4-mth-old (19 wks) new to rough NWs

[BethP781]

My angel/textbook baby boy used to sleep 6+ hours at one stretch at night. Now he's waking at night every four hours or more and screaming hysterically. The only thing that will calm him is nursing him. I'm a stay-at-home mom with a 3.5 year old spirited daughter, so I don't get daytime naps to catch up on sleep. He started these horrible NWs on May 26th. (I remember the date because the night before this, he slept 9 hours straight and woke up happy and not starving.) He now weighs about 13 lbs, and his doctor said he's healthy and a normal weight for age. And he always sleeps on his side or tummy, now that he's learned to roll over. We stopped swaddling after he started rolling to sleep, which is around the same time he started NWs. Please help!

How old is your child? 19 weeks old

What’s his/her daily routine?
WU/feed - 7AM
A - 7-9 (I'm including his feeding)
S - 9-9:45, 9:50ish-10:30
E - 11
A - 10:30AM-1PM
S - 1-1:45, 1:50ish-2:30
E - 3
A - 2:30-5
S - 5-5:45
A - 5:45-7 (sometimes a bath, but not every day)
BT/feed - 7
DF - 10:30 (have to change diaper, or he'll pee through)

NW - 1PM, 4AM, and sometimes more often (last night he woke at 1PM, 4:45, 5, 5:30, and 6)


What’s nap routine? put on sleep sack, turn on white noise machine, lights off (pretty much black-out), sit still in rocker and pat/shhh until calm, lay down in crib awake

How long are naps? 45 minutes most times, but sometimes he can put himself back to sleep and nap for 1.5 hrs. Always wakes up crying loudly.

What's bedtime routine? Time? 7PM nurse, put on sleep sack, turn on white noise machine, lights off (pretty much black-out), sit still in rocker and pat/shhh until calm but awake, lay down in crib awake

Do you bottle or breastfed? EBF, one bottle of BM at DF

How much? or how long? 15-20 minutes, bottle is 4.5-5oz

If breastfed.. one side or both?? (at each feed) one side, unless he cries after 20 minutes of sucking, then both sides (I figure he's getting 4-5 oz per feed)

How many wakes per night? 2+

What’s your LO like when waking at night? How long is he/she up? He screams hysterically and it takes a long time to settle him, unless I nurse him. He'd happily nurse at all NWs, but I can't believe he'd truly be hungry every 3-4 hours at night.

When you go to him/her is she fussing or crying? Or is it a mantra cry? Increasingly loud crying. Definitely not mantra or fussing.

What have you tried to settle?? PU/PD (hasn't worked yet), nursing (works every time), pat/shh

What do you do for A time and how long is it? drive older daughter to/from preschool, grocery shopping, tummy time with baby toys, sometimes jumper with lights/sounds (5 minutes or less, because it's very overstimulating)

Are there developmental issues such as teething or milestones? Probably teething, but meds don't help so maybe not.

Have you introduced cereal? Why, how much, and how many times a day? (for LO’s under 6 months) No foods yet. Only breast milk.

Do they have a prop? If so what is it? Uses a paci sometimes, but don't like it much. Breast may be a prop for NWs. Sucks thumb sometimes, but still learning to do this.

Do they have a lovie? He has soft lovies, but doesn't have them in the crib (SIDS risk)

[katie80]

It does sound like it could be a growth spurt to me, especially as it coincides with him being about 4mo and nothing settles him except for nursing.  It is quite possible that he's hungry every 3.5-4hr during the night if he's going through a GS, and there's often a pretty big one around 4mo.  He's on the younger side of having only 4 feeds a day.  I would start to offer both breasts at each feed (if he doesn't take it, fine, but if he does, that will help him get more milk) or a cluster feed after the CN and before bed.  If he's only taking 4-5oz per feed (although there's really no way to know that, as pumping isn't necessarily the best indicator), I would think that he might be little low on milk intake and that's why he's waking an extra time per night.  I went from single side feeding to double around 3-4mo with both my kids.

When you say he mostly sleeps for 45min for naps, do you end up shh/patting him back to sleep at the transition and then he finishes the nap or do you get him up?  The way you have your EAS written, it looks like he's going back, so I just wanted to check.  He is getting quite a lot of A time at the end of the day, 2.5hr between the 1st and 2nd nap and 2nd nap and CN, which is a bit on the high side for his age, so the other thing to think about would be OT at BT.  Just something else to take note of.  Have you tried sticking closer to 2hr for A time and seeing if it makes a difference in naps or NWs?

[BethP781]

I'm not sure it is a growth spurt, only because it's lasted for over two weeks now.

Last night my husband tried the wake-to-sleep at the 1AM habitual waking. He went in at 12:30, and my son stayed asleep all the way until 5 AM! It was glorious to have a whopping six hours of sleep. Of course I fed him when he woke at 5, but then it threw off his wake-up time. I topped him off at 7:30 AM (let him sleep in a bit), but he was overly full and spit up all morning.

Regarding the low milk intake: I noticed that when I have a lot more milk production, my son gets distracted easily and won't empty my breast. Then starts the vicious cycle of me not making enough milk and he's overly hungry again. I'm not sure what to do about this, but wait it out until he can start solid foods.

The past two days I've been feeding him every 3.5 hours, and he seems to be a bit happier with that. But when I re-read the BW books, she's adamant about sticking to the 4-hr EASY. Do you think that's just for formula-fed babies or babies who have supplemental solid foods??

Regarding the broken naps: Sometimes he'll wake up from a short nap and I'll try to shh/pat or PU/PD for 15 minutes, and he won't go back to sleep. Sometimes he does go back to sleep in a just a few minutes. I do my best to try to give him 1.5 to 2 hours of nap time. It's very inconsistent, so I follow his cues.

Regarding the long A times: I agree that 2.5 hrs seems a long time for his age. If he only takes a 1.5 hr nap, he'll get 30 mins of A time, then a feed, then 2 hrs of A time. He's been okay with this, but definitely tired by the end. With the 3.5 EASY, he'll wake up after a 1.5 hr nap, I'll feed him right away, and he'll only have 2 hrs of A time.

[katie80]

Last night my husband tried the wake-to-sleep at the 1AM habitual waking. He went in at 12:30, and my son stayed asleep all the way until 5 AM! It was glorious to have a whopping six hours of sleep. Of course I fed him when he woke at 5, but then it threw off his wake-up time. I topped him off at 7:30 AM (let him sleep in a bit), but he was overly full and spit up all morning.

That's great, although a bummer on spitting up.  You can always wait to offer the top up until the middle of the A time, to see if that helps.

Regarding the low milk intake: I noticed that when I have a lot more milk production, my son gets distracted easily and won't empty my breast. Then starts the vicious cycle of me not making enough milk and he's overly hungry again. I'm not sure what to do about this, but wait it out until he can start solid foods.

I'm not sure I understand this.  You'd still have him empty the first breast fully and then offer the second one. You can wait 10-15min before offering the second one as well to see if he's truly hungry and minimize overfeeding. 

The past two days I've been feeding him every 3.5 hours, and he seems to be a bit happier with that. But when I re-read the BW books, she's adamant about sticking to the 4-hr EASY. Do you think that's just for formula-fed babies or babies who have supplemental solid foods??

Yes, we do beleive that if Tracy were still alive she would have updated her info on BFing to take into account current research.  There are many EBFd babies who don't make it a full 4hr between feeds until they start on solids.  Some do and that's great, but if he's happier on 3.5hr and it works with his A times and naps, then I'd stick to that for now.  The one thing we know is that Tracy advocated listening to your unique baby, so if that's what he needs, that's what you do.

Hope that helps and hopefully w2s will keep working!