Help with PU/PD for 7mo spirited baby with reflux?

[LittleM]

hi
Has anyone any experience with PU/PD and reflux? 
My DD2 is 7 months, and at about 3/4 months, the reflux really started causing her discomfort, but it took a long time to figure it out because she was sleeping really good 6 hour stretches at night.  She is now on Nexiam and she is more comfortable.  During the 2 months it took to work out what was wrong, we fell into the bad habit of feeding to sleep (we are EBF).  Feeds were just taking so long, that by the time she settled into a feed it was time to sleep and the two just rolled into each other. 
This has become a problem as it has been taking 1 - 1.5 hours per feed to feed her and settle her for sleep.  I have a three year old, who is not taking well to mummy being so preoccupied with baby.
She was waking once at night - around 2 am - but in the last month has started another feed around 10 pm (and will then feed again around 2). And this weekend she was up virtually every hour both nights. 
I fished out my 'Baby Whisperer Solves all your Problems' and I can see that one of the first things I have done wrong is that I have kept her on a 3 hour schedule (because it suited nap times!).
So I started with PU/PD today and it took over an hour at lunch time to get her to sleep.  She was getting so upset and I could hear her gagging / coughing with the reflux.  Every time I PD she would start crying before her head reached the cot.  She was eventually so tired that I put her down and laid my hand on her and she did settle, with little sobs breaking through every now and then. 
For her afternoon nap - I was with her for an hour and my DD1 started being so disruptive that I couldn't carry on any longer. 
So when we got to bed time, she was completely over tired and when I put her in her cot, she immediately sat up, and I waited to see what happened.  She was getting agitated, and then bumped her head on the cot and that started her crying.   As soon as I picked her up to soothe her, she vomited all over the room. And that is what I have been afraid of - with her reflux, when she gets too agitated and cries, she ends up vomiting. 
Is there something else that I should try? I just found the post 10 Reasons you can't use PU/PD and reflux is listed, I am just not sure what I can do instead?
I did try putting her in her cot and placing a hand on her, but she just kept sitting up, wanting to play. She also doesn't love being held and so will wriggle and fight whenever I do the PU part.

IN terms of her routine  - I could also do with some advice in terms of timing now that she is on 3 meals a day as well as the feeds.

Wake 5:30 (we are in South Africa and it's the middle of summer, so this is a fairly normal wake up time)
E) BF 6:30/7
S) Sleep: 7 after feed
  Wake: 8/8:30
E) Breakfast 8/8:30
E) BF 10/10:30
S) 10:30
Wake: 12
E) Lunch 12;30
E) BF 2/2:30
S) 2:30 (although this sleep and feed have been causing the most trouble for me)
Wake 3 ish
E) dinner 5pm
E) BF 5:45
Sleep: 6 pm
E) BF 9/10 (when she wakes, I am not doing a dream feed)
E) BF 1/2 (when she wakes)
She is not hungry when she wakes up in the morning, and feeds very well at night.  So I am sure she is not eating well enough during the day either. Ever since she was a tiny baby, she has only ever woken up to feed, she really is a good sleeper otherwise.

Any thoughts/ suggestions / advice would be appreciated
TIA
x


She sleeps well, and will often do 1.5 / 2 hours in a nap during the day, and then two shorter naps

[trimbler]

(((Hugs))) reflux is tough  although I only have experience with silent reflux which was either under control or had calmed down by this age. I'll see if someone with more experience can pop on, but just for now I'll shamelessly paste something nevinsmama found from the archives the other day

OK, found the article, from the PUPD archives:
6-8 MONTHS OLD - Pu/pd becomes more of a partnership at this age and it is key that you follow your baby’s pace and make the following adaptations to the basic procedure;

•   You don’t pick them up as a matter of course but you offer them pick up. You hold your hands to your baby and say “let me pick you up” and you pick them up when they reach to you. 
•   You pick them up in a cradle position and say “It’s okay, we’re just going to sleep.”. Don’t rock or sway and don’t make eye contact. 
•   Put them down immediately after you say your key phrase. 
•   Once your baby starts to soothe you continue to soothe with words and a hand for presence if this helps your baby.  Some babies may find this too disruptive so you take your baby’s lead. 

Only in the case of bad reflux, I'd suspect it would be recommended not to pick up at all unless she really badly needs it...or at least, the issue would be with all that moving around unsettling her poor tummy

Moving on to the routine...

Have you considered trying to move her feeding to closer to WU time? I think many (most?) people would recommend some upright time immediately after feeding for refluxers, and if she's feeding to sleep then lying down then she's not getting that, which probably won't be helping her symptoms. Also if you think she's not feeding well in the day then that may be because she tends to feed when she's already getting tired, so then perhaps she's not feeding so efficiently, and then drops off to sleep. But I get that you're probably concerned about all that crying/vomiting which may result from trying to break that association oh it's difficult, isn't it! But the right routine should go some way to helping her settle to sleep more easily...

Looking at your day I think you need to be pushing out that first A time more, 3h (at least) would be about average for this age but you'd probably want to push it out more gradually, perhaps try 15mins longer tomorrow and see what happens, if she copes then try another 15mins the next day, etc...Hold for a while, then keep pushing slowly. Try to work towards feeding her sooner after she wakes in the morning, even if she doesn't seem terribly hungry, and move breakfast to before her first nap. I'm hoping that you'll end up with a later, longer first nap this way and begin to push out the second nap too. The EASY routine is largely about getting the E to come after the S, helping to ensure that it's a good awake feed, but I'll try to find someone to advise you on the reflux issues and breaking the feed-to-sleep association... [Btw please don't read this as step by step instructions, let's see how the first step goes before deciding the next step ] Eventually those later, longer naps should bring the last CN later in the day too, she may then be more tired for it and have less of a struggle getting off. Oh and I'll have a look for sample EASY routines for this age...

Ah yes, here we are, FYI: chronological EASY samples, 7-9 months

[creations]

I'll let trimbler continue with the routine advice, I only stopped by to post this for you
Gentle Removal Plan
There is a description of how to gently wean the feed to sleep habit, I would follow this for your LO rather than PUPD which is making her sick. Shush/pat or adapted is recommended for refluxers rather than PUPD, I think you know this now x
You can use a rub (rather than patting) when holding and a key phrase (described above) whilst holding (whilst feeding and after you have removed her from the breast) and continue a rub and key phrase in the cot if rubbing helps more than a firm hand.
You might also find it helpful to put her on her left side rather than right side, either whilst holding or when you put her in the cot. I am not suggesting side sleeping but as you are there when she falls to sleep there is no harm falling to sleep on her left side and you can gently roll to her back after she has nodded off for safe sleeping (if she is not swaddled and if she rolls both ways then it is ok for her to roll onto her side to sleep but the advice is still to put them down on their back before you leave).

It's not a quick fix but you've been dealing with this a long time so another 10 days or so is not a huge length of time. Maybe mark a date on the calendar 14 days from now and show your 3yo that by that date Mummy will not be spending so long putting baby to sleep, it's the goal?

[lauradj]

Hi there! I wanted to chime in, as my 8 month old also has reflux. As you mentioned, PU/PD does not work for little refluxers.  I did a modified shh-rub and held DS upright while rubbing his back. I didn't do the shhhh part because he didn't find it soothing for long stretches.  Maybe that would work for you.

[LittleM]

hi all
I am so sorry - I have just noticed that my reply didn't post and I feel terrible.  I really appreciated the advice and help.
Just after I posted this, my mother was admitted to ICU and all attempts to change my LO's habits fell by the wayside. 
Where we are now:
 I have moved her from 3 --> 2 sleeps per day, and I am working on 3 meals a day with light snacks.  So at sleep time she's been more tired and not hungry so she was feeding to sleep more quickly and we just carried on our bad habit 

What I have realised is that she can settle herself back to sleep and does so often at night.  Occassionally I have to go in and just place my hand on her and she will go back to sleep.  This has allowed us to move from 2 feeds at night to just the one.  Where we are still struggling is falling asleep for naps and for nighttime.  She still needs to bf to get herself drowsy.  She is usually aware that I am putting her down (eyes open slightly), and then does go to sleep.
The trouble is that now she is 9 months, and she wants to play and interact with me during these times, and we are back to taking an hour to feed and get her to sleep.  I am ready to stop bf now but as this is the only way I can get her to sleep, I have to keep going!

She is very alert and active, and if I try and put her in her cot before she is 'perfectly drowsy', she wakes up completely and struggles and fights (not crying yet), even if I have my hand on her and am whispering to her softly.  She will struggle for a long time until she is so agitated that she starts crying and then if I pick her up she usually vomits (the only real time that we see evidence of the reflux, so she is slowly growing out of it).  So I keep defaulting to bf her to sleep as I am completely over the vomiting. 
She won't let me cuddle her or rock her to get her drowsy, she just wriggles and wants to play.  She has never taken a dummy.

She is also probably filling up a bit too much on milk at her sleep times, and this is making her eat less during the day, which is why I suspect that she is still waking for a feed (not to soothe) once during the night.   Here is her routine:
Wake: 5:30
E 5:30/6 depending on when she has fed during the night
E 7am breakfast
S 8:30 (has a feed to fall asleep)
Wake 10 ish
E 10 am snack
E 12pm lunch
S 1/1:30 (has a feed to fall asleep)
Wake 2/2:30
E Snack at 3pm
E Dinner at 5pm
S 6:30, (has a feed to fall asleep)
Usually wakes between 12 and 3 to feed - and she is really hungry.

I have read the gentle removal plan, and it seems as though I am already doing some of it as I do put her down before she is completely asleep.  And we don't have a problem with frequent wakings.

What else can I try? 
thanks in advance for your help.

[lauradj]

Hi there!  I'm glad some things have improved, though I hope your Mom is ok?
If you've already started some aspect of the gentle removal plan, I'd suggest you stick with it.  It can be helpful for reflux babies as it's a gentle method and there's no moving around of babe, which as you know can aggravate the reflux.  What I would suggest for weaning your babe off the breast at bed time (is that a tongue twister?  ), is you BF outside of her room, allowing her to burp etc. Then carry her into her room and read a brief, quite book with some soft lullabies playing and then switch on the white noise (if you use it), close the curtains, have a last snuggle and lay her to sleep.  At this point, it must be you who holds firm.  You know she's not hungry but you are changing her routine so she will fight it.  I find it's best that I leave the room asap with my wiggle monster.  If I try to settle him, he'll just get frustrated.  If I leave, he sees it's time for sleeping, not play and he settles himself.  Sometimes it takes him 20 minutes but I do not go in unless he's crying his 'I need you' cry.  DS2 sucks his thumb and he 'hums' to himself right before he goes to sleep, so I listen for that sound and then I know he's nodding off. 
Could your DH trying to doing naps on the weekend and see if that helps?  She'll figure out he can't offer her milk and it might make it easier to break the cycle. 

[LittleM]

hi there
thank you so much!  What a big help, I feel like a huge weight has been lifted!  And my DH put her down to sleep for the first time ever on the weekend 
I have been putting her in the cot, and then she keeps sitting up, so I just keep laying her back down, while placing my hand on her back / side.  She'll wriggle for a bit and protest a lot! I don't chat to her or catch her eye, letting her know that it is sleep time not playtime.   And if she cries then I ask her if she wants up.  But often she just cries a little and carries on trying to go to sleep.  It's taking me 10 - 20 minutes to put her down now and this morning I put her down without a feed first. (she had just had breakfast) - she was quite irritated but accepted it pretty quickly.  I am so pleased how quickly she has progressed!
The next step will be for me to be able to put her in her cot and leave the room, but we will work up to that!
Thank you so much for the help and the support.
Sadly we've had to move my mum to a nursing home (she has dementia) but she is now well and settled and being well looked after, thanks for asking
x

[creations]

Great update

[trimbler]

Sounds like you 're doing really well, so glad to hear of the progress So sorry to hear about your mum though (((hugs)))

[lauradj]

That's great news!  Keep up the good work, you're doing a wonderful job.