4month old NWs and EW - don't know what to do!!

[hlh]

Hi there

DD2 is 18 weeks old and EBF. I have moved her onto 4hr EASY over the last couple of weeks and it is working well in the day. She is generally managing fine with the gap between feeds and naps are a lot better.

However NWs have been an ongoing issue. She was doing well at 8/9 weeks and we were down to one NW/NF. Then that crept back up to 2 NW/NFs which started to get earlier in the night. At 15 weeks she had a week long growth spurt where she started waking at 10/11pm for a feed and that waking seemed to carry on after the growth spurt. Sometimes she would self settle, sometimes needed shush pat and if neither of those worked I fed her. That waking then seemed to get later for a week but then was creeping back to 10pm last week. She has never been fed at that time since being a newborn. She doesn't have a dream feed as she won't take a bottle and I'd want to be confident of what she was taking to delay the next feeding.

I had stopped swaddling her as she kept breaking free causing more NWs but decided to go back to this last week when she woke at 10pm. I swaddled her with the miracle blanket and then put a sleeping bag over her and shush patted back to sleep. She then slept till 4am!!!! The next night she slept till 3am and I thought that was maybe the problem solved however after that she went back to waking at 1, 4 and then EW often at 5.30am. I would feed at 1&4 and then either shush pat at the EW or rock her if she was getting noisy as she has started to wake DD2 up.

This 1am has since been drifting forward again. My DH will go in and settle her (he usually ends up picking her up) if she is waking at 11.30/12 but then she still wakes an hour later so guessing she is hungry? Last night I just fed her when she woke at 11.30pm to see if that helped but she still woke 3 hrs later at 2.30. She just doesn't seem to go for a long stretch anymore before waking up. During the day and sometimes at EWs she will settle fine for me with shush pat but at night when I try she just wants me to feed her. She will settle for DH but then only sleep another hour. 

DH is off for a few days after Thursday so have a few nights in a row to potentially try some kind of sleep training when he doesn't have to go to work. Not sure if we should be resorting to PU/PD if shush pat not working at night or when in the night to do this. I am happy to feed her twice in the night but just feel she should at least be able to get to 1am before needing fed. She doesn't seem as hungry at the second feeding and sometimes not massively hungry for the 1st feed of the day.

She goes to sleep in her own cot and is put down awake but drowsy. She doesn't have a paci but is now swaddled for both naps and at night. She does have a slumber bear sound machine. We tried unswaddled for naps for a while and went back to it as it seems to help.

Her routine for yesterday was:

Wake up 5.45am didn't settle on own and started crying with shush pat so rocked back to sleep from 6.15-7am.
7.15 BF
8.55 - 11 sleep (woke after 45mins and resettled with shush pat)
11.05 BF
1-3.15 sleep (woke after 1hr 20 and resettled with shush pat. I woke her at 3.15)
3.20 BF
5.05-5.50 sleep
6.20 bath
6.40 - 7.30 BF
7.40 asleep
11.30 BF
2.30 BF
4.45 woke and resettled self
6 tiny BF then I held until 6.45

I wouldn't usually feed at that last time as usually feed around 1&4 and then she is ok until 7 feedwise but as I fed earlier than usual in the night thought she may need it to go back to sleep. Don't know if she is using me as a prop in the night though.

We are thinking of trying a dream feed with a bottle to see if she'll take it although I'm not very optimistic as had no success with a bottle in the day now despite taking it a few times around 5/6 weeks. If she did though what time should I then hold off until next feed and I know it takes time to work so do you not have to feed until that time for a number of nights?

Basically I am wondering what it is reasonable of me to expect of her at this age in relation to NWs/NFs. I know there is sleep regression at 4 months but it feels like this has been going on a month if not longer already. Should we try PU PD and if so how do you do this without disturbing DD2. I can cope with the 2 NWs if she didn't have the EW as well. It's difficult to do an EBT as trying to fit around DD1 and her dinner and bath time.

Any suggestions, I am so tired as haven't had a decent block of sleep for ages and no one to help with NFs as she won't take a bottle.

Thank you and sorry for such a long post!

Helen

[katie80]

Yes, it's perfectly normal to still have two NFs at this age.  The general rule that many follow is to not feed more often at night than during the day, so if she can go 4hr during the day, then don't feed sooner than 4hr at night.  It seems like you're doing that with shh/pat to settle her before that time, so I think you're on the right track.  Waking within an hour of resettling does often indicate hunger, so I think youre right in your assessment there as well.

There is a big GS at 4 mo, which it sounds like you noticed and is likely over.  There is also commonly a sleep regression, which sometimes means the extra waking at night that happens during the GS kind of sticks around afterward.  That might be part of your case here, but I think there are a few things to work on to see if you can't get rid of those extra wakes.

First, it's very common for EBF babies to need an extra day feed still, even if they can make it to a 4hr EASY.  Lots of EBF babies don't actually make the full 4hr until they start solids around 5.5-6mo.  I notice your last BF of the day is either really long, or you do it at some point in that interval that you wrote down.  I think instead of that, I might try a cluster feed, so feed her upon waking from the CN and then again before bed.  This will add in that extra feed and hopefully help to space out the NFs. Then, you're safe to shh/pat any wake that would happen before 4hr.  As for the DF, you can certainly try it. I would give it up to two weeks though (at least one) before you reassess to see if it's made a difference.  After that, the same rule would apply in not feeding under 4 hr.

Another thing to tweak a bit is her routine.  She's doing nice, long naps for you, which is great, but be careful in letting them not get too long.  Anything over two hrs for both of the main naps has the potential to take from night sleep.  So, I'd err on the side of waking at 2hr.  If she's had a short nap in there for some reason, you can obviously let her go over, but otherwise, I'd wake at 2hr. Because she's also doing a bit of waking mid-nap, I'd make sure you keep pushing her to at least 2hr A, as this may be an early sign that she's starting to get ready for a bit more A time.

Also, it's perfectly fine to have her swaddled still.  As long as she's not rolling over, there's no harm in it provided it's not a restrictive swaddle (i.e. she can move her limbs a bit still).  I did wonder about the night you swaddled and then put the sleeping bag over her. While I'm not sure I can recommend that if it's a SIDS risk, it made me wonder if she's a bit cold and that could be a factor in the NWs.  It wouldn't be the first time a LO has been waking more frequently due to temperature, so something to keep in mind.

Finally, as for the sleep training when your DH is off, I don't think you need to do any PUPD by any means.  Shh/pat should always be used first and I don't think we can say she's waking out of habit at this point.  Just like shh/pat, PUPD won't work if the waking is driven by a need, i.e. hunger, too hot/cold, etc. I'd work on the feeding and routine tweaks first and keep using shh/pat to settle in the night when it's too early for a feed.

[hlh]

Hi there

Thanks so much for getting back to me, your advice was really helpful and things have been improving!

I have started feeding her after the catnap. The feeding before bed is for that whole time, so she does feed a lot longer then than she does at any other feeding in the day.  I have also been extending the night time feedings to every 4 hours or thereabouts with shush pat as they were more like 3 hours. We tried the dreamfeed and she wasn't taking any of it so have decided to try and focus on a bottle before bedtime. DH has been trying every night and we are just going to keep at it.  Haven't had too much success so far and I will just then go and feed her so probably not a big incentive for her to take it but thought if we introduce it as part of the routine eventually she will hopefully accept it.

In terms of being cold, I have been putting a lower tog sleeping bag on over the swaddle than the one she was previously in so that she wouldn't be too hot and at SIDS risk so I don't think that was probably a factor.

I'm make sure she is doing the full 2hrs A time and sometimes a little extra even and naps are doing too badly although still getting the odd one here or there which seems to go wrong!

The result has been the first wakening has slowly been getting later and later and even better the last few mornings she has been sleeping until 7am which has been amazing!!!! Thank you 

Last night she didn't wake until 2am which was great. She then slept until 6am at which point I wasn't really sure what to do but decided to feed her as little as I could and she went back to sleep until 7am. I wondered whether to try and shush pat then until 7am as that is when I'd like the day to start but was worried she wouldn't settle and I'm so pleased with the later wake ups I didn't want to risk her waking at 6 every day to start he day. She didn't then feed great at 7 but just kept trying a few times between 7 and 8 and she had some milk so hopefully that will keep her going until the next feed.

What is the best way to deal with the 6am wakenening? I'm hoping that if things keep improving it may not be too long till I can just drop that second feed potentially as it will almost be the start to her day but don't want to speak too soon and jink the improvements!

Thanks for your help 

[katie80]

Hi Helen, I'm glad to hear things are improving.  The odd not so good nap is still really normal at her age.  Just keep an eye on A time, as if shorter naps start becoming the norm, she probably needs a little push. As for the 6am wakeup, you can do a couple things, which it sounds like you've already thought of.  It's worth trying shh/pat, since she does well with it. If my DS wasn't hungry at that time, he would usually go back to sleep fine with shh/pat.  But, if she's done a longer stretch at the beginning of the night, like last night, there's a good chance she probably is hungry again 4 hr later.  Feeding her just a bit is fine to do at that time and as you say, hopefully she will start to phase that out on her own.

As for the bottle, I thought my DS was done with it at 4mo, but I did keep persisting and he did take it.  I made sure the milk was very warm in it and he seemed to like that better.  I've also heard lots of LOs take to the NUK brand, if you have that where you are. My DD however, never took a bottle after 8-9 weeks, despite my best efforts.  Some are just a bit stubborn.

[hlh]

Thanks for the advice Katie, that's helpful. Fingers crossed things continue to improve.

In relation to the bottle, I think we can get NUK ones in the UK so will maybe give them a try.  DH has been trying the bottle for the last week or so and I think the most DD2 has taken is 20ml (although I think a lot of that ends up on the bib!) and a lot of the time it hasn't really been anything. We'll keep trying and see how it goes, it wouldn't surprise me if she is a stubborn one! Good to know you had success and some persistence though.

Thanks