5 night wakings for several nights in a row - please help

[SUNNY01]

I really need some help for my DS who is almost 5 mo old. He was hospitalized for first 4 mo of his life and has now been home for 1 mo. He has a clean bill of health.

At the hospital he slept through the whole night (he was fed by tube through nose so never knew what hungry was). since he's been home his sleep has gotten progressively worse day in and day out.

 We used BW for our first DD and it worked perfectly. We have tried with our DS but it is not working at all, and this after 4 wks. I am seriously thinking of letting him cry for a bit because i am at my wit's end.  Our pediatrician recommended letting him cry bc at the hospital he learned to self-soothe and it seems that by doing SP and PUPD, he's gotten used to the coddling when he didn't need that before.

Here is a sample of his day over the last 3 days.

Please note he NEEDS his paci and can go to sleep for naps and at night quite easily with it. without it we have to stay in room for entire nap doing shush pat or PUPD as he knows immediately when we leave room.

Monday
1230am NW
2am E ? Don't remember
4am settle with pacifier + awake on and off (whenever pacifier falls out so I have to hold it in)
530am still awake on and off. Brought into bed with pacifier
645am E 3 oz + BF
7am up for day
830am quiet time
850am sleep
10am awake
1010am E 80ml
11am S in drs office 20mins in arms
1220pm fall asleep in car
1230pm put in crib asleep
1245pm - 145pm PU/PD with leaving him cry 5 mins in between. Falls asleep when picked up
150pm E 100 ml falls asleep while eating
210pm transferred to crib while asleep
240pm awake and talking in crib
3pm went in to settle with pacifier
345pm awake
515 E 140 ml
6 quiet time and in crib
610 S (with paci then remove) good sleep
645 woke him up but he was v asleep
715 bath
730 E 60 ml + spit up
800 sleep
904 woke up gave paci to settle
1000 woke up gave paci to settle
1045 E DF 110ml

Tuesday
12am settled w paci
2am big poop and back to sleep after change
5am diaper change and fell asleep on chamge table
6am awake + bfed + feed very little 60ml slow then 40ml = 100ml
8am quiet time
830am asleep
930 awake and seems hungry. Only ate 50ml
1030 activity walk (was about to fall asleep so kept awake)
1120 asleep in crib - put down awake but very drowsy
1136 making noise, left on own then had to resettle w pacifier
1225 making noise, left on own went back to sleep
125 had to wake him up
135 E 90ml
225 A
3 quiet time since fussy
310 put down awake but very drowsy. Sleeping with paci
400 awake and activity
500 eat 60ml
525 activity
540 quiet
545 sleep with paci
615 woke him up
630 E 70ml
7 bath
730 E 70ml
800 sleep
904 woke up gave paci to settle
1030 DF 90ml

Wednesday
12am resettled w paci
2am tried to resettle but seemed hungry so E 50ml
4am resettled w paci but in v liight sleep
5am up again E 40ml
6am up for day
730 cranky bf 3 min
745 seemed tired so quiet time
755 Sleep

[SUNNY01]

I should add that he has Down Syndrome and is underweight (9lbs at 4.5 months) due to severe health complications during his hospital stay.

[katie80]

Hi there,
First off, big (((hugs))) for what must have been a terrifying and very difficult first four months of his life. I'm very happy to hear that he now has a clean bill of health. What you've been through and continue to go through is obviously exhausting and I know there is always the temptation to let a LO cry when you feel at your wits end, but I assure you it is doubtful that would help your situation and would likely cause more trauma to your LO. He's already had a rough start to life. Shh/pat and PUPD are methods of teaching self-soothing and aren't coddling at all IMO when done correctly. If you are very consistent in using them, they work (not always overnight, but they do work).

So, I think your biggest issue here is that LO is in need of consistency. You mentioned that he needs his paci, but also that sometimes he hasn't had it. PUPD and paci don't mix, so I'm assuming the times you've tried PUPD is when he hasn't had it? It sounds like he maybe has a bit of a prop issue with the paci in the MOTN, but he transitions through naps without it, so I don't think it's something you have to get rid of.

As for routine, it looks about right for a 5 mo old, with some naps a bit wonky still. You should be aiming for about 2 hr - 2 hr 15 min of A time. The one thing I notice is that after a short nap, his A time isn't always reduced. If he does less than 1.5 hr nap, I'd pull back on the next A time by 15-30 min depending on how short the nap was. This should help hinder OT and hopefully perpetuate a longer nap the next time. Ideally at this age you'd like two full naps and a CN. The other thing to try to aim for in routine is as close to a 12 hr day as possible. So if he wakes around 6-6:30 am, BT is ideally 6-6:30 pm (7 pm at the very latest).

Finally, how are you feeding him. I noticed a BF in there, are the bottles EBM or formula? I'll try to get some feeding eyes on this for you too. It seems like he's having lots of little feeds, which is likely not helping the NWs. Obviously, he may still be adjusting to being fed at intervals than continuously.

[SUNNY01]

Thank you so much for your response! Everything you are saying does make sense although I find it very exhausting doing shpat or PUPD for 45mins and it still doesnt work. i guess the hospital stay took more out of me than i thought.

He actually is pretty addicted to the pacifier. He will go down immediately with it for naps and now is always waking up around 30-45min mark and i have to try pupd or shpat and then finally when i just replug the paci he goes right to sleep...but then wakes up 10mins later and so the cycle continues. Its very exhausting. Im wondering should I address this problem in the naps section? Does this mean we should get rid of paci altogether?

Im also wondering why he would be waking almost every hour at night?

I am BF a few times a day and EBM fortified with formula for the other bottles. when he BF he never usually takes a full feed - his latch isn't that great but we are working on it. He is also never that hungry in the am and eats so much more in the pm. We don't think hes waking at night because of hunger. And in general, yes he does better with small amounts more often but we don't want him "snacking" so im slightly confused about what to do about this.

Thanks very much for your help and support, Katie. I definitely need the encouragement to keep this up!

[katie80]

(((Hugs))), hon, it's a tough position to be in, working so hard to get him some sleep when you're exhausted yourself.  Yes, PUPD can take a long time.  It doesn't mean that it's not working, he's just obviously used to going to sleep with a paci, so is likely wondering what in the world is going on.  What temperament is he: angel, textbook, spirited, touchy, grumpy? The other important thing to note is that PUPD can use a lot of calories for a baby, and since he's quite low weight, I'm not sure it would be the best option for you.  I'd stick with shh/pat as much as possible first.

Im wondering should I address this problem in the naps section? Does this mean we should get rid of paci altogether?

You don't have to make a separate post in naps.  We can keep it all right here.  The 30-45 min waking in his naps means that he can't transition to another sleep cycle and likely his dependence on the paci is why.  I think that's also why he's probably waking every hour at night.  It's totally up to you whether you want to get rid of it or not.  I got rid of my DD's at 5 mo, and she was generally a great independent sleeper from there on out.  It will definitely take work and probably a few long sessions of shh/pat or PUPD, but once it's gone, my guess is that he'll start sleeping longer naps and better nights.  The other thing you could do is to go in to him during his naps around 25 min or so and do wake-to-sleep (cause him to stir enough that he starts a new sleep cycle and also put his paci while he's still basically asleep), so that he sleeps past those transtitions.  This would likely have to be done for a week or two and isn't guaranteed to work and probably won't help solve the NWs.

I'm not sure what to tell you about the feeding.  I've not combo fed before.  I'll see if I can't get some others to come have a peek and see if they have any advice to offer.

[becj86]

Was he premature at all? If so, what is his adjusted age? It may be that he needs to be on a routine more suited to his adjusted age than his actual age, especially given his weight - he is pretty tiny. At that weight, I'd be feeding around every 3hr where possible through the day at least. What does the paed say?

Do you have white noise? I just wonder if he got used to a particular sound while in hospital - machines whirring or something - that may help him sleep?

I agree with Katie, I really wouldn't be doing PUPD with him - he's too small. PUPD uses a lot of calories with the crying. Its also meant as a last resort when other methods haven't worked after being used consistently.

Huge hugs, I'm sure you're exhausted. Let's see if we can get some sleep for him and for you. xx

[Erin M]

And another question -- have you had some IRL bfing support?  Has his latch been checked so you know that it's ok? 

[SUNNY01]

Hi there, thanks for all your responses.
My DS is a touchy baby. Ive tried the WTS several times for naps and NW and it does work. He did 2 nights of sleeping from 730 to 530 with a DF and doing 2 WTS.

We do use white noise to mimic the hospital sounds and we've done this from the first day we brought him home.

He was not born premature but the fact that he was hospitalized and so severely sick for so long (he had 3 surgeries) made it so that his age is not really his "age". He was always small - he was born at 5 pounds - because he had a heart defect that needed to be surgically repaired. His pediatrician actually said he is doing very well and catching up faster than they expected. To the point that he does not necessarily need a night feed. We find that he actually is not waking from hunger because when we did feed him in the past, he would take a very very small amount. We are now feeding him every 3 to 3.5 hrs with a cluster feed and DF and that seems to suit him. I really think it is habitual waking because it is a;ways at the same time of night.

As for BFing, we are working on his latch. I am actually having someone come to help me with that bcause he often latches on then comes off crying and repeats that. I think it's part of his touchy personality?

I am taking your advice and stopping PUPD and the pacifier.  Im definitely seeing some progress with sh/pat and WTS, but it's taking a lot out of me. It’s tough to do it for every single nap and then 3 WTS at night.  I guess I am wondering how long I can expect it to take? With my daughter (textbook) it seems like she caught on so much faster than my DS.

[Erin M]

I can imagine you must be exhausted.  Will he fall asleep any other way -- in the swing, car, etc?  For my dd2 and ds to keep my sanity, I would aim for 1 decent nap and BT in the crib and other naps happening to the best of my ability.  Sometimes you just have to do what works best for your entire family, including yourself. 

So glad you're getting the IRL support for the bfing.  Does he feed differently from a bottle (doesn't come off crying)?  Do you know if you have a fast let down?  Or a slow one?  Sometimes the fussiness can be caused by the flow of milk not being to a LO's liking.  What do you think?

[becj86]

Thanks for explaining, its hard to advise when we don't know much of the story and we really don't want to misguide you.

Its great that he's doing well after such a rough time.

His whole world has changed which can be a big deal for a touchy. He's in a new environment - everything smells different, sounds different, looks different. I'd say you're basically starting from scratch in terms of training. When you say he learned to self settle in hospital - how was that? Did they leave him to cry there and he eventually stopped? Did he learn that it was safe place and settle himself independently?

I guess I am wondering how long I can expect it to take? With my daughter (textbook) it seems like she caught on so much faster than my DS.

Looking back at your posts re: your daughter, it really took getting her routine spot on before she napped well - maybe that's the case with your son as well.
I can't say how long the WTS and shush/pat will take but its good that you're seeing an improvement already.

[katie80]

Will he fall asleep any other way -- in the swing, car, etc?  For my dd2 and ds to keep my sanity, I would aim for 1 decent nap and BT in the crib and other naps happening to the best of my ability.  Sometimes you just have to do what works best for your entire family, including yourself. 

I am in total agreement with this. I did one nap per day in the swing with DS until he was 5 mo, because I needed that time to do lunch and rest time with DD. It didn't hinder his independent sleep skills at all, because he was going down for all other naps and BT on his own. Let yourself have a break when you need it, it makes you a better mom.

I also agree that having a good routine will help most in getting the W2S to work more permanently. I think typically, the average is anywhere from 3 days up to 2 weeks. His touchiness will likely play a part in that time frame as well.

(((Hugs))), you're doing a great job!

[SUNNY01]

Hi everyone!

Will he fall asleep any other way -- in the swing, car, etc?

Yes, he can definitely nap in the car seat and I think this may just be the way to go...

Does he feed differently from a bottle (doesn't come off crying)?  Do you know if you have a fast let down?  Or a slow one?

It actually depends on his mood. He will do the same thing with the bottle if he is in "that" mood. He is treated with meds for reflux so I have a feeling this may play a part. For bfeeding, I do have a fast let-down and have noticed that if I pump before, he doesn't do this as much. But I find that the Bfeeding doesn't sustain him as long as the bottles - he will always be hungry 1 hr later.

When you say he learned to self settle in hospital - how was that? Did they leave him to cry there and he eventually stopped? Did he learn that it was safe place and settle himself independently?

That's a great question that I've been meaning to address. At the hospital, they would put him on his side and put the paci in his mouth and make sure it stayed there with a soft pillow (because he was always monitored, there was no risk of SIDS).  Also, since there were so many babies there, if one cried but the nurse was busy, he would not get attention right away (so sad, I know). So this is the environment he got used to. I guess thats why I feel it's strange that he used to be such a great sleeper there and now at home, it's such a struggle.

I really have to thank you all for keeping me going. Honestly, you have been a lifesaver. My husband is going back to work tomorrow after being off the whole time our DS was in hospital (so now a total of 5 months). I'm quite nervous of doing it all on my own, but at least I have seen some progress and you are right, perhaps his routine just needs to be spot on.

I'll keep you posted. Thanks!

[becj86]

The fast letdown can make the reflux worse and the hunger an hour after feeding may be about soothing reflux/gas pain from the gulping he has to do with a fast flow of milk. It may be due to a less efficient transfer of milk though too - I don't know a lot about BFing and Downs but I am aware if can be quite tricky to master. Hats off to you for persevering!

So this is the environment he got used to. I guess thats why I feel it's strange that he used to be such a great sleeper there and now at home, it's such a struggle.

He got used to the environment too - the constant bustling, humming of machines, beeping of monitors, crying of other babies, etc. is what he's used to, so home proably seems really odd to him. I think you may need to think of him as a 4-5 week old baby in terms of him getting used to the home environment - his whole world has changed a lot.

Do you have his cot mattress on an angle to help with the reflux? Its possible that he's waking from discomfort too.

[SUNNY01]

Yes we definitely incline his bed for this reason.

Can you have a look at his routine these last few days and let me know where I am going wrong? Why is he having so much trouble in the early part of the night?

Sunday
600 E 80ml
615 S
730 awake
900 E 100ml
930 S
1115 awake
1200 E 80ml
130 S
245 awake
300 E 80ml
450 S
510 crying, sh/pat
540 awake, crying
600 E 60ml
645 bath
700 E 120 ml (spit up)
745 S (we woke him up before eyes hit crib so as not to associate eating with sleeping)
815 crying, sh/pat
845 S
904 crying, shpat, E 40 ml
1040 crying, DF 80 ml
1145 crying shpat

Monday
155 crying shpat
455 stirring - did nothing and fell back asleep on own
600 wake and E 80ml
615 S
730 woke him up for day
800 90ml (ate in 2 sittings 30mins apart)
945 prepare for sleep
950 sleep
1025 crying - did sh/pat and when didn't work, let cry for a few mins then came back to shush then pickup.
1120 asleep (I'm now waiting to see when he will wake up)

[katie80]

(((Hugs))) for starting to do it all on your own.  I remember those first few days well, it is a bit nerve-wracking.

I think you may need to think of him as a 4-5 week old baby in terms of him getting used to the home environment - his whole world has changed a lot.

Just wanted to start by saying I totally agree with this.  He's got so, so much going on, I think you'll have to be pretty patient and remember that it's like starting over with the sleep training stuff.  His reflux is another reason to avoid PUPD; it can often be aggravated by all the moving around.

From your day on Sunday it looks like he was OT going to bed.  He'd had a broken 50 min nap from 4:50-5:40 pm (which was possibly OT as well, since the mid-day nap was only 1h15m long) and then didn't get to sleep until 2 hr later.  I would've probably aimed for 7:15 ish bedtime.  It could also be that the reflux is bothering him.  I notice that he woke crying within a couple hours of being fed each time.  Do you think his reflux is well controlled?

As for this morning, his A ended up being too long, and he did an OT 35 min nap.  I know it's frustrating when shh/pat doesn't seem to work right away, but I really wouldn't leave him to cry for any amount of time.  Besides the fact that we don't believe in leaving a LO to cry at BW, he's still just learning how all this works.  If you need to just take a deep breath, step back and do it, but please don't leave him for a few min.  You definitely don't want him to feel abandoned and consistency is what you're working for here, so you need to keep doing what you're doing over and over.  If you don't feel like you can do it for that nap, then use the car seat or swing or a carrier.  It'll be a good break for you both.