4mo: 3.5-hour or 4-hour EASY?!

[Apple001]

Hello,

My DD is 4 months or 18 weeks. She is been on 3.5-hour EASY for 3 weeks. She usually has feedings at 7am, 10:30am, 2pm, 5:15pm, 7:45 pm (I breastfeed her for bedtime at 8pm) and then she has 2-3 feedings during the night. If there are two feedings, she will wake up usually around midnight and 4am (so it is even 4 hours). If there are 3 feedings (which happens once or twice a week), then at 11pm, 2am, 5am.

We transitioned to 3.5 hour EASY when she started eating for 2-3 minutes per feed and most of the time she wasn't hungry when the 3-hour mark hit. She transitioned very well: one day we noticed that she is not that hungry, the next day she was eating every 3.5 hour. After that her feedings become the regular 5-7 minutes and everyone was happy 

Now she started eating for 3 minutes again, but she definitely shows hunger cues at 3.5 hour mark (at least for most of her feeds). But her naps went wild. She usually has two good naps (1-1.5 hours) and two catnaps (one for 45 minutes and another one for 30 minutes). The last nap started to decrease up to 10 minutes (yesterday). However today her EASY was:

WU/E: 7am (8 minutes)
A: 7:10
S: 8:55-9:30
A: 9:30-10:15 (We tried to put her back to sleep from 9:30 to 10am using shush pat, but we failed)

E: 10:15 (3 minutes)
A: 10:20
S 11:50-12:30, shush-pat + paci, 12:40-2:30 !!!
A 2:30-2:40 (tummy time)

E 2:40 <- She is getting a bottle with breastmilk (since I'm at work) and she ate 150ml or 5oz in 7 minutes
A 2:50
S 4:45-5:15
A 5:15-5:40 (tummy time)

E 5:40 (3 minutes)
A 5:45
Bath 7:30
E 7:50 (15 minutes)
S 8:05pm

Just a note: our pediatrician suspected a reflux and she recommended to keep her upright after the feed - that's why we used to have a tummy time right before the feed. Recently spitting up decreased and her A-time increased. So we started giving her tummy time in one hour after the feed and we kept the original tummy time before the feed.

So it seems like nap-wise she wants to be on 4-hour EASY with 2 big naps and 1 catnap, but feeding-wise she is not ready since she is usually very hungry at 10:30am and 5:15pm feedings (even though most of the nights she feeds every 4 hours).

What should I do? Right now I'm just going with the flow: if she is sleeping, I let her sleep; if she is hungry and it's around the feed time, I feed her. But since I'm working and I want to skip as little feedings as possible (i.e. schedule my meetings in between feedings), I would like her to be on the fixed schedule.

I will appreciate any advice.

Thank you.

[jessmum46]

Unfortunately 'fixed schedules' at this age change constantly, and from what you've said this is a case of her needing more A time so nap times do need to change.  In terms of breast feeds it's very normal for a breastfed baby to not manage 4h between ends until much later once solids are in the mix so you do need to be creative.  There are a few options
- feed at the beginning of A time then offer a top-up say 30 mins before sleep
- accept a variation to the EAS pattern, so EASAES or similar for a while
- think about trying a slightly different nap routine, with DS at this age who needed 3h feeds (big hungry boy!) I found a short am nap, long second nap and short pm nap worked much better for fitting in feeds.  on that sort of routine you could deliberately keep your first nap at 9.30am as an UT nap, then try second nap slightly earlier than you did yesterday, say 11.30 or so and hope for a long nap.  Then fit in afternoon catnap where it suits.  So eat at 7/10.30/2 etc as you usually do. 

Do any of those sound possible?

[Apple001]

Thank you for your reply and your suggestions!
I'm definitely accepting EASAES pattern - I'm totally fine with it and we actually dealt with it from the start (due to reflux).

Is it possible she might be accustomed to feeding at those times and she doesn't want to change them? Similar to habitual night wakings. If you look at the EASY I provided above it seems like she shows her hunger cues if she is awake, but if she is sleeping she can feed later.

[*Ali*]

That's very normal. If I wake up early I want to eat earlier too. We don't feel hunger in our sleep and so we don't feel hungry until we wake up. Plus being away uses more energy than sleeping so it makes sense that more time awake would mean she needs to eat sooner.

[Apple001]

*Ali*,That makes sense. Thanks!


Anyways, today was our 4 month check-up and the doctor told us to drop the night feedings. He said that she should be STTN. I'm not sure if I trust the pediatrician (our doctor had an emergency and she couldn't see us, thus we had a new-bie doctor who just joined the practice we are at). 
Her stats from 2month appt: 75% height, 80% weight
Her stats today:                   50% height, 96% weight

I will probably try to remove one night feeding, but I don't think she is ready to STTN.

[jessmum46]

Personally I'd ignore them there is no evidence base for that statement, it is normal for breastfed babies to need one or more night feeds at this age.  Sorry to say but many doctors have little or no training in breastfeeding so I would do your own research or seek the advice of a trained lactation consultant x

[*Ali*]

What Katherine said. Shocking they still give this advice for babies who still clearly want to feed at night. Also reflux babies do better with more frequent feeds and the milk soothes the discomfort. Refusing to feed at night will involve lots of crying which aggravates reflux. The World health organisation recommend feeding as often as baby wants.

[Apple001]

*Ali*, jessmum46,  thank you girls for your opinions! The doctor told us that she is getting too much weight and it seems like she is getting lots of calories during the day.

We actually decided to try to remove one of the night feedings. I don't think that she is ready to STTN, but just one night feeding sounds so alluring.
So we tried it last night. My DH and I decided that I will feed her the first time she wakes up and then I will leave to go to sleep in the other room and he will be taking care of DD. If she starts crying or he wouldn't be able to soothe her, I will feed her right away.
I fed her around 1am. DH said that she woke up several times, but he was able to soothe her with pacifier and/or patting .
I woke up at 6am feeling fresh and full of energy! (I pumped some milk since my breasts were engorged.) At 7am she woke up and I bfed her.

Tonight I will be on guard with DD, and my DH will get his sleep in the other room.
I'm afraid that I have habitual night waking (since I was waking up at the same time as her usual feeds even in the other room) and if I heard her being unsettled in the crib I would fed her without letting her soothe herself.

[*Ali*]

There is no such thing as too much weight from breastfeeding. Sounds like your Dr is very confused.  It is only a worry if babies are overweight from formula as that can make them overweight as adults.  The same is categorically not true of breastfed babies. There is more info here. http://kellymom.com/bf/normal/weight-toomuch/

Fwiw all three of my EBF babies shot up from 50th to 90+ centile lines in the first 6 months before the became mobile. My older two slimmed right down by 12mo and are now just above the 50th. DD is not quite 8mo and I haven't had her weighed recently but I'm sure she'll be the same.

If your DD keeps waking after being settled with the paci I'd say she is obviously genuinely hungry.

[jessmum46]

I'd agree, STTN is so tempting but no need to force it.  I would try one paci resettle but if she wakes again within an hour or so I'd take that as hunger. Certainly as Ali says weight does not look like an issue to me, often medics (I am one so very aware of their training!) don't realise the significant differences between breast and bottle fed babies in terms of normal feeding patterns and growth.

[Apple001]

*Ali*, thank you for the link! I will share and discuss it with my DH.
I also thought that as soon as DD becomes more mobile she will lose weight, so I was not concerned about it that much. But I read somewhere that it is bad when babies jump between those centile lines - that's why I didn't ask the doctor to elaborate.
I was actually more concerned about her height measurement (she went from 99th (at birth) to 75th (2-month) and now she is 50th.) The doctor said that they do not care about it until the baby can stand up and take the measurement upright.

jessmum46,  I asked DH about the details and he told me that he resettled once around 4am using pacifier (usually if she is hungry, she will not take a pacifier), then close to 6am (but before I woke up since I rushed into the room right away) - she took a pacifier at first, but then 5 minutes later it got dropped and she woke up. He gave it to her again and she slept till 7am, when I fed her.
When she woke up and I fed her, I didn't notice any hunger issues. But she did ask for the breast 20 minutes earlier at her next feeding and she was feeding for 8 minutes (while before it was around 3-4 minutes). All her other feeds were about 4 minutes each at the regular time (2pm, 5:15pm). She slept for a total of 3 hours during the day (without the last nap), while she usually sleeps for at least 3.5 hours.