4 mo: help needed with adjusting WU time & go to sleep routine

[LaraDaisy]

Hi everyone!
I am a FTM to 4 touchy mo baby boy. He has been on EASY since about 2 months old, he is a short napper but recently two new issues appaeared that I need help with.
He is in general healthy little boy, he is growing well. He is touchy, he has reflux and gas (i am on dairy/gluten free diet and elimination diet for months now and it helps but not perfectly), he takes ppi for his reflux. I do combination feeding, introduced formula about 2 weeks ago as a means to get some more sleep during the night, because end of March he also started being a very fussy eater and it is very frustrating to feed him during the day (he eats in 2-3min intervals and then wants to eat after 2hrs and at night suddenly was eating every 2 hrs), during the day he often refuses the breast but takes the bottle with either EBM or formula, so it is also an area for improvement. Like I mentioned he is a short sleeper and only way I can extend his nap is if i manage to grab him just as he starts stirring at 30-40 min mark and keep him in my arms, which is not always working and which i try not to do too much as I feel it is not a healthy way to go, but on average i do it once a day. I tried w2s but he does not stir easily once in deep sleep and several times it seemed to work but he woke up 5 min after my w2s attempt so I do not do it anymore. Swaddling him is also not an option - he is even fighting me if I try to keep his arms from jerking around. So for now I almost made my peace with his short naps, but other issues I would really like to improve.

Here is his yesterday's routine:
06-35 WU
07-25 breastfeed (was trying to give him breast since he wake up but he did not take it)
08-35 sleep till 10-35 (for his first nap I lay down as well, as he sleeps in a co-sleeper, and after he wakes up at 40min mark I take him and put him next to me in our bed and we sleep another 1hr-1,5hr)
10-35 breastfeed
12-25 sleep till 13-05
13-05 breastfeed
14-45 sleep till 15-25
15-25 breastfeed
16-40 eat again (bottle of 70ml formula)
17-25 sleep till 17-55
19-00 breastfeed + 70ml formula - after that bath + BT routine
19-53 fell asleep (yesterday was not typical day, for the last week I made sure he is asleep at 19-30/19-40)
22-45 DF of 170ml formula
02-15 NF 200 ml formula
and this morning he woke up at 6-15

So, I need help with:
1. wake up time - his wake up time is fluctuating between 6 and 7 but most of the time it is closer to 6, which I would really like to change. His BT is normally around 19:30-19:40 and I will post his sample routine below. Maybe there are some suggestions?

2. going to sleep routine: we used a swaddle since birth and about a month ago he was fighting it very actively and I tried to put him to sleep without it and it worked, for 2 weeks he was going to sleep without a swaddle and it did not seem to influence his falling asleep times. Then two weeks ago he started screaming when I put him in his crib. I did no let him CIO or anything, so fear of the crib he has been sleeping in for 3 months would be strange. But his going to sleep routine has become quite difficult for me, for wind down he seems to prefer to be vertical on my shoulder when I walk around and do sh-pat and then i take him in the cradle position and give him a paci and continue sh-pat until his eyes are almost closing and then I transfer him to the crib. When I take him in the cradle position he normally fusses a lot, jerks his arms and legs and even cries a bit, his most prefered way is when i walk - then he falls asleep almost instantly. But transfering to his crib often wakes him up and then i have to do the whole process again. I tried having him in his crib and doing sh-pat, but he was only crying more and more untill his was totally hysterical and screaming at the top of his lungs and on such occasiaons it took me 30-40 min to clam him down afterwards, so i do not do it anymore. But this type of putting to sleep together with short naps of 45 min (which means I put him to sleep more often) is taking a toll on my back and is really frustrating me, as before he was falling asleep without all this carrying around. First, I though it was WW or GS but now after two weeks, I don't know anymore. I tried tweaking his A times but if anything he screams more after shorter A time. Any ideas on what I can change?

Huge thank you in advance to anybody who can help me with any of those mentioned above!

[weaver]

Hi hun, are you confident his reflux is entirely under control?  the short naps and the preference for sleeping upright (ie with you walking rather than laid in his crib) seem to me to indicate that he's having trouble settling when laying down. 

Not sure what to say about the breast refusal and so on...I think the general position is that a baby who won't nurse, can't nurse, for some reason, so there may be more to it than you think, in terms of what's going on with him.  Have you seen this for example?
http://kellymom.com/bf/concerns/child/back-to-breast/

[Domestic Engineer]

I would suspect that the reflux is at the root of most of these problems. Especially when you say that he prefers for you to hold him on your shoulder for shush-pat, then gets upset when you put him down in the crib - it's probably the lying flat that causes instant pain. Do you have head of the crib elevated? I would tell the pediatrician how he is doing and ask them whether you should up the medication dose or try a different medication. It might be that the dose he was on was sufficient while he was smaller, and now he's bigger and needs more.

With the breastfeeding, is it possible that lying flat is the problem there, too? Have your husband carefully look at the position he's in when you're breastfeeding him and the position he's in when you give him a bottle. If he's more upright with the bottle, it could be that the cradle nursing position just doesn't work for him. You could try alternate positions for nursing that are more upright - it should be easier to get him into different positions at 4 months than it is for a floppy newborn.

As for the wakeup time, unfortunately, there is often not a lot you can do to control the time a baby naturally wants to wake for the day. Somewhere between 6 am and 8 am is often just preprogrammed for them somehow at this age, and you just have to go with it. He's obviously not waking out of hunger, since he won't nurse for another hour. Have you tried putting him down later at night?

With the swaddle, if you don't think he needs it, that's fine, but we had to keep swaddling my son at that age even though he hated it and cried and struggled when we put him in. If he wasn't swaddled, we couldn't transfer him from our arms to his bed and he would wake himself up frequently at night flailing.

What about talking to your doctor about the possibility of stomach sleep? 4 months is still back sleep recommended, but it's also past the highest risk time for SIDS. A lot of reflux babies do better on their stomachs.

[*Liz*]

Popping by to see if I can help - and I agree about the reflux likely being the issue here.

What formula are you using?? It can be tricky to find the right one.

Do you use white noise? I settle my LO in a similar way, but I find white noise helps the transition to the crib.

[LaraDaisy]

Hi! thank you dear ladies for help and support and suggestions!
weaver & domestic engineer - I had the same thought about reflux and yesterday went to see the pediatrician and we now have an increased dose of omeprazole, in about 5 days if there is no improvement she suggested we try a special formula and if that does not help she said we will have to go to hospital and be under observation for several days and night to see how he acts. We'll see.

Liz - I am using Nestle's BEBA Optipro 1 (we live in Switzerland and this is the basic one from Nestle), I started with BEBA Comfortis which is for babies with sensitive tummies (it contains some kind of probiotics), but then switched to regular one and did not notice any difference. And I do not think he is reacting to formula because he started being like this way before we introduced formula.
I use white noise since very ealy, but now I mostly use it in the evening to even out the noise from outside (I keep the window open and now that the weather is good there is a lot of people having dinners on their balconies, making a lot of noise) and i keep it on during the night on lower levels, sometimes I also use it during the day if it is noisy outside. But I have not noticed any difference in his behaviour. But the last couple of days it has been getting a bit better - he allows me to put him in the crib while being awake and sh/pat him there till he sleeps, not every time, but every other time is already good. I also elevated the head of the crib.
As for positioning - I very seldom feed him when he is flat, only when he is still sleeping, when he is awake I keep him quite vertical and most of the time I have to walk around holding him parallel to my body and rocking him so that he keeps eating - this started a while ago and it was the main reason for me to suspect reflux, since he almost does not have spit ups.
As for stomach sleep - I do'nt think it would work for him, he does not really like being on his belly, he gets upset so fast when being on his belly, it is always a struggle to have tummy time, I tried putting him to sleep couple of time on his belly about a month ago to see how he reacts but no, he did not like it and started crying. But I put him to sleep on his side and then later in the night he turns by himself on his back.

Domestic engineer - the early WU news is not making me happy as I was so hoping to get some sleep in the morning but ok, if it is normal, it is normal. I tried putting him to sleep later couple of days in a row but it did not influence his WU time and I stopped as at least now I have some time in the evening to myself after I put him to sleep and sinc ehe is a short napper and I spend a lot of time with him during the day sometimes I really crave those precious moment of peace and quiet where I can just relax

weaver - thank you for the link, I read it (I love the kellymom site, it is so packed full of good advice on BF) but for us it is more the issue of a fussy eater I think, well not so much fussy as more not being comfortable enough to nurse properly, or so it seems to me.

and off the topic of sleep and eating, yesterday when we were at the doctor he had a huge disastrous meltdown for no apparent reason, well, I suspect he became scared of the new place & smells, he had the same during his 4 month appointment - he was screaming at the top of his lungs the moment he was put on the changing table to be undressed, it was terrible - he was screaming this very high pitched scream with tears rolling down his face, all red and shaking and there was NO way to calm him down, I was rocking him and shushing him and bouncing him and trying to give him th paci or breast - nothing worked! And in the mean time he had to be weighed and checked by the doctor so I had to put him down in this condition and I really feel horrible about it, I am not an expert in babies but do you think he might have some trust issues with me now? Because I was there, he saw me but I could not help him. I myself felt like I was failing him...
And any ideas what can I do in future to try and calm him down if he is scared?

[Domestic Engineer]

Being scared at the doctor is really normal, especially if you have to put him down and strip him. I don't think it will cause trust issues as long as you don't leave his sight. There's not a lot you can do, really, but I would hold the baby and undress him in my lap, then put him down to be weighed as quickly as possible and ask to put clothes or a blanket on again right away. If he takes a pack, give it before you start the weighing process. Asking them to turn off that fluorescent lighting can also help if there's a window or enough hall light.

I hope the extra medicine helps!!

[weaver]

Hugs for the doctor's misery, hard on you!  I know he's only 4 mo but I genuinely think it helps to tell him in advance what's going to happen, and keep talking to him throughout, stay right beside him, have your hand on him if you can, on his chest or on his head or holding his hand.  Stay where he can see you if at all possible.  Do they strip him down? Maybe they don't need to do that entirely throughout? Leave some clothes on or cover up quickly so he doesn't get cold, which is another cause of discomfort and stress. If the lights are very bright maybe there's an option to dim them?  Lots and lots of cuddles

Hope the new meds kick in and help lots!

[*Liz*]

I just replied about the formula on your BFing thread - its really confusing when you are on an elimination diet. Did you notice a change she you started the formula?? Its a major dairy challenge really isn't it??

You won't lose trust like that honey. Sometimes as parents we are helpless  . And sometimes we can't change what needs to happen. Hopefully the sheer fact you are there helps them  . As my older 2 get older I realise more and more that I can be there for them but can't always make the world right for them. My DS3 was born early and went straight to NICU. I held him briefly after birth, and then not again for 48 hrs. For the next 7 days I got 30 mins kangaroo care a day only - they rest of the time he was in his incubator. Despite all of that he always loved the bit of care I did give him, and was a very cuddly NB when he came home. They bond to you by instinct and smell, and they don't hold a grudge for a bad time at the doctors. Promise  .

[LaraDaisy]

Domestic Engineer, Anne, Liz, thank you so much for advice and nice words!
He needs to be naked for weighing and just in a diaper for the examination. And I do not think they will allow dim lights but I will see how he can be better comforted next time. I will definitely also try to undress him in my lap, maybe that helps as well. But with this kind of reaction I am really reluctant to go see the pediatrician because clearly I do not want to subject him to any more of hysterical crying...

So, he's been on the max dose of omeprazole for one week now and no considerable change in his condition in terms of BF And sleep related issues are still bothering me:
- his WU time is getting earlier and earlier, these days if he sleeps past 6 I am happy (but it has not happened in a while) even though his BT is quite stable at around 19-30 give or take 15 minutes
- now he does not like any kind of wind down except me holding him in a cradle position (he with a paci) and walking around. any ideas how to change that?

[weaver]

But with this kind of reaction I am really reluctant to go see the pediatrician because clearly I do not want to subject him to any more of hysterical crying...

I was very selective in my attendance at health checks for both LOs tbh, but I didn't have any thing like reflux to deal with and was very happy with their development throughout.  Perhaps you can negotiate your way around different bits of checks, not do everything every time?  I still think your doctor will have a role to play if his reflux is still acting up. Liz will know better than me.

If his WU is getting earlier, then his BT might need to get earlier too.  What is happening during the day for him?  Night sleep will be very influenced by daytime sleep. 

If you have a wind-down that works and doesn't drive you potty, use it.  I would aim to slow and then stop the walking, and work on getting him happy with you standing still and holding him.  Just go gradually. 

[LaraDaisy]

Hi Anne!

I still think your doctor will have a role to play if his reflux is still acting up.

sure I cannot avoid going to the pediatrician but his next appointment is at 6 months, I would like to try and stay of her office till then But of course if there is a medical need I will go, crying or no crying, his general health is important to me.

If his WU is getting earlier, then his BT might need to get earlier too.  What is happening during the day for him?  Night sleep will be very influenced by daytime sleep.

Since he is a short napper we do not have fixed by the clock schedule but he sleeps normally 4 to 5 naps (1 or 2 long ones and 2 or 3 short ones) depending on his WU time, total DS is normally between 3.5 and 4.5 hrs, BT between 19-20 and 19-40. I keep his A time 1.45-2hrs, unless he is showing signs of being tired and then I can put him to sleep after 1hr30 min or so. The last couple of days we have a new "routine" in the early morning - he starts stirring and moaning and grunting at around 4-4.30, I pull him next to me (he sleeps in a co-sleeper) and then we sleep till 5-30/5-40 when he starts to be active again (arms flying around, head moving from one side to the next, some sounds), then I breastfeed him for 2 or 3 minutes and he falls asleep for another hour or so. Like this his final wake up time is at 6-40 - 7-00 which is easier for me, since I get to sleep a bit in the morning.
You think I should move his BT earlier?

p.s. I had a major meltdown yesterday about his sleep, I receive regular mails from what to expect site (subscribed when was pregnant) and yesterdays mail was about STTN where they said that babies between 2 and 3 months should be able to sleep 5-6 hrs at night and between 5 and 6 months - 10-11 hrs uninterrupted sleep at night! And i feel lucky if my LO sleeps 4 hrs without waking up at night not to mention that during the day 45 min independent sleep in a crib is maximum! I was crying so hard! When i am faced with info that somebody's baby was or is sleeping better I just feel like i am doing something wrong! I know every baby is unique and is developing at his/her own pace and I keep telling that to myself everyday, but it is not always working...

[weaver]

Ok, from your last post, then his WU isn't getting earlier, as you're getting him to sleep til 7 or so, that sounds fine to me, I would stick with what you're doing for now.

I'm so sorry you had a meltdown over his sleep, sorry you were feeling so sad.  Big BW hugs from me!

[LaraDaisy]

Ok, from your last post, then his WU isn't getting earlier, as you're getting him to sleep til 7 or so, that sounds fine to me, I would stick with what you're doing for now.

I'm so sorry you had a meltdown over his sleep, sorry you were feeling so sad.  Big BW hugs from me!

OK, I will keep BT at around 19 and observe and come back if I have questions!
Huge thank you for the hugs! Sometimes they are so needed! I really would not know how I would do without this forum and all you wonderful ladies!!!

[weaver]

I think with the short naps I would expect less settled night time sleep.  I'd see the two are related. Honestly, it's not that you're doing anything wrong.

[*Liz*]

Oh emails like that drive me crazy. Who says they should all sleep like that by now?? Its silly blanket statements like that that lead to people doing silly things like putting cereal in bottles etc  .

Follow your instinct with the medical stuff - my baby has reflux as well but the last time I went and saw anyone was almost 2 months ago now. He's plodding along iyswim? Typical refluxer, but nothing a doctor can do much with for now.

There is a huge developmental leap at this age - and the great 4 month sleep regression. A lot of it is likely related to that. I've had some hideous early wake-ups recently 4/5am  .

Have you found the birth clubs where we all chat about what little pests they all are?? It does help give a measure of what is normal.