Reflux and short naps

[Ellie-Leo]

Hi all - we have been fighting with 30 min naps for weeks on end now. I've continually worked on the theory that it is OTness, but I am not sure that it is all the time a I have tried shortening up A times for days on end. I know that if he doesnt get enough short naps, we do get into OT territory, but that's a different story. Anyway, the reason for my post is that LO has silent reflux, which has been more noticeable recently as he's started taking bigger bottles. Having flicked through this board, I see that lots of refluxers seem to suffer with short naps. It's not that he often wakes crying or visibly in pain from the reflux but I wonder if it is common that reflux babies struggle to transition? He is textbook with a large dose of spirit, and 21 weeks, but the 30 min naps started maybe 7 weeks ago.

Just possibly looking for an explanation because by rights i think the zillion short naps a day and good night's sleep should eventually have sorted the naps if it was OTness...(and we occasionally have a few days of improvement but then back to square one, when nothing has changed in our routine etc)

Any advice or thoughts welcome

TIA

Ellie

[mom of two]

Do you think it could be UT now?  I don't know much about the reflux having a factor...but my LO was taking short naps and I thought he was OT (his big sister was a touchy baby so I was always on the alert for OT) but he was really UT.  I kept him up longer and he started napping longer.  Will your lo go back to sleep after 30 minutes?  Mine will still wakes a few times during a nap, sometimes but I can give him the paci and he will go back to sleep.  Just a thought.

[Canwi]

How are you taking care of his reflux?  Meds/position changes etc. 

[babybarr]

Any progress on this post as I would be interested to hear??

[JennŠ]

Think I'm going to send this to the naps ladies.  Hopefully they have answers.  Definately post all about your babe's reflux stuff, that i bet we can help with. 

[Ellie-Leo]

Hi, sorry for being so slow in replying.

mom of two - to be honest, I dont think it means he is OT or UT anymore, I think it's just his sleeping pattern. For a long time we worked on the basis of OT, and shortened A times for days on end but it had no impact. Have also tried lengthening them - same. We occasionally (v occasionally!) get good naps and the next day I always try to repeat the pattern of timings/activities etc, but it either works for a couple of days and then stops, or doesnt ever work again. There doesnt seem to be any rhyme or reason to it. We havent had more than 30 mins in the morning (and he wakes up happy) for about 6 weeks and that's with all manner of A times experimented. Am trying to just leave it by now to the extend I can, although there's no doubt these naps make planning our day difficult. Sometimes things work, sometimes I get quite down about it.. He went through a week of going back to sleep after 30 min naps, and i thought we had it cracked, but never again! He either wakes up happy and wide awake, or v distressed in which case he gets more distressed by my trying to resettle him - it has never worked. I think the spirited side of him has that effect. Like you though, i am getting to the point of stretching A times a little again as i think he has to be really tired (eg sleeps really well after baby massage usually)

canwi - LO is on Gaviscon in all feeds, and we raise his mattress a little although he tends to scooch round until he is sideways across the crib and therefore more or less flat. We had a period of time where he seemed to be ins ome distress and he was v fussy with feeding, but that seems to have passed for the moment so apart from the odd occasion, i dont think he is in too much discomfort. I think he suffers with stomach acid etc, rather than spitting up (esp with Gaviscon)

So i'm not sure that the naps are really anything to do with the reflux (if only it were that simple) - it just struck me that an awful lot of the reflux posts mentioned 20/30 min naps and it suddenly occured to me that tghere may be something in that. We have started first tastes of solids this week so it will be interesting to see if that has any impact.

babybarr - are you suffering with the same problems??!

[Canwi]

Reflux is more than just spitting up, unfortunately.  My LO doesn't spit up very much, no more than the average child.  But without his Losec he is in agony.  His stomach contents come up his oesophagus, but don't come out. 

The reason that reflux seems (to me anyway) to be part of the problem with sleeping and naps esp.  is that after 20-30
minutes our LO's are at their most relaxed.  The little muscle band at the top of their stomachs also relaxes and allows stomach contents & acid to come back up their throats.  It burns and is sore.  Repeat this process enough times and the oesophagus gets irritated.  So then if you neutralise the acid you can still have pain with the episodes as the neutralised stomach contents pass the irritated oesophagus.

Gaviscon only works while it is in the stomach.  So once it has been digested, your LO will have no medication to protect him from his reflux. 
He may benefit from another drug that actually works on the acid production itself.

We also have issues with scooching in the sleep.  DS2 has to be placed in one of those infant positioner things at the moment as he is so wiggly in his sleep he would always be at the end of his crib.  (HOPEFULLY we get our Losec dose increased next week and we can dispense with the amount of incline on the crib & that will help)

I hope the solids help you out.  Will follow your progress with baited breath as we are looking at starting solids in the next few weeks.
Hope this info helps.

[mumofashie]

Hi all

Ellie, hope you dont mind me jumping in.

It's with interest that I read that your LO is also refluxer, Ellie, as my LO is also refluxer and sorry that things have not improved for you.  I have been battling with the GPs to try and get at least zantac for him.  In the meantime, he is on Enfamil AR formula (I'm not sure if you are BF Leo or if he is on formula but Enfamil AR is prescription only in UK) which seems to be helping him some but I am going back next week to get LO on zantac.  I want to trial it for 2 weeks at the very least.

Canwi, thanks for explaining why short naps and refluxers seem to go hand in hand.  Seems to make perfect sense as my LO seems to wake up in pain (always seems shocked to have woken up).  And I can hear him as he swallows the contents back down while he is alseep (in the night too).  Could you tell me the difference between zantac and losec as BW babies seem to be either on one or the other?  Also, when my LO cries his throat sounds very dry - could that be the reflux?

My LO is averaging about 1.5 hours of naps a day, sometimes two hours (he's 5 months and 1 week old) and yesterday he napped for 1 hour only - 2x30 mins naps.  He just finds it really hard to sleep.  Unfortunately, he's feed cycle is still coinciding with his sleep cycle (3 hour easy for feeds - he cant cope with any more but 4 hour easy for sleep) so he is feeding about 5/10 mins before he goes for naps. 

One good thing is that he is averaging 13 hour nights (with DF and 1 or 2 NF  - he has had a growth spurt - and a couple of very short EA - lasts a minute or 2-he's easy to shhh back to sleep) so it's like his body is compensating for lack of day time naps.  On another thread on general sleep board I read about looking at total sleep (day and night) to work out bed times when Los do short naps.  For example, yesterday as he only had 1 hour total naps I put him to bed an hour early and he still got up the same time today that he normally wakes up.

Ellie, one thing that I have tried hard to do is to go with the flow.  Some days are better than others, but it does help to be chilled out - I am so much happier and my LO seems to be happier too (no stressed out mum) and the other thing that I have done is make sure I take on board all the help that people are offering so that I can get a break as with a couple or 3 x 30 min naps I get no time to myself - as you know we have to rush around trying to get things done.  This means that sometimes my LO may not get the naps that he needs because he doesnt seem to want to be helped to sleep by anyone else ( it can be hard enough with me trying to get him to sleep sometimes) but since it makes little difference to nap lengths/amount of naps I know that I can always put him down for the night early.

I have also been doing lots of AP (like holding him in my arms as he sleeps) recently to see if he can go past the 30 mins and it has not helped!  Luckily, LO does not seem to have forgotten independent sleep (thank goodness).

One exciting thing is LO has started on solids this week.  Baby rice and pears so far.  He loves holding and chewing his spoon - hasn't eaten much but that's okay cos he is so proud to be "eating" with a spoon  .  I've only offered solids once a day so far as I dont want to overload his system - I think with a refluxer its best to go slowly?

BTW, when I and LO went to visit my HV for a weigh-in and I told her that LO has new formula for reflux, the HV told the HV student that reflux was no big deal, only a nuisance as babies clothes have to be changed so often and sometimes your clothes as well.  I really despair at HV's indifference/ignorance on so many matters.

Anna x

[Canwi]

Could you tell me the difference between zantac and losec as BW babies seem to be either on one or the other? 

This is a link that is from BW site.
http://babywhispererforums.com/index.php?topic=70373.0
There is also good info on the MARCI website
http://www.marci-kids.com/medications.html

Also, when my LO cries his throat sounds very dry - could that be the reflux?

Could be.  They often have hoarse throats.  Can't remember why.

Ellie, one thing that I have tried hard to do is to go with the flow.  Some days are better than others, but it does help to be chilled out - I am so much happier and my LO seems to be happier too (no stressed out mum)

Agree wholeheartedly.  It may even mean doing some APing or even not strictly following EASY.  You have to do what works with a reflux baby.

'Scuse me being blunt, but your HV is a twit.  Yeah, my screaming baby's reflux is no big deal.  Let's see ... weight loss, no sleep, REFUSING feeds even when it's obvious he's hungry.  Yup.  No big deal.  GRRR!  If reflux was only excessive spit-up, then her view point would be true.

[babybarr]

Hi
I have a post about a very unsettled baby during the day on the reflux board - I have no idea how to do a link sorry - but I have been given zantac now for DS.

Ellie - Leo my DS has never liked taking naps in the day for a long time I just assumed that was him - as mumofashie I have also tried AP and that hasn't made any difference either.  Thanks to Canwi for explaining the relux and sleep thing that definitely makes sense.  Am I right in thinking that Zantac neutralises the acid and Losec stops it being produced?  Maybe that is why I'm seeing no progress really with Zantac and his sleep is just getting worse.  I should really count myself lucky because DS doesn't have nightfeed atall and sleeps pretty much from 7ish till usually 6ish and then sometimes goes back to sleep other times just fusses till I get him up.  I'm guessing though this has a lot to do with lack of sleep in day.  During the night though he wakes up a lot, always stirring and squirming, sometimes I hear him screamout then fuss and go back to sleep.

I am sure that if you have tried UT & OT and other BW techniques and you can't extend the naps then surely there must be something else going on.  That is kinda the conclusion I came to with my LO and once I started reading about reflux (mainly silent) I started to think this sounded just like him.  I just feel bad because he is now nearly 4 months and when I look back clearly this has been going on since he was born.  I just thought he was going to be a high maintainence baby.

[Canwi]

Am I right in thinking that Zantac neutralises the acid and Losec stops it being produced? 

In essence yes.  Zantac works on the receptors in the stomach, Losec (& it's friends Prevacid & Pantoloc) work on the cells that stimulate acid production that live in the duodenum (first part of the intestines just after the stomach).

Maybe that is why I'm seeing no progress really with Zantac and his sleep is just getting worse.  I should really count myself lucky because DS doesn't have nightfeed atall and sleeps pretty much from 7ish till usually 6ish and then sometimes goes back to sleep other times just fusses till I get him up.  I'm guessing though this has a lot to do with lack of sleep in day. 

The lack of progress with Zantac could be a number of things.  It can take a week or so for any progress to start to show up.  Zantac is a drug that is notorious for needing to have the dose adjusted to account for weight gains by the child.  Zantac doesn't work for everyone and, finally, children can develop a tolerance to it where it just stops working.
You may also find the sleeping thing takes a while to come "right" as you may need to "catch up" on sleep missed out on.  DS2 took a while to 'perk up'.

During the night though he wakes up a lot, always stirring and squirming, sometimes I hear him screamout then fuss and go back to sleep.

That would be him refluxing in his sleep at a guess.  The squirming is him trying to get in a position that his stomach contents don't bug him so much, the scream is the pain and then he goes back to sleep out of exhaustion/habit.
Are you raising the head of his crib?  It will help.  DS2 is a wiggler so I only have his crib raised about 4 inches (blocks under the legs of the crib) and use one of those infant positioning devices (http://www.toysrus.ca/product/index.jsp?productId=2689244) to keep him from rolling onto his face - which he likes for a while and then gets mad!  

Oh yeah.  Found out why reflux babies often have hoarse throats.  It is because the acid can cause some damage to their vocal cords.

[babybarr]

Canwi - thanks so much for that that has helped.  He sleeps on his tummy and cot is raised slightly.  I have been wondering about sleep positioners I don't know if they work with tummy sleeping?

[babybarr]

Canwi - sorry one more thing - do you think it's bette to push for something like Losec over Zantac just in your opinion?

[Canwi]

In my opinion Losec is better, but there are those I know who have had good success with Zantac.
Most Docs will want to try Zantac first.  It has been used for much longer for kids than Losec and the other drugs.

If your LO is tummy sleeping, positioners probably won't work very well.

[mumofashie]

Thanks Canwi - you have been a wealth of information    Interesting and a bit alarming about hoarse cry and vocal cords    I have only noticed it in the last two weeks or so. 

Babybarr, my LO sleeps in the room with us and I can also hear him squirming around and crying out etc.  It's quite distressing.

My LO only slept for just over an hour today (40 mins and 30 mins).  It was a struggle to get him to sleep today. The third nap, he tried so hard to sleep but he just couldn't do it.  We tried for 1.5hours to sleep (with a break in the middle) but no go.  He went to bed super early.  I must admit that I got completely frustrated and at one point I had to leave the room to take a deep breath or five  .  Anyway, in his second nap, he woke up crying and was all shaky/shivery and a little frightened - has anyone come across that?  I know he was not hungry as he had fed about 15 mins before going for nap and I checked for a leaky nappy too - my DH thought it could be a nightmare?  Could that be possible?  Or was it reflux?  I was wondering if he fought the third nap because of how he woke up from the second nap?  He's done the crying/shiver/shakey thing a few times now.

Has anyone got any advice on how I can get my LO to actually take a nap?  I think that I am pretty good at reading his tired cues and I have a consistent wind down routine that works on days that go well.

My DH does not agree with me about getting LO medicated.  He has much older children from previous relationship who used to chuck up all the time apparently.  He doesn't think there is a problem with LO - its a design fault in babies that they will get over in time - and why bother medicating someone who seems very happy (got to admit that LO is a very happy baby).  Having said all this to me, he said he would go by whatever decision I made!

Wish me luck with the doctors.

Anna