Sleeping and routine a mess please help

[nam207]

I'm not sure where to start. Perhaps by holding my hands up to a bad case of AP! My DS is 5 1/2 months old and a combination of touchy and spirited. He was in the NICU for a couple of weeks as he was born with a chest infection and he's seemed quite unsettled since we've been home. The only way DS could be soothed in the first few months was by nursing and it continues to be the only way to get him to sleep. DS has always been a bad napper - never longer than 40 mins and very resistant to going down.  For a while we were able to get him to nap pushing the buggy back and forth with white noise going but now he really cries each time we try to put him down in it so Im back to feeding him to sleep and even this is hit and miss. Night sleeping was looking promising up until just before 4 months but now DS wakes every 40 mins and I have to feed him to sleep again. Because this meant I had no sleep at all I've started co-sleeping with him which feels like I'm going backwards. The Health Visitor thought starting weaning might help but that's not working either as I have to nurse DS to sleep so often he's never hungry for food even though he's very interested. DS's sleeping is so all over the place we haven't been able to establish any kind of routine so far either across the day or to wind down before naps/bedtime and this won't be helping matters. DS is getting more and more unsettled and overtired with each week that goes by and I know I have to sort it out I just don't know where to start. Please can you help me come up with a plan. 

[anna*]

The first thing to do is to start putting him down for naps at regular times, and putting some space between feeds and sleep. At this age he can probably manage around 2-2hrs15mins awake between naps - that includes feeding, winding down, falling to sleep. So tomorrow morning you'd wake him, feed, then at about 1.75hrs after his feed you'll take him upstairs for a short wind-down. Keep it brief. Just a few steps so that (after you've repeated it 50 times) he knows it's going to be sleep time. So like, nappy change, close curtains, into sleeping bag, sing song, into cot.

Presumably he'll be crying up a storm before you put him in the cot. Lie him down anyway and spend a couple of minutes at least trying to settle him in his cot. Stroke his head, sing to him, stroke his back, jiggle his mattress - anything you can find that helps him to ease up or at least not escalate his crying. If it's not working, pick him up and hold him, pat his back or just cuddle him, tell him it's ok he's just going to sleep. If he starts to calm down, great, if not, lie him back down anyway and try again to settle him in his cot. Keep doing this for 45 mins. I expect he will skip his first nap. There will be a lot of crying but keep in mind he is not in pain and not afraid, just tired and frustrated because he doesn't know how to go to sleep without nursing.

So after 45 mins you bring him out of the bedroom and do a little bit of low-key A time. You might need to nurse him (depends what time it is by now) but don't let him fall asleep on the boob. Feed him in a well lit part of the house and as soon as he stops actively feeding, take him off the boob and keep him up for 5-10 mins before heading upstairs and going through your wind-down routine again. Try again to settle him for a nap just as described above. 45 mins. He might skip this nap too.

Keep going. He will fall asleep eventually, and the first time he falls asleep without nursing will be a breakthrough, because then you will both know that he can do it.

At bedtime, don't take a break after 45 mins, keep going until he sleeps.

Overnight, I would feed him at 10.30am. If he wakes up before then, settle him without feeding. (if he wakes up at 9.30, and it takes two hours, still settle him without feeding - you can feed him at his next waking). If he wakes and it has been less than 3-4 hours since his last feed, settle him without feeding.

It will be hard but you can do this. Keep his A times short - after a short nap he won't manage a full 2-2.25hrs awake, so cut it back if he has a short nap.

Before you begin though, are you sure he is not in discomfort?

[nam207]

Hi, thanks for your quick reply. I don't think he's in pain or discomfort. We've tried two different types of medicine in case he had silent reflux and they didn't make any difference. We've also had a referral to Bristol Childrens Hospital who put me on an elimination diet in case he had a milk protein allergy but that made no difference either. Cranio sacral therapy didn't help and I'm not sure if there is anything else that could be wrong?

I'll probably start your plan at the weekend when my husband can help too. Before I do, can I ask a few questions...

If DS doesn't nap, how long should the A time be before I try and put him down again?

What would count as a good nap? I'm assuming not the 40 mins he does or would that be ok?

Also, because DS is so overtired it can be difficult to work out when to put him down. If he does have a short nap approximately how long would you recommend I have him up for before putting him down again?

Thanks for your support

[anna*]

Hi, thanks for your quick reply. I don't think he's in pain or discomfort. We've tried two different types of medicine in case he had silent reflux and they didn't make any difference. We've also had a referral to Bristol Childrens Hospital who put me on an elimination diet in case he had a milk protein allergy but that made no difference either. Cranio sacral therapy didn't help and I'm not sure if there is anything else that could be wrong?

I'm not sure either BUT if he looks/sounds/acts like he's in pain and if you FEEL that he is in pain, do follow that instinct and keep badgering the Drs. If you believe he's fine, then let's go ahead with sleep training.

If DS doesn't nap, how long should the A time be before I try and put him down again?

Maybe 45 mins after you get him up from his cot? So say he wakes at 7am, and you try for a nap at 9am, and at 9.45am he's still screaming, then you'll get him up, calm him down, feed him at maybe 10am and try for another nap at 10.30 or so. There's not a science to it, and short naps or non-existant naps are pain because it's hard to judge what to do next.

What would count as a good nap? I'm assuming not the 40 mins he does or would that be ok?

At least an hour. Probably if he gets past the 45 mins mark he'll do another 45 mins which is excellent.

Also, because DS is so overtired it can be difficult to work out when to put him down. If he does have a short nap approximately how long would you recommend I have him up for before putting him down again?

Again, I'm guessing but maybe 1.75hrs? If he does another short nap then shorten the next A time too.

Good luck! Let us know how it goes!

[nam207]

Thanks, I will. Fingers and toes all crossed!

[nam207]

Hi,

So I've had the flu and that's delayed starting sleep training and now I'm confused about what to do having read The Plan on this post: Starting E.A.S.Y. at Four Months or Older

Should I pick a schedule and stick to the times whilst teaching DS to self soothe?

Should I be trying to get him to nap for longer than 40 mins right from the start and PUPD even if he's napped for 40 mins?

Thanks for your advice

[anna*]

I think the 'official' advice is to stick to a schedule, personally though I've always adjusted times so as not to wind up with too much overtiredness. So if the first nap is short, the second nap will be brought earlier so that you don't end up with a massive long A time. Yes I would try to extend naps if you can.

[amayzie]

I think the 'official' advice is to stick to a schedule,

I agree with Anna- it's so up to your child and your style and preference here. Some people feel a sort of hard line, start from scratch thing will work, and if the LO can tolerate a bit of OT then it usually does, but if that's not your style- and you are orried that once your LO gets OT then it will be a big mess then you don't NEED to be that rigid.

[nam207]

Thank you both.

I'm going to start on Thursday this week. I'll get up at 7am and see how the day pans out. I'll post my progress for you to see.

[nam207]

Hi There,

I'm finally starting today and am currently sitting in the chair beside DSs cot avoiding eye contact and have realised I have a couple more questions.

When I first put him down he grumbled and I did shush pat but now he's laughing and kicking his legs and I'm just sitting nearby. Is that right or should I be shush patting him? And what do I do if I'm shush patting and he starts to play with my arm?

Also, does the 45 min of trying mean from when we took him upstairs or from when S time should have started? And if I try and get DS to sleep from 915 to 10 and keep him up for 45 mins that takes me to 10:45 - only 15 mins before his feed is due so what do I do then.

Thanks

[amayzie]

hmm- the laughing in the cot sounds like you should try for a longer A time- he doesn't sound tired enough! Really i've found for shh-pat to work they need to be crying- it's to settle them to sleep. If he's not crying and upset you can either leave the room- he might chat himself to sleep (they can do that) or you can get him up again and have some more A time. If you leave the room and he starts crying then you will know that he needs you to come in again and settle him.

I would start counting the 45 minutes from when you put him down- when the S time has started.

when i was doing this with my guy i did the following: Feed him at the start of the A time. Then do the A time- say 2 hours, then start the settling. I'd do this for 45 minutes- then decide if i wanted to give up then, or change tack and do some APOPing or put him in the stroller or something. If i decided to get him up i would feed him then- or wait till the 3 hour mark. I found that otherwise i'd just get all mixed up! Then start another a time- but it might need to be shorter this time...

Anna may have other suggestions for you!

[nam207]

Thanks Amayzie.

Im basing his A time on what works when feeding him to sleep. DS is nearly 6 1/2 mths old now and until today was up for 2.25 hrs, being fed and falling asleep at about the 2.5 hr mark. At 2.25 hrs DS is showing tired signs such as being quiet, fussing and yawning.

The EASY I'm trying for is

700 BF
800 Solids
930 S
1100 BF
1200 Solids
130 S
300 BF
430 S
515 BF
600 Solids
730 S
1030 Dream Feed

Does that sound ok?

I think I'll have to do what you suggested for now though and get the schedule on track after DS goes down more easily.

PS. Just as I was going to stop at the 45 min mark for the second nap his cry changed to a mantra cry and he's now asleep in his cot!

Thanks for the support.

[amayzie]

Sounds like you are making progress!! Don't be afraid to kick up the A time- some babies are on closer to 3 hours at 6 months. Keep it up!!