5 mo waking up middle of the night

[alec]

Hi,

Our DS who slept 5-7 hours straight when he was 3 mo started waking up every 4-5 hours at night since 4 mo until today (5 mo). He's exclusively breastfed and on a 4 hour EASY.

During the day, he feeds quite regularly every 4 hours (20-30 min or 4-6 oz expressed milk from bottle each feed) and is really active with 30-40 naps each cycle, and sometimes skips a nap during the day.

He has the last feed of the day at 7:00pm, then we start the bedtime routine consisting of bath, reading, cluster feed (which he always demands by crying untli fed and it's usually a 20-30 min feed, i.e. we assume he is really hungry). He gets sleepy at the end of the feed and sleeps by himself when put in his cot, sometimes needs to be cuddled or walked around a bit. He would then wake up at 10:30-11:30pm for a 20-30 min breastfeed, after which he falls immediately asleep; then wakes up typically around 2:00-3:00am for another 20-30 min breasteed, falls asleep immediately and wakes up again around 6:30-7:00am.

We tried PU/PD but doesn't seem to work - typically we wouldn't give him the breast immediately but pause and try PU/PD; when I do the PU/PD if he doesn't have gas he would not stop crying until I give him to my wife - after which he would immediately make his way to her breast, only to start crying if he does not get fed. As mentioned, night feeds are quite long and he sucks actively, so we would assume he is really hungry. Typically after each night feed he'd fall asleep almost immediately at the end of the feed.

He is perfectly healthy, doesn't seem to be teething, and despite these long night feeds he dropped from 45th to 30th weight percentile in from 3 to 5 mo (which obviously could be totally unrelated).

Any hints on how to reduce the number of night feeds? Ideally we'd love him to get him back on clusterfeed + one feed around 11:00pm-12:00am and sleep through until 6:00ish, as he used to do at 3 mo!

Thanks!

[Kellyjs]

Hi hun and welcome to BW.

I'm actually going to move you over to the BF board as I think you might get some better help there. I'm presuming this started when you moved him to a 4-hr easy feeding routine?

He does seem like he's actually hungry rather than a prop issue of needing to be fed back to sleep. That being said, you can always pop back once the lovely ladies over there have checked out your feeding routine ok? X

[*Liz*]

They often do this - it is just that they are bigger and starting to need more food. Night feeds often come back before they are on a decent amount of solids.

[*Ali*]

Very normal. Can you fit an extra feed in the day somewhere?

[Bella89]

Hard to break that to ya, but you have  a normal and perfect baby:) He is on EASY, eats well and sleeps like a dream!

You can try what Ali said, extra feed. My DS slept for 7-9 h when little. Once he started moving more woke up to 4 times a night. When started solids at 6 months it is still feeding at 11 and 4 or 5. I don't have experience on what will happen after .
I would just hope that he will grow out of it.

So basically, try adding extra feeding during the day. In our case It didn't really help though, sorry :/

[alec]

Hello everybody

Thanks a lot for your replies. DS is now 6 mo. and still not sleeping through the night. We've started weaning and he is now on a mixed milk/solid routine

7:30am - breastfeed followed by solid breakfast e.g. fruits
10:30am - nap (usually ~1/2 hour)
11:30am - bottle from expressed milk (~5 oz)
1:00pm - solids e.g. veggies
2:30pm - nap (usually ~45 min to 1 hour 15 min)
4:30pm - bottle from expressed milk (~5 oz)
7:00pm - breastfeed then bath

Here comes the problem:
- usually wants another breastfeed right after the bath (i.e. 7:45-8:00pm)
- then another one around 9:00-9:30pm
- then wakes up at 11:00pm or so
- on a good night he would wake up again at 4:00am. On a bad night it's more like 2:00am and 4:00am and sometimes 6:00am too. Very funny.
- each time he would suck for ~30 minutes (1 or both breasts) and fall asleep at the breast

Questions:
- does the above routine make sense
- is it possible that breastfeeding is now a prop? on one side whenever he wakes up he would cry until he is fed and eventually sleep at the breast; but he also sucks for ~half an hour and my wife says he actually sucks normally like during daytime
- any suggestions to make him sleep longer?

Thank you again!

[*Ali*]

I have a couple of thoughts. Why does he have bottles in the day? Is that just your choice or is he away from mum (e.g. Because she is at work)? I am wi during if it is a case of reverse cycling. Check out this link for more info on what that is and how to deal with it. http://kellymom.com/bf/normal/reverse-cycling/

The other thing is that he must be mega OT if he is only having 2 short naps and very long A times. Has he ever done full 1.5hr naps or have they always been shorter 30-45 mins mostly? He he only ever seems to manage short naps then I would aim to fit in 3 naps to keep the A times down and increase the day sleep.
How does he go down to sleep? Is he an independent sleeper or does he have any props like rocking, dummy/paci, rubbing back etc.?

I also wonder if 4 milk feeds a day is enough since he is taking so much milk at night. It sounds like you may need to try to get those calories in him in the daytime. Would he take an extra feed somewhere? Maybe before the first nap? He's also going a really long time between the two bottles so I'd maybe look to move that first bottle later if you squeeze in an extra fed before his first nap.

[alec]

Hello,

Thanks for your prompt reply. The baby has bottles (of expressed milk) during the day while mummy is at work. He seldom sleeps more than 1 hour in each nap.
At night, he is usually fed to sleep - we tried several times to let him fall asleep without props but (including PU/PD) but he starts complaining, then crying and if picked up arches his back while crying and tries to reach for the breast, which made us thought he is really hungry (as opposed to looking for comfort) - not sure if this makes sense.

We went to the paediatrician yesterday for the a check and its weight percentile has fallen from 30 to 25. We were told to increase solids to 3 times a day.

Cheers

[*Ali*]

So it could be reverse cycling don't you think?

Moving from 30th to 25th percentile is nothing. Babies don't follow the curve exactly so as long as they are in the region it is fine. Breast Milk has more calories than solids so increasing that is more likely to help growth. Too much solid food at this age can actually displace more calorific breastmilk and have the opposite effect on growth so do keep an eye on how much milk he is taking. If it drops then you may need to reduce the solids again to get it back up.

[Shiv52]

Is your paed using the growth charts for BF babies?  I wouldnt be worrying about that drop at all. My DD2 went from 90th to 75% and finally settled on 25th and they weren't concerned at all.

[alec]

Hello

Thanks for your replies.

Now LO is 7.5 mo and we've just been to the paediatrician. He is 50th percentile in height/head circumference and ~23rd in weight. He's put on 470gr in the last month which leaves him on the same weight percentile although his height percentile has increased from 50th to 90th. All of these are vs. WHO tables for BF babies (I used an app because here in Singapore they have weird national tables and I don't think they apply as they must be tuned for Asian babies while our LO is half blood).

The routine is now as follows
- BF at 7:30am
- breakfast (fruit, yoghurt: ~3 oz) at 8:30am
- nap at 10:00-10:30am (typically 1 hour-1 hour 15 min)
- lunch (meat, vegetables) at 11:00am - typically takes 1 hour to feed ~3 oz
- expressed milk at 1:00pm - ~7 oz
- nap at 2:00pm (typically 1 hour-1 hour 15 min)
- snack at 4:00pm (vegetables with rice or pasta - ~3 oz) - typically takes an hour
- expressed milk at 5:00pm - ~6 oz
- sleep routine starts at 7:00pm - bath, then BF

Typically sleeps at breast around 8:00pm and wakes up around 9:30pm. I (daddy) can't soothe him in any possible way. He only calms down when again at the breast, feeding sometimes for 10-15 min and falling asleep at breast. Would then repeat this at 11:00pm to 1:00am (variable). On a good night he'd then sleep until 4:00am, on a bad night he'd wake up at 2:30am and 4:00am. Each time, if I try to soothe him it just doesn't work - neither in the cot, or picking him up, or picking him up and patting on the back, or walking him around, with or without singing. Just no way and cries get louder with tears. He calms down immediately when he sees mummy, but starts crying if she doesn't give the breast after 2-3 minutes.

I'd like to try PUPD but I have the following questions...
1) how do we distinguish if he's hungry vs. if he's just unable to sleep by himself?
2) what do you do if when you pick up the baby he doesn't stop crying no matter how calm you are? Words, patting, nothing works. Should I put him down while he's crying? And then what? In the BW book it seems like the whole technique is based on the fact that the baby settles when you pick him up but it NEVER happens!

Thanks again

[*Ali*]

It's completely normal for a 7.5.mo to wake at night for a feed or two, especially one who is away from mum during the day so I wouldnt try to wean all the NFs. Did you read the link on reverse cycling that I posted above? What are your thoughts on that?

How does he go to sleep for his naps? Just wondering if he needs to learn independent sleep in the day to cut down the NWs.

If you and his Drs are still concerned about his weight then do you really want to actively wean NFs? I think I'd be tempted to put up with at least some of them for a few more months to help get as many calories inside him as possible.

[alec]

Hi,

Thanks for your reply. We've observed the situation for another month, including on vacation (i.e. mummy doesn't go to work for a few days) and I've read through the reverse cycling again. We'd decided to tackle weight/intake first, sleep later.

- firstly, things are getting better with weight and intake, he's now steadily on the same percentile (25-30 or so; depends on which tables they use as here in Singapore they randomly use WHO or their own tables which I believe are tuned on Asian babies). When mummy goes to work, after the morning breastfeed he gets 3 times 2.5 to 3.5 oz solid and twice 6-7 oz of expressed milk. So it doesn't look like he doesn't want to get food if mummy is not around. During the last few days on vacation he had even more appetite for solids, up to 4 oz each time

- on your question how he gets to sleep during the day - our helper would wait for signs of tiredness and walk him to sleep. She'd put him down either drowsy or sleeping, which usually works at the first shot. As you may imagine training a helper to do PUPD or other techniques is at best very difficult, as she has other chores to do and is not as vested in the child's development as a parent. So I am not sure starting PUPD during the day is an option now

- when he's on vacation, during the day he either falls asleep with motion (in ergobaby for example) or at breast. At night he wants the breast to fall asleep, usually still sucks vigorously most of the time. Every time he cries my wife would wait 1-2 minutes, walk into the room and pat him on the back/on the thigh. If nothing happens for 1-2 minutes, she'd pick him up. If he still cries after 1-2 minutes, she'd give him the breast. If I walk into the room I don't succeed in settling him down with any of these techniques, he just cries louder and longer except very rare occasions (like once in 3 months) when I walked him to sleep for 30 minutes bearing with the cry because mummy wasn't available. On the rare occasions when he is left with our helper in the evening, the helper reports that it is quite hard to put him back to bed without crying including by giving him the bottle.

- night pattern is roughly the same, sometimes with longer stretches (6 hours). He's teethed 4 incisive, didn't change the wakings at all except perhaps one night. It looks like teething doesn't really bother him

So with that we're back to the questions on PUPD. As I mentioned the whole logic of PUPD seems to be that the baby settles when reassured or picked up; if not at the first attempt, at some point. We have the impression that our baby never settles and continues to cry if we reassure him or pick him up , so how would PUPD work? Wouldn't it be equivalent to CIO if the baby never settles? Are we supposed to let him cry unendlessly while picking him up and putting him down, no matter how hard he cries? Have you had any experience/success with teaching babies how to get themselves to sleep in these situations?

Thanks - you're doing an awesome job!

[Shiv52]

Its only the equivalent to CIO if you leave the room.   THat is the difference.  With you there reassuring your LO knows you are there. 

Saying that PU/PD is not for every baby.  Neither of mine liked it.  We were trying to break a rocking prop so it was too close to the prop we were breaking IYKWIM?  So when I PU they settled as they thought they were being rocked so I'd PD and they'd be horrified and scream even more.  In the end I stopped PU/PD and just reassured in the cot.  I rocked a little bit and sang and then when slightly drowsy I put down and continue to sing and pat and then faded.  My DD1 was not impressed and did scream/cry for about 40 mins the first nap time but after that it was much much smoother.  AS she got used to it I then started putting her down more awake and working on self settling. 

It seems like you have props to break-the walking to sleep with the helper and the feeding to sleep with mummy.

First though its probably a good idea to check your routine.  CAn I see a rough outline of how your day is at the minute? 

[alec]

Thanks for your explanation on PUPD vs. CIO. For the record, we tried settling him in the bed and it doesn't seem to work.

Sure, this is the rough routine. We would like to move him to 4 solid a day, so we are looking for different options where he wakes up at 7:00am and goes down at 8:00pm or so.

7:00a Wakes up and plays happily in the cot. We usually pick him up, my wife gives a breastfeed in our bed, we play with him a bit
8:30a Breakfast (yoghurt and/or fruit; 1.5-3 oz depending on how hungry he is)
10:00a Nap (usually 45 min to 1.5 hours; our helper walks him to bed when drowsy; doesn't wake him up)
11:00a Lunch (vegetables and/or meat or pasta; 1.5-3 oz depending on how hungry he is)
12:00a Expressed milk from bottle (~5-6
2:00p Nap (as above)
3:30p Snack (vegetables and/or meat or pasta; 1.5-3 oz depending on how hungry he is)
5:00p Expressed milk from bottle (~5-6 oz)
6:30p-7:00p Depending on when mummy comes back from work; breastfeed and play
7:15p Bath
7:30 Down to bed - my wife brings him to his room (quiet, dark), reads story, gives milk (~15-20 min), baby falls asleep at breast. We don't use dummy or loveys
9:45p typically first waking; my wife would walk in after ~1-2 minutes noise and try to settle in cot; seldom works; if it doesn't, he feeds for 15-20 min and sleeps immediately at breast
11:45p typically second waking; as above

Then on a good night he'd wake again at 3:00a and 7:00a. On a bad night, one more waking. In the past couple of days he was teething and woke up every 2 hours, always eating for 10-15 min. Of course I can't say how much he's getting from the breast, my wife says most of the times he actually eats (sucks vigorously), fewer times he seems to only need comfort.

Finally since a couple of days he seems to show more signs of separation anxiety - e.g. he never cried when mummy goes to work in the morning, now he's done it a couple of times - and testing his limits on things he can't play with, etc.; so going back to your link on reverse cycling, one component could also be that he wants to spend more time with mummy.

In terms of priorities, we'd obviously like to tackle night wakings first; we usually go to bed around 11:00p or so, so we don't mind a cluster feed or night feed. We don't walk him to bed at night. If we get to sleep better at night, but he still needs a bit of walking (usually not more than 5-7 minutes for the record) during the day, that'd still be a good outcome for us.

Thanks very much for your help!

[*Ali*]

I definitely think this is a prop issue rather than a just feeding issue. He's just used to looking for mummy to help him get back to sleep every time he stirs I think. Am I right in thinking he is 8mo now? If you would like help with gently teaching him to go to sleep independently, can I suggest you post on the General Sleep board? I think this would help him to do better naps in the day and also to enable him to just roll over and go back to sleep if he wakes at night and isn't actually hungry.

I wonder if he might do better with an extra milk feed during the day. BFed babies are used to eating more often in smaller quantities. So he is probably hungry enough 5hrs after his morning BF  when he takes that first bottle but he may not be able to manage more than the 5-6oz. Normally we say to offer milk first and solids an hour later so that they are not full from the solids. Solids like veg contain much few calories per ounce than milk so filling up on those can be counterproductive to increasing calorie intake. Would you consider either swapping the solids and milk feeds or offering a top up of milk at the solids sitting? That way you might get more calories in during the day.

[Shiv52]

I have to agree with Ali. I don't think you'll have any luck settling at night until you tackle Independent sleep. I don't think he'd get that during the day and for bedtime he gets fed to sleep or rocked or walked but during the night you want him to do something different.  If you did want to go ahead its best if dad does the NWs so baby knows there is no milk coming and you'd need to resettle in the cot not by rocking or you'll just replace one prop with another x