4 month old waking every hour from sleep cycle or something else

[jyang]

My DD has been waking every hour or so each night and I just can't tell if she's waking at the end of each sleep cycle or if something else is going on to pop her out of her sleep cycles. Usually she will sleep pretty peacefully from DF (10PM) until 1 or 2 am. But lately it's been waking every hour starting from 12:30. By 5 she will typically get a feed (nursing one side or a 2-3 oz bottle) then go back to sleep.
She does have reflux. We were on Zantac, then Prilosec, and we just started Prevacid for 4 days now. I don't know if Prevacid is working better as she's now spitting up more during the day with burps after each feeding.
She's also a very gassy baby and used to cry whenever she needs to pass gas in the middle of the night. We are trying probiotics which seems to help with her BM. I've cut out dairy, soy and eggs from my diet.

Last two weeks or so when she wakes she would fuss and I let her cry for a minute or so before I intervene and give her the paci. Past two nights she's been crying quite loudly when she wakes but would settle back with paci.

She's been sleeping with one arm out for naps and night, but for night time her arm will start to bother her and I'd have to swaddle it back in. So it's hard for her to self sooth back to sleep this way.

I'm hesitant to sleep train her not knowing if her reflux/gas issues are all under control, as well as she still can't sleep well being unswaddled. My DS had reflux too and we were never able to sleep train him as he would vomit all over himself then keep crying. And he was swaddled for a long time as that made him much more comfortable for sleeping.

I'm just a bit lost as to how to help DD sleep better at night. Thanks for any suggestions/advice!


Her typical EASY look like this (we just recently got her on the 4 hour EASY)
7 am wake up and feed
9-10:30/11 nap
11 E
11:30-1 A
1-2:30/3 nap
3 E
5 catnap (25-30 min)
5:30 E
7:00 E (top up bottle)
7:30 BT usually asleep by this time
10 DF

[katie80]

Have you tried feeding her before 5am? There's often a decent growth spurt at 4mo, so she could be hungry. If she's only take 2-3oz per feed, I would guess that 5-6 feeds may not be enough.

Is there a reason you are unswaddling her? Many babies are swaddled until 6 or 7 mo or even longer unless they are rolling in it. It may be that she just doesn't have the control to sleep well without it yet. And, if at some point during the night you're having to put her arm back in, I think I'd just start fully swaddled and see if that helps.

Waking that often can also indicate pain, as I'm sure you know. I don't know how long it takes to see if a new reflux med is working, but I'll see if I can get some more experienced eyes on this for you.

Her routine looks good, although the last A after the CN may be a tad long. Have you ever tried a 7pm bedtime instead? Some babies still need a full A after a CN, but some prefer it to be shorter.

[jyang]

Thanks!
I was nursing her before 5am, between 2 and 3 am then she gradually extended back out to 5 am. She actually has been doing about 8 feedings per day lately:
5am (2-3 oz bottle or nurse one side)
7am when she wakes, but she will only nurse one side I think it's because she had the feeding at 5 so she's not so hungry
8:30am 2-3 oz bottle
11am (nurse or 4-5 oz bottle)
3pm (nurse or 4-5 oz bottle)
5:30pm sometimes she would only nurse one side
7pm nurse with a top up bottle (she would take anywhere from 2 oz to 4 oz)
10pm DF (typically 4 oz)

I've tried not giving her the 8:30am bottle, but she would consistently wake up after only 45 min or less due to hunger. Rest of the day feedings are pretty consistently.

I do swaddle her arm in for part of the night. I also tried having her arms in from BT but made no difference in her waking pattern.

I have been wondering about the last A after the CN. For rest of the day she would always yawn right around 1 hour 45 min of A time and if I get her to nap pretty quickly, she goes down very easy with little/no fussy. The last A she would never yawn, but she does start to be sleepy when she takes the top up bottle. After I burp her, read her a quick book, get her swaddled in the crib would be another 10-15 min. I put her down awake but she would fuss/cry until I give her the paci to fall asleep. So I have been debating whether the last A time is too long. Any thought here?

Also, she always wakes from her naps screaming! I'm not sure if her personality is just more intense or if something else is going on. My DS used to wake happy and chatty, so I'm really not used to her waking screaming.

Any input would be appreciated!

[katie80]

So, it does look like maybe she's going through a GS with all those feedings. Are you feeding her expressed breast milk in the bottle or formula? In the morning, can you just wait and do one single feed at around 8am, rather than both 7 and 8:30? I know that sometimes reflux babies do better on smaller, more frequent feeds, but I also think that feeding too often can be irritating. It's ok to do AEASY, if she's not quite hungry when she wakes.

I have been wondering about the last A after the CN. For rest of the day she would always yawn right around 1 hour 45 min of A time and if I get her to nap pretty quickly, she goes down very easy with little/no fussy. The last A she would never yawn, but she does start to be sleepy when she takes the top up bottle. After I burp her, read her a quick book, get her swaddled in the crib would be another 10-15 min. I put her down awake but she would fuss/cry until I give her the paci to fall asleep. So I have been debating whether the last A time is too long. Any thought here?

I would try putting her down for 7pm instead of 7:30 for a week and see if that makes a difference. I would also leave her swaddled for now, if she's not rolling. Unless you have some other reason that you are wanting to get rid of it, I don't think that extra factor needs to be in there (but that's purely my opinion).

Also, she always wakes from her naps screaming! I'm not sure if her personality is just more intense or if something else is going on. My DS used to wake happy and chatty, so I'm really not used to her waking screaming.

It's totally normal for some kids to always wake happy and some to always wake unhappy. I guess the question with a refluxer would be if the scream is a pain sound or not. My DS2 never wakes happy and my DS1 didn't really wake happily until he was older (18mo-2yr, I'd say) and they have totally opposite personalities. (DS1 seemed upset he had to be done sleeping, while DS2 seems upset he ever fell asleep in the first place, LOL! ) Do you know her temperament? The BW "Know Your Baby Quiz"

The one other factor I see is the paci. It's entirely possible that it has become a prop in the MOTN and she's waking for it. I'd rule out the other factors first before going down that route, though.

[ZacsMumme]

Hey Hun,
Yk I wonder if you have a touchy baby m y first was super touchy and cried a lot. He also had terrible silent reflux but even when it was controlled he still woke crying, cried often and just found life a bit over stimulating.
I totally agree with Katie, this could be the 4 mth GS (which will cause a reflux flare) coupled with the 4 mth sleep regression where the paci will/may become a prop. It's a good time to decide if your going to keep it or ditch it. We kept it for our boys because they needed it for their reflux. This did mean we had to work on re plugging as soon as we could so it became a comfort item ASAP.

Are you seeing reflux symptoms still? How's the spitting up? Any acid breath, hiccups, coughing, arching?

[jyang]

Sorry for the long silence! First DD had her 4 months immunizations and had a few rough days. Then we started her on rice cereal and she was all gassy and uncomfortable. As as a result, she had many restless nights where she was moving her legs so much I wonder if she had restless leg syndrome. A few nights she's been fully awake between 4 and 5:30, even though I nursed her, she wasn't able to go back to sleep unless I hold and rock her back.

Her reflux is much better now we are back on Prilosec. Not sure if Prevacid was too hard on her system, and she also happened to developed a rash so I decided to switch her back to Prilosec. She still has spits up here and there, sometimes smelling a little sour, but in general she doesn't have sour breath. (DS had terrible sour breath so I'm extra sensitive about smelling DD breath all the time). She does cough and have hiccups, especially after she eats, so not sure if that still is some symptom of reflux.

I'd say her temperament is more spirited, although she could be a real angel when she's nice and happy. She's great in public and generally during the day. But when she cries, if I don't tend to her needs pretty quickly she can escalate so fast and then have a hard time calming herself down. She really cries for hunger and sleep, and when she's uncomfortable from reflux or gas. Her intensity is pretty strong and her cries are quite loud right from birth.

I started swaddling her arms in again. But for the past couple of days, she's been wiggling her arms to her chest and waking herself up in the process. I do think overall swaddling helps her sleep. I'm thinking to keep swaddling her until she breaks out consistently. Any suggestions here?

I'm fine keeping the paci. Seems to really help sooth her and she doesn't always fall asleep with it. She will suck on it then spit it out. But when she wakes at time, she can be looking for the paci and if I get to her quickly she typically will go right back to sleep.

Any suggestions on how to help her learn to self sooth back to sleep?
Thanks so much!

[katie80]

Have you stopped giving her solids?  Did you switch the meds back yourself or with your doctor's help?  Just wondering if she's on the correct dose, if she's been through a GS and still having some noticeable symptoms.

I'm thinking to keep swaddling her until she breaks out consistently. Any suggestions here?

Yes, that sounds right.  You might like to read this link: Weaning the swaddle - when, how, tips and tricks

Any suggestions on how to help her learn to self sooth back to sleep?

Is it mainly at night you're still concerned about?  Does she sleep straight through her naps? Can you post what her EASY is looking like these days?

[jyang]

We just started giving her solids but she became so gassy and having a much harder time with bowel movement. I guess her digestive system just need more time to adjust to solids.
The doctor was OK with switching the meds back. We are still on the same dosage but I feel her symptoms are so much better.

She doesn't sleep straight through her naps most of the time. She will have cry outs but usually goes back very quickly with paci/patting.
I have returned to work so have a nanny 4 days. On those days, her schedule tends to be more all over the place and sometimes doesn't nap as well. On the days I'm with her, when she cries out in her nap, I get to her pretty quickly and she goes right back without much help needed. So I'm not sure if her not napping as well with the nanny is because she doesn't get to her quick enough.

Here are her EASY for the past few days:
Wednesday (with me)
5:15 night feed (2 oz bottle)
6:50 wake up and feed
9:00 Nap for 1 hour 45 min (cried out twice but right back to sleep)
10:45 feed
1:00 Nap for 1 hour 30 min
2:35 feed
4:40 catnap for 45 min
5:30 feed
7:00 feed
7:25 bedtime, asleep by this time
9:55 DF

Thursday (with nanny)
4:10 night feed
6:20 wake up
7:40 feed
8:45 nap for 1 hour (woke up crying really hard)
10:05 feed
12:00 Solid
12:15 nap -- did not really fall asleep. cried intensely, so nanny took her out of her room and kept her up
1:50 feed
3:20 nap for 1 hour 30 min, cried out once but went back to sleep
4:50 feed
6:30 feed
7:05 bedtime, asleep by this time
10:10 DF

Friday (with nanny)
5:30 night feed (2 oz bottle)
6:30 wake up
7:40 feed
8:45 nap for 1 hour 15 min
10:45 feed
12:20 nap -- slept for 30 min then kept waking, took her out of the room at 1:40
2:00 feed
3:45 nap for 1 hour (cried out once)
5:00 feed
6:30 feed
7:15 bedtime, asleep by this time
10:10 DF

I was going to post in the nap forum about these nap inconsistency I'm having. I know typical 4 months old (she will be 5 months in 10 days) awake time is about 2 hours and clearly sometimes she's going beyond that, so if she's in a OT/UT loop. Also if she gets put down at different times every day for her naps, that is affecting her ability to stick to a schedule.
I feel that the naps are affecting her night sleep and feeding and may have to try and solve day sleep problem first.

Appreciate any advice!

[katie80]

Sorry for my slow reply... busy weekend! So, is she still having some solids, but things have settled down digestively?

Your EASYs don't look too bad, really. Like you said, pretty typical for a 4/5mo old. It looks like she does pretty well with 2h10-15min A time, actually, so I'd have your nanny try to stick to that. I'm sure it will take both of them a bit of time to adjust to each other as well and hopefully the naps will become more consistent with the nanny too. It's ok for the naps to not be at exactly the same time everyday, they will eventually even out. Have you described to her how you get DD down and then quickly go in to extend?

What do the nights currently look like? How often is she waking, how often are you feeding?

[jyang]

Thanks for getting back! Things are busy here too with snow days and two kids at home!

My nanny has been with us for two months now. Initially she was able to have her nap pretty consistently. But for the past couple weeks, DD has had a harder time. Morning naps would be anywhere from 30 min to 45 min, then she would have 1.5-2 hour nap in the afternoon. Sometimes even 1 hour catnap. I have described my routine to putting her down and about getting to DD quickly to extend her naps but she hasn't been very successful. DD cries escalate much faster with the nanny and that's when the nanny would just keep her awake. This inevitably leads to a very tired baby who is cranky and yawning the whole time she's awake. I continue to talk with her and try to see how to help DD have better naps.

Yes she's still on solids. I'm trying oatmeal cereal instead of rice to see if that helps any. We have introduced pears and prunes to help. She's been very gassy lately. She will pass gas all day long, but at night time it particularly bothers her. I don't know if I should stop the cereal for awhile and just stick with fruits and vegetable for solids. Just the gas is bothering her so much and affecting her sleep so much.

Past two nights she's been up and down a lot with gas. She would kick her legs trying to pass gas but not successful then start to cry out. I try cycling her legs and tapping her bottoms to help her pass. Typically she goes back pretty easily after she's passed the gas.

Both nights she was really restless between 2 and 3 but didn't seem like she was hungry. Then she became fully awake around 3:30 but would take paci and go back to sleep for a little bit then keep waking. So I ended up nursing her around 4. But instead of going back to sleep, she was just awake. She wasn't crying or upset, and would take the paci. I tried to rock her and she would start to drift off then wake again. Every time I try putting her down in the crib she would wake. Both nights took more than 1 hour for me to finally get her back to sleep then she slept peacefully until 7am.
She napped well during both days (two 1.5 hour naps and a 30 min catnap) and A time before BT was 2 hours so she was asleep by 7:20 and went to sleep pretty easily. So I'm not sure what is the reason behind the long NW.

Thanks so much!!

[katie80]

I think it sounds like the long NW are discomfort.  She's pretty young for solids, right? Do you think it's worth it to stop everything for a few weeks and see if the gassiness resolves or were you advised to start by her doctor?

Also, I've never had a baby with reflux, so you'll have to take any advice on that from me with a grain of salt, but seeing as you've been back and forth with meds, I wonder if it isn't worth it to check her weight and the dose to make sure she's on what she needs.  I guess I would just want to rule out that she's waking from that, as although her breath isn't sour, she's still having some small symptoms.

I think if you can rule out discomfort from solids/reflux, then you need to look at the paci possibly being a prop and will have to decide if it's worth keeping for a couple more months until she can replug on her own. The NW may in part be tied to routine, but really I don't think it's that far off.

What do you think?

[ZacsMumme]

I agree with Katie, I would stop the solids. Definitely sounds like discomfort, possibly food related more than reflux though
Remind me is your lo dairy and gluten free (I guess not fishing oatmeal but other than that)