Trouble falling asleep

[Lollipop86]

Hi.
I've received a lot of good advice for my first baby here and now I need help with the second one 

I have a preemie (4 months, 6 weeks corrected age) who is now starting to show some sleep issues. She is BF, has a pacifier and loves to sleep on me (from kangaroo care in NICU).

I usually have her in my arms a lot or if I am doing something I put her in a bouncer with a baby nest. She is happy there but needs her pacifier a lot (had it in NICU already because she had a strons sucking reflex). But then when she gets drowsy or closes her eyes, no matter what I do she will not fall asleep unless I go to my bed and put her onto my chest (If I do that I can eventually put her down in my bed and she will keep sleeping.). That is the only way she will relay and deeply fall asleep. Otherwise she looks like she is asleep but if something happens (a sound, a move or her bowel movement) she will open her eyes widely and we go from the start...

I've tried putting her down in a crib awake, drowsy, "asleep", white noise, darkness, nest in the crib, having her in my arms already in a nest and putting her down with it, swaddeling, ssh/pat. So far nothing has worked. Also when she looses her pacifier she will start to  cry.

She has no problems falling asleep at night. (thank God!)

Also she has a lot of tummy problems. Especially if she does not poop after one or two feedings she cries and is gassy. When she is in my arms she is quite calm but emediatelly after I put her in the crib she will fart or start crying like her tummy aches. If she manages to fall asleep she will start crying every few minutes.  (she is restless even during BF and she keeps latching off and moving her head, arms and legs.)

So what should I do? I know I have to wait for her bowel to evolve completely... But during this time - keep trying to put her down or alowing to sleep in my arms or on my chest?

[trimbler]

Hey there, sorry you haven't had a reply to this yet, and congratulations on your new LO I don't have experience with preemies, but from what I understand their adjusted age is the one to go on when thinking about their sleep, and 6 weeks is still very young, so personally I'd say don't worry too much about getting her to sleep independently, it's usually more important that she gets the sleep that she needs, and of course all these discomforts won't help her. If you do think that there's a time in the day when she's more comfortable, you could try some gentle sleep training just for one nap, perhaps. When you say she settles well at night, does that mean she settles in her crib with just a little help from you?

A few other thoughts which may help:

Try to make sure her A times are appropriate, I'd suggest to aim for around an hour at this age, see the  link below... If she's already OT she'll have a harder time getting to sleep What are A times and how do they fit into the EASY plan?

Try to be consistent with your approach when encouraging her to settle in her crib - sounds like you've tried lots of different things, but if you keep,changing then she may find it harder to learn. Try to stick to the same thing for three days or so, before changing something, to give her a chance to get used to it.

I'm assuming you're still having appointments to assess how her bowels are developing and whether she needs to be on any medication, especially if she's in discomfort?

A few links to posts here which you may find helpful, if you haven't read them already...
What does a good wind down consist of (Includes 4S ritual)
Shush-pat - How to

[Lollipop86]

Hi.

Thank you! Yes I realise the changes may confuse her that's why I also posted my question I found out something else - I must not have fed her enough! She has grown a lot and aparently she needed more food. She eats form one breast at a time because I have a lot of milk. So now when she is finished I change her diaper and then offer her the breast again and she always eats some more. And after that she also sleeps better! She still needs soothing in my arms but when we go out with the stroller she falls asleep inside and can sleep for three hours. Usually she won't sleep in the evening before night time. At night she will fall right back to sleep after BF. Sometimes in my arms or in the crib when I put her down. Sometimes she looks around but when I turn off the light she doesn't fuss and falls back to sleep.

We don't have any appoitments regarding her bowels. I don't think they are necessary. I just ment that all babies don't have their bowels developed until around three months of age. And some have more problems with this than the others. Also maybe D3 vitamin and iron drops can make some discomfort. So I'm giving her probiotics and I think it helps.

Thanks for the links. I totally forgot to check the wind down page. This will help.

[trimbler]

That's great that you've worked out the feeding issue I used to do something similar with offering the same breast again after a nappy change. How are you feeling about things now? If you feel she's struggling to settle in the evening, I could take a look at your routine if you like and see if I can make any suggestions? Just post something like
E 7am
S 8-9.30
E 9.30
S 10.30-12
...
Or whatever it is for you! We usually would recommend not letting them go more than 3h between daytime feedings at this age, which would generally mean not letting then nap for more than 2h - it's lovely that she'll sleep for 3h in the stroller, but it could mean that she doesn't get as much milk during the day as she could and might have to make up for it at night...

[Lollipop86]

We have not established a routine yet... But it is usually like this:

E 8am
S 9, 9.30 - 10.30, 11 (she has trouble sleeping in the morning and she often wakes up)
E 11am
S 12, 12.30 - 2pm (a little better, especially if we are outside)
E 2pm
S 3, 3.30pm - 5pm (with waking up)
E 5pm
S almost nothing
E 8pm
S 9pm (I put her in pijamas, turn the big lights off, feed her again and when she gets tired I put her in the crib, turn off the light and she falls asleep! - I did this a few times now, I hope it lasts...)
E 12-1am (goes right back to sleep)
E 4-5am (goes right back to sleep)

We tend to shift this timetable 1 hour up during the day. Sometimes I feed her on 2,5 or 3,5 hour intervals.
We don't go out as much now because it is quite cold and it gets dark at 5pm. I have one 3 year old DD to feed at 12.30 - 1pm and to put to bed at 1.30-2pm so I am a little bit limited

[trimbler]

Hey it sounds like you're both doing really well Completely normal to have some variation day to day. I'm not sure how it works with preemies, but I expect similar to full term LOs in that the classic peak of colicky crying/fussiness is around 6-7 weeks, so you may just be in the middle of that, do you think? Or is she happy in the evenings, just not sleepy? Sorry, you probably said but I just can't find it right now That BT settling is great Many mums will just work on BT settling first as that sets you all up for a better night, and work on naps later. I just worked on one nap a day with shh pat etc with DD, and ended up far more relaxed about it that with DS, where I struggled through trying to be consistent with sleep training but just ended up with a fussy OT baby The other thing that may contribute towards the evening restlessness could be OT accumulating through the day, it's a bit hard to see from the routine you posted, as it's an average of several days. If you could post, say, what she does today, then it might be easier to see if she's likely to have got OT by the evening and so struggle to settle. Mine often struggled with the evening CN, especially DS, as he short napped the whole day and just ended up so wired! But really, she is still very young and things will be changing all the time, don't forget there's usually a growth spurt around 6 weeks too so lots going on... Continue to be flexible about feed times, 2.5-3.5h during the day sounds good to me although sometimes it may be more like 2h especially in the evening, and we wouldn't usually recommend stretching to 3.5h just yet but if previous intervals have been shorter and she's short napped and then just got back off to sleep again or something, I'd let her go to 3.5h

Sorry rambly thoughts today, hopefully something in there will make sense Just want to encourage you that you're doing really well, it's such an intense time especially with an older LO too, so hang on in there  it will get easier eventually

[Lollipop86]

Thank you, this really means a lot - to know we are on the right track. We are having good days and bad days. Sometimes she will sleep for 2 hours, sometimes just one. Now she started to wake up evey 3 hours at night too. I think it must be a growth spurt. She is constantly hungry. She is also very nervous during the feedings. Especially on the R side where I have a lot of milk. It helps a little if I walk around... She keeps latching off and shaking her head and moving. I think it will pass. My first DD did similar thing though I think it was in the first weeks. I went on a milk-free diet but it didn't help. It passed over time. So I'm not very worried.
So we do things without pressure - if she is very fussy I go to bed with her, sometimes I have her in my arms, sometimes she sleeps in the stroller if we go out. However it is very interresting that almost every time I put her in the crib (even though she is asleep and completely relaxed for a long time in my arms) she will almost instantly start to move and fuss and then she farts. As if something triggered this. We are getting Ewan The Sheep today (I know, a prop) and I hope at least this will help her transition from my arms to the crib. I will report

[trimbler]

There's certainly a big growth spurt around 6w with full term LOs, so I expect you're seeing that now! Well done for keeping a relaxed attitude, that will certainly help you get through these intense weeks Yes keep us posted! Just another thought, have you tried feeding her in a reclined position, ie laying back? That can help with very fast flow

[Lollipop86]

Hi.
Yes I've tried this position. It is working for better latch and less gulping but sometimes she is still fussy on the breast so I walk around and it's OK. We started going to the developmental physiotherapist (I don't know if this is  also the title in English?) and we have a lot of restrictions now regarding baby positions, handling, cloth diapers and pacifiers. Also she was so tired from the session (she cried the whole time) that she fell asleep for two naps without a problem but for the evening nap she cried the whole time and then she couldn't fall asleep at BT. I think everything came back to her. When she cried it all out she slept as usual (WU at 1 and 5 am). We will see how she copes with it next time 

[Lollipop86]

Oh, and also it sometimes looks like she eats in sleep. This doesn't count as sleep right 
Or sometimes she falls asleep right after the feed for a few minutes - like a power nap   Is this OK and should I count this as sleep?

[trimbler]

She may well eat in her sleep...or she may just like feeding with her eyes closed tbh I'm not really sure how to tell but I used to count dream feeds as sleep and if they fed to sleep at night I'd count the asleep portion as sleep. I'd count a power nap as sleep but wouldn't expect a full A time afterwards. It's very common for young babies to fall asleep near the beginning of a feed, due to the hormones in the milk, just be sure to check she's not still hungry when she wakes as some will cut their feed short when they fall asleep but readily take more when they wake. Or you could work on helping her to stay awake for the whole feed. Sounds like you had a better night, despite the evening troubles, which wouldn't surprise me at all given then busy day. I think it would be unusual to see a physiotherapist at this age over here, my mum used to work as a paediatric physio but would only occasionally see babies as young as 3mo but no younger, I think it would have taken at least that long to get a referral Why did your DD see one? Are there underlying health issues?

[Lollipop86]

Well she is a preemie and here the pediatritian sends you to a developmental pediatritian who then tellshow the baby is developing - usually they have hypotonus of the muscles. So the physiotherapist shows parents how to handle the baby and what not to do to encourage improper baby development. You have sessions once a week. The pediatritian then looks the baby at 3 months corrected age.  I think that the real therapy starts then if needed.    At least this is how I understand it.  But they are very stirct as I said - no cloth diapers (we were using them), no bouncers, no baby carriers, the right pacifier... Allthough I am really asking myself if cloth diapers and good baby carriers really have that much impact on baby's development. If there are studies that confirm it.

As for my DD is concearned we had a few really good days. I think that the cramps are subsiding and we are getting to know each other I hope it lasts

[trimbler]

That's all very interesting, I have no experience with preemies at all, mine were both overdue! So glad to hear the last few days have been better