Up to 10 NW, including before DF - 4 month old - help pls!

[Mamamonty]

This is my first post here and I would be very grateful to receive any suggestions as my husband and I are up constantly in the night at the moment and not sure what to do!

We had my almost 4 month old on a rough 3 hour EASY format, but we were waking him twice a night to breastfeed (but not a dream feed) due to weight issues until about a month ago.

We have recently introduced more formula and now that I know he is having enough food (he has put on lots of weight etc) we have introduced EASY more strictly. We were on the 3 hour schedule initially and are now closer to a 3.5 to 4 hour schedule (activity time is now between 1.5 hours  (later in the day), but more often it is 1.75hours to 2hours).

My baby has always struggled to sleep by himself and since introducing the routine two weeks ago - his naps are longer and he goes off pretty well most time with up to about 5 mins of patting and shushing.

However, when it comes to the bedtime sleep he really fights it and we spend up to 2 hours trying to get him to sleep - sometimes I end up bouncing him a bit if he is too worked up or giving him a small breastfeed to calm him down.

If he does go down ok at around 7 - 7:30 he usually wakes up every hour until I give him his dreamfeed at about 11. I give him a big bottle at 7ish so I don't think it is hunger at least earlier in the evening.

If he wakes too closely to 10:30 - 11, or if he is still up after being unable to settle him, then I end up giving him his final feed (what would be the dream feed) and he goes to sleep for a 2 hours or so uninterrupted, but usually wakes up every hour or two crying until 7amish when we get him up. Sometimes it is just a matter of turning him over but other times he is inconsolable and after trying to pat shush for up to an hour I sometimes give him a small breastfeed at around 3/4am to make sure its not hunger. I will only feed him a max of twice a night, once at 11ish and once at 3amish, otherwise we pat shush/PU/PD. Most nights he wakes up now between 5 and 10 times a night and this has been since we've been doing EASY two weeks ago.

I realise that at 4 months babies have lots of changes so it could just be down to that, but if anyone has any tips on how to reduce the NWs, then pls let me know.

Yesterday's rough EASY was as follows:

3am - woke crying - shushed to sleep
3:30 - woke crying - shushed to sleep
5:30 - woke crying - shushed to sleep
Up at 6am as nappy was soaked and on jumpsuit and had been down since 7:15pm the night before
A - 6am - nappy change
E - 6:10-6:50 - small breastfeed + 100 mls of expressed milk - very distracted, but fed in darkened bedroom and still difficult
A - 6:50 - 7:40
S - 7:40 - 9:10 (1.5 hours)
A - 9:10 - 10:00
E - 10:00 - 10:30 - small bf +150mls formula
A - 10:30 - 11:00
S - 11:00 - 12:20 (1 hr 20 mins)
A - 12:20 - 13:30
E - 13:30 - 13:50 - breastfeed +130 mls of formula
A - 13:50 - 14:10
S - 14:10 - 15:40 (1.5 hours)
A - 15:40 - 17:00
E- 17:00 small bf + 70 mls expressed milk
S- 17:25 - 18:00 (35 mins)
A 18:30 - 19:00 bath then 180mls of formula
19:00 - wind down, then cot at 19:20 as was grizzly
S - 20:00 - 20:30 - woke crying/pat shushed to sleep
woke at 21:30 - lots of crying, pat shushed for ages, then ended up giving next feed of 180mls at 10:30 and he fell asleep
woke at 2am - crying
woke at 2:30am - crying - swaddle off
woke at 4am - changed nappy as soaked and bf fed
woke at 5:30 - crying
woke at 6:30 - crying
woke at 7:15 - crying

Pls let me know if you have any suggestions on how we can improve things. Maybe drop the dreamfeed and see what happens? We've been doing it for almost two weeks now and no real signs of changes/improvements.

THANK YOU

[becj86]

Hi, welcome!

Its obvious the nights are much worse than the day. I don't know that any extension in those A times is going to do much for the night, unfortunately, they are a little short for his age but I don't think it would cause the nights to be this bad.

So, I have a couple of questions:
- What are the differences between nights and naps? Sleeping location, wind down, etc.?
- Does he have reflux or any other medical conditions? I see you've had a time of it with the weight gain in the first few months.
- How's his behaviour during the day? Is he generally happy?
- Does PUPD help? He's pretty young to be doing PUPD (its a last resort method not to be used before 4 months).

Hugs xx You must be exhausted! We'll hopefully get to the bottom of it for you.

[Mamamonty]

Hi becj86,

Thanks so much for your comments.

There is no real difference between the nights and naps - he mostly sleeps in the same cot or occasionally in a pram during the days. For the bedtime sleep we give him a bath and try not to do too much play time, which is the main difference to the naps (which have more playtime).

He doesn't have reflux or any other medical condition that I am aware of. Slow weight gain and colic in the first few months but these have been resolved.

His behaviour in the day is generally good, happy, smiley, chatty and loves to play. But he has been a bit more grizzly lately and harder to feed even a bottle lately for most feeds. It takes a long time to feed him and he moans a fair bit. He is more grizzly in the evening.
He does constantly have his hands in his mouth and is dribbling a lot more of late so I am wondering if he is starting to teethe.
We are still fully swaddling him and I am thinking we need to try and start to leave one hand out  so he can possibly start to settle himself with his hands, so perhaps he wont need to cry in the night for us to comfort him/change his position.

I mentioned PUPD but we mostly pat/shush and will pick him up if he is really crying and will put him back down if he stops so its not really strict PUPD - I haven't done that yet as pat shushing is working in the day. We'll try that later.

thanks again - much appreciated.

[becj86]

Sorry, I have more questions:
- What's his behaviour like when he wakes in the night?
- Does he settle more easily after a feed?
- How long have nights been like this? Has it become worse gradually or suddenly?

Sounds like shush/pat and not PUPD, keep doing that, its fine to pick up as part of shush/pat if LO is really upset.

This doesn't sound normal to me, the wakings are all through the night, not just when I'd expect for undertiredness from those short A times and really not enough of a stretch to suggest he's crashing from overtiredness either. I think you may need to take LO to a doctor and that you may be looking at silent reflux being an issue. Have a read of this:
Reflux 101 - General reflux information

Swaddling with one arm out is worth a try. You could try increasing those A times a bit but I really think given the poor quality of night sleep I'd keep the days as they are for now.

[Mamamonty]

Thanks Bec. In answer to your questions:

- when he wakes at night - most often he is crying but eyes are closed and just needs a couple of minutes of patting and shushing/slight reposition to send him back off to sleep. Other times he is more inconsolably crying and only bf or feeding him will quiet him and send him off to sleep.
- he does settle more easily after feeds
- the nights have been like this for the last couple of weeks since we've been doing EASY more strictly. We do sometimes have to give him a bit of a pat/shush during his naps in the days too. I'm going to see today if it is closer to him having a bigger formula feed before he naps.

Thinking about this more, since we've been doing EASY, we have also been feeding him more less often - to get him more on a 4 hour routine (this is in line with the recommended amounts and frequency on the formula instructions for his age and weight). The other thing I thought of is that in the nights is that we're giving him a bigger feed (180mls formula) at 7pmish before bed then another big feed of 180mls at 11ish. I used to give him a max of 120mls at 7ish, then a bigger bf (than now) + maybe 60mls of formula at about 12:30 then again at about 4 or 5am another bigger bf (than I do now) + 60mls of formula. Maybe the bigger feeds have worsened any silent reflux he has.

The other thing with bf my LO is that at about 2 months old he got very fussy bf and would pull away when i fed him in the usual cradle position I always had. We then figured that he was only happy to bf lying down so I was doing that for a while (before it became too inconvenient!), including in the nights - I was pulling him into our bed to feed him until a couple of weeks ago (when we moved to EASY). I had read that this might have been due to silent reflux at that time but then it seemed to resolve things by feeding him lying down so I moved on from it.

It seems that this is something I should check out with the doctor - thank you for your time. It is much appreciated.

[creations]

Hi Just stopping by with a bit of support.
I would certainly not rule out silent reflux. My LO was not diagnosed until around 4.5 months and we'd struggled a fair while before that with the GP saying he was fine (always decent weight gain).  The reflux meds and a milk thickener helped.

I don't think it's a good idea to chop and change his routine too much but it does seems that these NWs have come on since extending his day time E times, how would you feel about going back to more of a 3hr maybe 3.5hr E routine to see if it helps?
Some LOs (Tracy mentioned this in her book) don't manage the 4hr E until they are more like 6 months. The babies she mentioned were BF, prem or low birth rate (that doesn't mean all these babies cannot do 4hr E, just it's worth keeping in mind). Mine was none of these but he was a petite boy, small tummy I would think, and his silent reflux did impact on his feeding. He could not move from 3hrly milk feeds until more like 6 months, after the introduction of solids (so actually E was less than 3hrs then as there would be milk then one hour later some solids with a milk top up), he naturally increased the time between milk feeds when he had solids and naps coming between those E times.

Dropping off a hug too - you must all be exhausted with all those NW!