the short naps are very developmental.  What that means is that for the first few weeks lo's are working on figuring out their night time sleepign habits and patterns.  It seems that your ds has figured this out by sleeping from 10-7 the last few days.  Next, they start working on day time sleep and while this is occuring, things will usually go a little wacky for a few weeks.  To help things progress I suggest working on the following:
-keeping A time low key and short, no more than 1 hour-1 hour and 15 minutes to help prevent overtiredness
-pat/shush or some other calming technique to extend nap times when they are short to avoid overtiredness before bedtime
-work on bringing the bedtime earlier and earlier over the next few weeks.  Shoot for 9ish by about 10 weeks and then 8ish by about 12 weeks, then 7-7:30 by about 16 weeks (these are in adjusted ages obviously).
-work on teaching ds independent sleep over the next few weeks so that he can learn to make it past the 45 mintue mark once his body is developmentally ready to sleep longer.

let me know if you have any questions.  I really think you are doing great so far and seem to really have gotten to know your lo well so far.  You are doing a great job!

[Angela Michelle]

Hello again!

Thanks very much for the feedback!  It is so good to know that I'm not doing things really wrong and that my ds is pretty normal.  The past couple of days have seen a bit of a turnaround - we've actually had a couple of 45 minute naps later on in the day which wasn't even a possibility last week.  I have become a little more in tune with his sleepy signals - he fidgets and his leg movements become jerky - and then swaddle him and try to wind him down.  He usually isn't too happy to start with, but then he does nap in his crib.  He can't seem to transition into another sleep cycle yet and can't get back after the first 45 minutes, but I understand from your response that this will eventually change with time. 
Our trip to the doctor yesterday revealed that he has also been battling a very itchy rash on his face that I had thought was baby acne.  Poor little guy!  We are now getting that under control which will be sure to help.

Thanks so much to Stacy for her comments regarding the fast letdown issues with nursing.  I can really relate to what you mean with the yanking, fussing and the uncomfortable sensations with letdown!  I am very fortunate to also have access to a terrific lactation consultant who has worked us through some of the issues, but things still need a little tweaking.  I already do the method in your second suggestion and I will be sure to try out some of your ideas in your first suggestion.  Thanks!  I appreciate your input.  I am finding that some of the techniques for reflux babies (raised crib mattress and feeding at a sharper angle) have been helping in the areas of spit up as spitting up has been an interruption to his sleep.  His doctor said he may have a bit of reflux but the issue for him is more the fast milk supply.

We'll keep working on things and I'm sure in another couple of months things will be much different.  Thanks! 
 

[Taylor's Mommy]

Hi Angela,

So glad to hear things are going well and that the trip to the doctor was successful.  Glad to hear as well that reflux isn't really to blame.

Keep us posted of your progress!