What to do after pu/pd

[jkitiara]

We've been doing pick up put down for about a month now--little one just turned 5 months. It works pretty much every time so far, but it's not getting easier. In fact it is getting harder as he gets stronger and grabbier. He plays with my hands the whole time when I pat his belly. He kicks his legs. He will stare into space forever and I think it's starting to work, but then he abruptly looks up at me and smiles and spits out the pacifier.

Where do we go from here?

[creations]

It sounds like he might be a bit UT. Do you want to post a recent EASY for us to look at?

[jkitiara]

Sure1 I actually was suspecting overtired, but it's hard to know with my touchy little dude.
7am wake and eat
9am eat (he eats every 2 hrs due to intense spit up issues. I do not feed him to sleep but it is the beginning of our nap routine)
9:30 asleep
11am wake and eat (sometimes this is only 30 min, but more and more lately it's a 1.5 hr nap)
1pm eat
1:15/1:30 sleep
2 wake and eat
3 eat solid food
4 sleep
4:45 wake and eat
5:45 eat
7:15 eat
7:30 bed
3am eat

Thanks!

[creations]

It looks like more of an eat issue than a sleep one tbh.
At this age LOs would usually have 4 day feeds and one night feed (or dream feed) making 5 feeds in 24hrs.  Your LO is taking 9 feeds in 24hrs.  This might be the cause of spitting up and poor sleep.  Have you considered possible reflux?  Have you seen a doctor about the spitting up and frequent feeds?
Also it is a bit early to begin solids already, most countries advise to wait until LO is 6 months old.

I tell you what, I'll see if I can get some bottle feeding eyes over here for you too.

[Martini~]

Hmmm you feed him because he spits up - but is he hungry? I mean spit up often occurs as a result of overeating:). How much does he take for every feed and in total during 24h?

[jkitiara]

Thanks! He has bad reflux and is on medication. It is mostly controlled now.
I tried to switch him to doing 6 five oz feeds in a day and he started doing constant "overflow" spit up, to the point where he wasn't gaining well. Our pediatrician and lactation consultant both seemed to think that 5 oz was too much at once for his age (this was about a month ago at 4 months old). So we scaled back to smaller feeds more often. He totals about 28 oz a day.
My pediatrician recommended we start solids. We only do about 2 tablespoons. She recommended starting with prunes to help his constipation and it totally worked! He seems to have much less straining and tummy pain now. Poops normally once a day or every other day.
He is now entirely formula fed. I should also mention that he is very active and almost agressively cheery a lot of the time. Sometimes my first sleep cue is his laughing taking on a sort of frantic tone.
He seems properly tired for most of these naps. When I pick him up he digs his face into my shoulder and when lying down he rubs his eyes.

[creations]

What meds is your LO on and what is the dose please?
I wonder if the dose needs altering to get the reflux better under control.

[Martini~]

I tried to switch him to doing 6 five oz feeds in a day and he started doing constant "overflow" spit up, to the point where he wasn't gaining well. Our pediatrician and lactation consultant both seemed to think that 5 oz was too much at once for his age (this was about a month ago at 4 months old). So we scaled back to smaller feeds more often. He totals about 28 oz a day.

Ok, I get that 4oz was ok for him, quite reasonable for a reflux 4mo! Maybe now at 5mo he could take 5oz, what do you think? My point is that even with 4oz you only need 7 feeds a day to get 28oz, with 5oz feeds maybe 5-6 feeds per day. And if you are saying that he is taking 9 or more feeds per day it seems that some of them are very small. The case is that with milk offered so often it might that he is snacking and being fed to quickly which doesn't help with sleep:)!

[jkitiara]

Thanks for the reply! I have a question and some concerns. First, why does snacking interfere with sleep?

My concerns:
Using a bottle as part of our naptime routine is when things finally started to go a bit smoothly. Otherwise he still cries as soon as we walk into the bedroom. He is super touchy around naps and I am hesitant to give that up. We don't feed to sleep. It is step one in our nap routine.

Second, my pediatrician actually recommended feeding him before sleep. He spits up much less that way. In fact, I feed him a 5 oz bottle for his middle of the night feed (and have since 4 mos) and he doesn't spit up any. Whenever I feed even 4 oz after waking, he tends to spit up a lot as soon as he starts his activitites.

[Martini~]

You just have to find a good balance between his health and well-being vs good sleep, I guess taking into account what pead said and some advice about sleep. Snacking usually means more night feeds and shorter sleep patterns as they tend to be hungry every 1-2-3h. In terms of your routine - you are coming into age when not only feeding to sleep but also calming with breast or bottle before sleep can impact his sleep  length as when he is in transition between sleep cycle he needs the same way of settling/calming down. Secondly the older they are the less effective are the methods with calming on bottle - so it's worth to think about a routine and some self settling in the crib so he CAN do it, not only waits for a bottle to calm him.

[creations]

First, why does snacking interfere with sleep?

Personally I feel you have two different issues going on here.
One is that feeding as part of your sleep wind down will be a habit even if it is at the beginning of the wind down routine and even if LO does not fall to sleep on the bottle.
The other is that frequent feeding at short intervals and frequent spitting up I would take as a sign that your LOs reflux is not under control. Some refluxers like to feed frequently (too frequently) because the sucking action helps to swallow down the acid, they are seeking relief from the discomfort of reflux however they are not necessarily properly hungry or need the food which can lead to even more spitting up.

Feeding prior to sleep is not the EASY routine and not the BW way, however many people on the forums have adapted the routine to suit their own needs or their LOs needs. I would say that if your LO takes his feed better during the WD routine and you want to continue that then I'd suggest you only feed at those times and not again when he wakes from the nap - basically following a 3-4hrly E even if it is at WD rather than WU.  It is very common for refluxers to take milk better at BT and in the night (DF or NF), often taking a lot more and being able to keep it down. My own DS was like this and took 2 to 3 times as much at BT and his night feed than he did for other day feeds.  I believe it is because LO is more relaxed and finds it more comfortable to eat at this time.
As Marta has said feeding to sleep (or part of WD) can impact on LOs ability to transition between sleep cycles, they begin to look for the bottle again rather than just continuing to sleep so it can effect sleep this way.
When LO snacks they need another feed very soon, and then only snacks again, they do not take a proper feed so are unable to go longer. It is the same if a adult snacks all day too.

What medication and dose is your LO on for his reflux meds?  What weight is he?

[jkitiara]

Thank you both so much for your support. I recently spent some time with two of my mom friends and both have their baby (though at 1 and 2 are no longer babies) in bed with them and are unhappy about it. So it's a good reminder why I keep fighting for good habits even when it's a pain!

I checked with our pediatrician who uppped his meds and now the reflux seems controlled again.

But I still have to figure out if I want to feed before or after nap. One problem is that without bottle, we have almost no nap routine. He cries when I walk into the bedroom with him, cries while I dim lights, try to read a book, sing a song, and put him in his sleepsuit. It does not make for a great wind down! On the other hand, he has calmed down a bit and doesn't flail as much--though it's hard to tell. Night sleep has gotten very bad in the past week so that is making him exhausted and thus napping easier. We never had night sleep issues before so I'm at a loss. I think I need to work on that first so I'll ask for help with that issue on the appropriate board.

[Martini~]

Being honest we had almost no nap routine at that age I think. Not even a song. Just into the room,
nappy, swaddle or at that age sleeping bag, maybe a 10sec lullaby and directly to sleep. 3min max LOL. Even now we don't go for anything more except from Bt

[jkitiara]

It is always such a fight to get him to nap, I assume a routine helps us. But maybe it would be exactly the same if I just let him cry for the little bit of a routine and then did pu/pd into the crib. It's not as though it's gotten much easier over the past month, even with our "routine".

[creations]

We also only had about 3 min wind down, any longer and my DS would be very very frustrated. He liked to full on play right up to the point of being ready to sleep and then it was upstairs, nappy change, into his room, a song (or half a song, whilst I held him) and into cot awake then I told him "call if you need me" and left the room. Actually around 4 ish months I remember trying to start a "proper" WD routine, it drove him crazy.

How is the spitting up now? Has it stopped?  How many formula feeds is he taking? What frequency?