Night time feeding of 4week old?

[JudyLee]

Have a question which is a bit of everything I think.
DD is four weeks old (three weeks premmie) and feeding at night is an issue.
During the day I have to wake her to feed, so she manages three hours fine. She'll feed for anywhere from 5-25mins. She will vomit/reflux about every second feed but refuses to feed anymore post vomit.
Her A time is only feed/nappy and a cuddle really still. Sometimes she manages 45mins in total, other times if she's had a previous big A time and just done a big feed, she'll pass out regardless of tickles, nappy changes and what not.

Night time - she's only doing two hours between feeds and only doing 5min feeds before vomiting then refusing further feed and then passing out.
I have to keep her upright for awhile after feeds in attempt to keep some of the milk down. Her cot is tilted, she's swaddled, she is pretty good so far at self settling and it's only the middle of the night waking that seems to require regular pat/shh from us to get her off to sleep. She also refuses a dummy. We've tried three different ones and it gets rejected every time we've tried it.

Any ideas for what I can do to try to extend the night time feed times? Can you see something which I should be doing or shouldn't?
Thanks!

[Khalam's Mama]

It is important to make as much difference between night and day as possible so they don't get them confused. In the day have the light on, talk to her through everything, change her nappy and offer the second breast after to get as much calories in as possible. Keep waking her after 3hrs from her last feed.
In the night keep it dark, avoid eye contact and talking. Only change her if she poops.
Have you tried to resettle without feeding?
Saying that she is still so young. Only a week old adjusted (?). I would aim to differentiate the two but expect it to change slowly rather than o/n.

[JudyLee]

Thanks for the advice.
I try to keep it as dark and quiet as possible at nighttime. Daytime curtains are open, we cha and since she's got a 4yr old sister, there is lots of noise!
So is it that she thinks night is day so she's waking the 2hrly?

[amayzie]

Congrats on the new little one!! I typed this ages ago and then hours later went to post!! So i think i'm saying much of what the others have said...

 I don't have heaps of experience and it sounds as if you are doing all of the right things! The only things i was going to say are that she is very young still and i assume small? THis might mean that she has more trouble taking more at feeds and tires. Sometimes too the 'passing out' is a sign that she isn't managing, and it's her way of saying 'nope- too hard mum'. Are you able to see a Lactation consltant to get your attachment looked at? Also she could have her days and nights 'switched'- so keep trying to keep her up in her uptimes during the day. I've heard that making sure that she gets some natural light on her during the day too to help with establishing a good day- awake/night asleep thing... even if that's just through a window....

Anyhoo- just some ideas that might work!! I think at this age it's just trying to find the secret trick that will work for your LO!!

[Erin M]

She does sound day/night reversed to me -- in which case she should grow out of it in the next few weeks.  I found it helpful to get a good BT routine started early on to signify the start of the night.

[JudyLee]

Thanks guys.
Erin, do you mean the 4s's for getting to bed, or do you mean...always do a bath, books then bed...that sort of thing?

[amayzie]

we started off doing the bath, book, 4s then beb bit after the 9pm (or so) feed rather than 7 at that age.. then this changed to 7 eventually (didn't take long) sort of makes more sense...

[Erin M]

The bath, massage, pajamas, feed, bed thing (or at least that's how it goes for us).  It took a few weeks to make a difference but it's a huge sanity saver for me to be able to put him down and hav him fall asleep. 

[Khalam's Mama]

BT routine is really important. I agree it helps to be consistent.

Is she crying/upset at the NW?

She is little and her adjusted age is still really young but do you think she needs to be awake any longer than 45min? YOu say sometimes she manages this long. Does that mean other times it is even less?

I agree with PP that she may be finding the BF hard too. How are you nipples? Are they sore at all or does she seem to have a good latch? Could you try giving the breast a bit of a squeeze while she feeds to speed up the flow if she is getting sleepy? I find this wakes B up a bit and also helps him get more before he falls asleep.

[JudyLee]

She sometimes passes out after 10-15mins and other times she gets to 30mins and ONCE she made 45min.
She's got obvious sleep cues - huge yawns, slow blinks and if I can get her down earlier rather than later sleep comes easier for her.
But on average - she's still under 30min A time total from the moment her eyes open.

She seems to have a good latch and from the amount of milk she throws up all over me most feeds - she's getting enough milk. She is also very content after she's covered me with milk and totally refuses any more top ups. Nipples are fine.

Thanks!

[amayzie]

Hamish was a shocker with A time, sometimes doing the hour- other times doing less (to none at all!!)- Do you try doing the nappy after the feed? Or feed 1 side, change nappy, then the other side? I found this would sometimes work to wake hamish up- otherwise no chance!

[bflorrie]

since she is vomiting after every second feed during day and after every feed at night, me thinks she is hungrier after the vomiting hence the 2 hour wakes.

Am no expert but I have learnt that with reflux, shorter and more frequent feeds help reduce the vomiting. My one also wakes every 2 hours and feeds for 10  mins ( as opposed to 30  during day) and he's not had an episode in 2 weeks.

My heart goes out to you. Keep a positive attitude, it helps a lot.

[Khalam's Mama]

The other thing with refluxers is they may wake due to discomfort and want to feed to soothe the pain. Do you think she is in pain/discomfort at all?

[JudyLee]

Oh that makes sense! Throw up - hungry. Oh dear, it looks like I'll be feeding for a long time yet to come.
Definitely got pain you can see it in the wake ups and facial expressions. She is not really a crier though *which is great for our ears*, but means the doctor doesn't want to start her on meds, cause it can't be that bad for her...

Have to change the nappy at the beginning of the feed or she loses everything. And she absolutely refuses the second breast. She is showing attitude at an early age.
Cheers!