5 months old NW every 1-2 hours

[oxfordmum]

Hello,
I have been reading the babywhisperer forum for the last 3 months and it has been very useful with addressing some of the sleep issues we had.
My daughter who has just turned 5 months has never been a great sleeper (usually 2-3 NW and never more than a 4 hour stretch). She sleeps in  a cot next to me and would start the night in her cot and at around 2 am I would take her to bed with me, when she wakes up as she wouldn't settle in her cot.

For the last two weeks she has been waking up every 2 hours and she doesn't even settle when I take her to bed with me. She is a reflux baby, but I don't think that this is the reason during her NW as she settles fine for naps during the day and has stopped crying after feeds ( she was on medication). She still does bring up quite a bit of milk after a feed. She is exclusively BF.
Here is our EASY when we can follow it:
E7 am wake up and feed
A 7-9 am
S 9-10/10/15 am nap (she only recently started to nap longer than 45 min, but I have not managed to push her nap to 2 hours, she wakes up happy)
E10 am
S 12/12.15-1 pm (this one I cannot extend beyond 1 hour and she wakes up happy).
E 1 pm
A 1-3 pm
S 3 pm-4.30 (she wakes up after 45 min screaming, I calm her and we sleep another 45 min next to each other in bed when we manage).
E 4 or 4.30
A 4.30 -6.30/7 pm (if she wakes up at 4 pm from the nap I try to settle her at 6pm, but she rarely falls asleep before 7 pm. WE have a bed time of sponge bath, story, being held,...)Usually she cries for about 30 min when I alternate between holding her and putting her in her cot. She seems unsure whether she wants to be held or in her cot that is why I try both.
E 30-60 min before she sleeps I offer her food but usually she doesn't drink much
8 pm wakes up and cries (I feed her again, sometimes she falls back to sleep other times it takes 40 min to settle her) The cry is more to get my attention it is not a screaming cry, but if I ignore it does escalate).
9 pm wakes up and cries ( try to offer her feed again and she drinks)
10 pm wakes up and cries (offer feed again and she drinks)
12 am wakes up and cries (offer feed and she drinks)
1.45 wake up and cries  (no feed offered), I try to calm her either by putting my hand on her and if that does not work I pick her up.
4 am wake up and cries (feed offered and she drinks) sometimes she settles, but recently has stayed awake until 5 am with me having to hold her. She does want to be active though and wants to climb around in bed.
7 am wake up and start day
Last night I went in at 9.30 pm to do a wake to sleep attempt, but nevertheless she woke up at 10 pm.

I am offering her feeds every time she wakes up as it has been very hot recently and I am worried that she is thirsty. I have tried to move her to 4 hours EASY, but with the short naps we are still at 3h EASY.

I have also tried to extend her A time, to 2.15-2.30, but she seems tired before so we usually stick to 2 hours unless it's before bedtime, when she does not fall asleep before 7. She is quite a small baby (9th percentile) and I have been advised not to offer her water instead of breastmilk at night to make sure she gets all the calories she can. I have tried to increase the amount she eats during the day by giving her additional expressed milk but either she is not interested or if she drinks in addition to BF she throws most of it back up.
The problem is that she seems to eat more during the night than during the day. During the day she is not too interested in eating at all and the feeds are very short.

She has recently learned to turn from back to front and she is practising at night when she wakes up. She does it a few times and then cries so I pick her up and try to put her back in cot and she may try to practise again and we repeat this for a few more times until she is exhausted and falls asleep eventually.

During the day she usually falls asleep in her cot with me holding her hand. She also has a paci, but when she wakes up at night it is not enough to replace the paci. We have white noise all night and during naps.

I am not quite sure where to start addressing the problem. I think I need to get more food in her during the day and probably have to do the wake to sleep approach at night. Any suggestions would be very welcome. Thank you!
Eva

[katie80]

Hi Eva, welcome to BW!  I'm not sure what happened to your other post, but this one reads the same, so I'm hoping we aren't missing anything.

It looks to me like there might be a few different factors in why your DD is waking.  Firstly, I think you have a bit of a prop issue.  She may still need a couple night feeds, but she surely doesn't need to be fed or even offered a feed every time she wakes, even when it's hot.  Have you ever tired to settle her with shh/pat or something similar? I think if you worked on settling her that way during the day for naps and BT and then at appropriate intervals during the night (you can still feed her every 3.5-4hr to begin with), it would go a long way to getting her to be more of an independent sleeper and not needing your assistance to get back to sleep.

Second, she is having a good amount of day sleep on a lower than average A time.  I think this may be making her a bit undertired to sleep a good long interrupted stretch at night.  I do think she needs a bit of a stretch in A times as you don't get a full nap until her last one of the day, when you AP her back to sleep.  The nap times of 1h-1h15min earlier in the day signal that 2hr A time is not quite long enough for her to sleep a full nap (1.5hr or two sleep cycles). I'd gradually start pushing her A times out by 10-15min every few days until you start getting those longer naps.  Ideally at this age, you want two full naps and a CN of about 30-45min.  Pushing out the A time will also help you to get on at least a 3.5hr EASY, so she takes better feeds during the day and isn't just snacking and then taking more feeds than necessary at night.

Another thing is that it sounds like she's being disrupted by some developmental milestones she's working on, as she starts rolling back and forth when she wakes.  There is not much you can do to prevent her from doing this, but giving lots and lots of practice during the daytime can help her master the skill more quickly, so that she doesn't feel the need to practice at night.  Another good thing about settling her with shh/pat is that you can do this whether she's on her front or her back in the crib. 

Finally, I know you think she is not suffering as much from her reflux, but I don't think you can totally rule it out if she's still vomitting frequently.  You mentioned she was on medication, but is now off.  Was there a good reason you and your doctor thought she should be done with the medication?  I'm only wondering because frequent waking like she is can indicate discomfort.  This could be from the heat or it could be from reflux or it could be a combination. Or, it could just be a prop issue.  Are you using other natural reflux helps like an inlined mattress?  You mentioned she does have a paci, which I know can help as well.

(((Hugs))), I know it's tough to be up so much in the middle of the night.  We will help you work through this, so hopefully you will get some better sleep soon.

[oxfordmum]

Hello Katie,
many thanks for the helpful tips. I re-posted the same post as I noticed I didn't have it tagged as new, but with the second post nothing changed...so sorry about posting the same post twice and the confusion.

I will try and extend her A time a bit and see how that goes, I have been so worried that she may get OT so I kept A time to about 2 hours.

The reflux is a tricky issue. She has been on Rantinidine and I didn't really see any difference in her behaviour. In the past she used to cry during feeding but she stopped doing this and this is why I stopped with the Rantinidine. She is still on Gaviscon though. We don't really have a good doctor at all (just a general GP), so I can't rely on their judgement. They didn't even believe me she had reflux and it took me 3 visits but that is another story. The mattress is not inclined now, but that will be easy to fix, I'll try that tomorrow.

I have tried shh/pat in the past but from 4 months on I noticed that she was getting more upset by it. I now just pick her up and hold her and tell her quietly to  sleep, if soothing in the cot does not work.  During the day I can put her in the cot awake and she keeps holding my hand and eventually drifts off. At night this doesn't work and she usually falls asleep on my shoulder the few times I have tried not to feed her. I will definitely stop feeding her now so frequently at night, thankfully it is a bit cooler  and will try to make her sleep with some modified shh/pat.

Once again many thanks for the helpful suggestions. This night has not started out well, I have been in her room 5 times already (not feeding) from 7pm. I will post some updates if I see an improvement over the next few weeks. Thank you!

[katie80]

I re-posted the same post as I noticed I didn't have it tagged as new, but with the second post nothing changed...so sorry about posting the same post twice and the confusion.

No worries... I just wanted to make sure we weren't missing something. A post won't be marked as new for you when you've read it, so since you had typed it and likely read it, it didn't show up marked new. It did show up new for me however, since I hadn't yet read it. But now that I've replied, it should show for you again as there is a new post since you've last read. Does that make sense?

I will try and extend her A time a bit and see how that goes, I have been so worried that she may get OT so I kept A time to about 2 hours.

Yes, I've been nervous about OT before too, but if you go slowly it should be ok. You can even push by only 5-10min if you think that's better. There are just a few signs that she's taking UT naps, so I think she needs a little more. And the average for her age is up toward 2h15-2h30min.

The reflux is a tricky issue. She has been on Rantinidine and I didn't really see any difference in her behaviour. In the past she used to cry during feeding but she stopped doing this and this is why I stopped with the Rantinidine. She is still on Gaviscon though. We don't really have a good doctor at all (just a general GP), so I can't rely on their judgement. They didn't even believe me she had reflux and it took me 3 visits but that is another story. The mattress is not inclined now, but that will be easy to fix, I'll try that tomorrow.

Hmm, that is tricky. If she doesn't seem in pain anymore, then it might be fine. I just don't know that reflux usually resolves itself this early. Are you ever able to see another doctor and get a second opinion? It could be that another medicine would work better for her. I can get some extra help on this from one of the reflux ladies too.

I have tried shh/pat in the past but from 4 months on I noticed that she was getting more upset by it. I now just pick her up and hold her and tell her quietly to  sleep, if soothing in the cot does not work.  During the day I can put her in the cot awake and she keeps holding my hand and eventually drifts off. At night this doesn't work and she usually falls asleep on my shoulder the few times I have tried not to feed her. I will definitely stop feeding her now so frequently at night, thankfully it is a bit cooler  and will try to make her sleep with some modified shh/pat.

Yes, I think a modified shh/pat is a good idea. And your modified PUPD sounds fine too. I would just try to find something other than holding her hand that settles her as that can be a prop and it will be best if you can use the same technique in the night as during the day. The only caution in all of this is if she is indeed waking out of discomfort, these things may not help until that is under control.

Do keep us posted!