4 1/2 mth: HELP, Why is he waking?

[thegodwingang]

How old is your child? 4 months, 2 weeks (he was sleeping 7-9 hours prior to 3 months)

What’s his/her daily routine? 
E 600-610
A 610-730/800
S 730/800-900 (sometimes I let him sleep til 930 if he didn't go to sleep til
E 900-910
A 910-1030
S 1030-1200
E 12-1210
A 1210-130 (sometimes he stays up til 2)
S 130/200-300 (sometimes he is up at 230; 30 minute nap)
E 300-310
A 310-430 (sometimes he crashes at 4; sleep til 430)
E 510-520
A 520-600 (will sometimes get in a 20-30 min nap around 6)
700 bath and ready for bed.
E 730-745
S 730-

Ok, the night time   I don't do a dream feed.  He occasionally wakes around 9 just unsettled; mantra cry; shush-pat works.  Gets up around 12; sometimes mantra cry sometimes more' I nurse him.  Up again between 3-4; I try shush-pat and he just gets furious; he nurses.  We are usually never up longer than 10-15 minutes.  I wake him at 6 to start the day.

What's bedtime routine? Time?  Bath at 700, snuggle time, nurse, read a book.  He is very fussy after bath; fine after he nurses.

Do you bottle or breastfed??  Breast at home; pumped milk from bottle at daycare

How much? or how long? He nurses about 8 minutes, one side at each feed.  3 oz from a bottle.  Reflex, on meds.

Are there developmental issues such as teething or milestones?  He rolled from front to back at 3 months and that's when the erratic night times started.  It didn't help that he had an ear infection 2 weeks later, and then again 2 weeks after that.  We just finished meds 2 days ago.  He is not teething.

Have you introduced cereal? Why, how much, and how many times a day? no

Do they have a prop? If so what is it?  He takes a pacifier at nap time 90% of the time.  Daytime sleep isn't an issue; only nights.

Do they have a lovie?  Not yet, I have one to introduce.

He is my third child and I have used BW with all three; I  am just not sure what else to do.  Seems like he is hungry at night but I am not sure how to get him more calories during the day without starting cereal (my other 2 children were 6 months before I started solids).  He was 5 lbs 7 oz at birth and is now 11 lbs ( same growth pattern as the other two; I have petite children)

Thank you in advance for helping me troubleshoot 

[goldmom]

My DD is round the same age and we still feed twice at night (DF & NF after 1).

Looks like you're still on a 3 hour EASY, at this age you should start switching to a 4 hour EASY and extending times between feeds with more A time during the day. 1.5 hour A time is a little short for 4.5 months. This may also help with some of your naps.

[amayzie]

Hi Hon- Often at this age they still need the 2 feeds over night- we were still doing a dream feed and often a second feed until closer to 6 months- and then often a night feed till 9 months..

[katie80]

Hi there, just popping on to agree with the other ladies.  It's totally normal to still have 2 NFs at this age. 

Looks like you're still on a 3 hour EASY, at this age you should start switching to a 4 hour EASY and extending times between feeds with more A time during the day. 1.5 hour A time is a little short for 4.5 months. This may also help with some of your naps.

I think this^^^ is what will help you most to even out the night sleep.  At 4.5mo, you really want to be closer to 2hr A time rather than 1.5hr.  Gradually pushing those A times out to get 2 solid naps and one CN of 45-60min should help with his day sleep which often helps the night.  I notice that you wake him in the morning at 6am, which isn't giving him a very long night.  Is there any way you can get him into bed a little earlier in the evenings, so he's getting closer to 11hr in bed at night?  That would help rule out the wakings from OT.

[thegodwingang]

I will start transitioning to the 4-hour EASY.  He takes a 3 oz bottle of BM every 3 hours at daycare (he nurses when we are together) so should I leave those at 3 oz or up it to 3 1/2 for the 4-hour routine?  I read somewhere (can't remember) that he should be sleeping through the night before we transitioned to a 4-hour routine and that is why we are still on a 3-3 1/2 hour.  The 1-2 feedings during the night isn't the problem, it's the waking between.  I did up his reflux med last week since we still on the dose that we started on at 4 weeks; this may have helped a little.  Thanks for the help!

[katie80]

You know, he doesn't need to be on a full 4hr EASY.  Some EBF babies don't make a full 4hr in between feeds until they're startd on solids around 6mo.  It has nothing to do with STTN, but moving the feeds apart often helps them take bigger feeds during the day, so that they need less at night.  At his age, I don't think 3oz is much at all at each feed.  My DS didn't have a bottle very often, but took 5-6oz each time I did give him one at this age.  I think I'd start offering more in each bottle as you push the feeds apart. 

I'm guessing the reflux meds definitely needed to be upped, as he's obviously gained wight since he was 4 weeks old!  Keep us posted on how things are going.