Exhausted Mum, 5mo baby SUCH hard work, don't know where to start!

[mrsginafrica]

Hi, posting my question here as I don't even know where to begin even on the FAQ board. The main issue is my son is such a bad sleeper. From birth he's always been difficult to get off to sleep (needs movement, as much blocking out of stimulation as possible, feed-to-sleep etc) and I've been doing what ever I needed to just to get him to sleep and get me some too. I've only had 4hrs sleep in one go on three seperate occasions since he was born. He is now 5.5mo
I've tried implementing some kind of structure but I think I haven't had enough energy to follow through consistently for long enough and now have accidental parenting problems all over. Here is a rough EASY. He goes between 3-4 feeds, usually depending on length of nap.

6am wake and eat (EBF)
Awake time usually around 2hrs
8-8:30 (can take a while to get him off to sleep) SLEEP
Naps for 20-30mins
9-9:30 EAT
11am - Sleep (this nap can get up to 2hrs but needs top-up feeding or rocking or in the car)
1pm - eat, awake and play
3pm - attempt another nap (usually 20-30mins again)
Depending on how the day has gone I'll either try for one more cat nap or go straight to bath around 5pm, and he's always fed-to-sleep. Asleep by 6:30-7.
Then wakes every 2-3hrs during the night, mostly for resettling 'feeds'.

As you can see, it's erratic. There are usually 3 naps a day though and definite night sleep, even though he clearly can't self,soothe. For context he had undiagnosed tongue tie early on (first 6-8wks complete nightmare), we live in S Africa but we flew back to the UK for 10wks from Dec to last week when we came back (and he slept a glorious 7hrs in a row! One-off though...) and has had an ongoing cold basically for the last 10wks meaning sometime he just wakes himself up coughing... he has an inhaler for the wheezing but it's a real schlep to get him to take it.

SO... whilst I'm prepared to say he just needs more physical comfort, do what works, it's been a stressful/ill period, I am also sooooo exhausted that I feel I need more structure and some effort at helping him to independent sleep as basically my day is spent feeding or getting him to sleep with a sleep-deprived attempt at playtime in between. He often is trying so hard to get to slee but can't so my gut is that if he can crack it, he'll be fine.

Any ideas for what to implement first, where to start, what to aim for etc. My DD was a compete textbook baby so this one has thrown me completely. He's almost six months old and I still feel in survival mode (and yes, on antidepressants!)

Appreciate any ideas and tips. Cheers

[creations]

Hi there, sorry to hear you're having such a tricky time. Hugs.

Looking at your EASY and your situation I'd suggest you go directly to a "stricter" routine to get a suitable, predictable routine established as quickly as possible.
It looks like he is probably UT for those naps.  At 5.5 - 6 months an A time of 2hr 30 to 3hrs is the guidance - it is tempting to reduce the A time thinking LO is OT and many parents desperately want to avoid OT but often do not realise that UT is just as hard (if not harder) to deal with.
As it will take a week or two to make the changes and your LO will be 6 months by that time, I would suggest you move to 2hr 30 A time for a few days and then increase to 2hr 45 and then 3hr A time.

For now I would focus on the day sleep, stop feeding to sleep, get the naps in the cot. Use shush/pat or a firm hand to rock in the cot if necessary and ride out the difficult days to get the structure you need implemented.
Your routine would look like:
WU 6
A 2hr 30
S 8.30 - 10 (do not put down earlier than 8.30am)
A 2hr 30 (even after a short nap)
S 12.30 - 2.00
A 2hr 30
CN 4.30 - 5pm
A 2hr
BT 7pm

Then increase A times and focus on establishing the long naps so:
WU 6
A 2hr 45
S 8.45 - 10.15 (use W2S to pat/firm hand/rock through transition to extend nap)
A 2hr 45
S 1 - 2.30 or 3pm
A 2hr 30
CN 5 - 5.15 (shorter CN if naps have been longer)
A 2hr
BT 7.15pm

And then increase to 3hrs, drop the CN
WU 6
A 3hr
S 9 - 10.30
A 3hr
S 1.30 - 3.00
A 3hr
BT 6pm (BT comes earlier due to nap drop)

I would suggest each of those routines for about 3 days - if at some point the routine establishes beautifully before you reach the third routine you can stop where it is working, otherwise plod on with the increase and wait for the routine to establish - it will.  Tracy was pretty strict on timings when establishing a routine and although we always adapt routines to fit with LOs needs and take care not to over stimulate or make LO over tired, in these days of routine setting the OS and OT can even help to your advantage so long as you can stick it out.
You will support LO throughout of course, being there when he needs you.

For E times - put them 3-4hrs apart around naps as you have been doing but you will need to stop feeding to sleep if you want LO to become independent. As BT approaches do your E at whatever time it was due after the last nap and do E again before BT even if 3hrs has not passed.

Overnight, for now, I would do what you are currently doing.  Nights might change as the day routine changes anyway and tbh I feel you have enough on your plate to cope with. you can look at nights in a couple of weeks perhaps once this day routine is established.  Feeding to sleep at night is unlikely to have a huge impact on the ability to self settle in the day, although ultimately you want him to self settle at night too so that you can get a better stretch of sleep.

I hope you find this helpful x

Also, while I am here, if you feel like talking with others or receiving support or even just hugs we have a PPD board here:
Post Partum Depression

[creations]

he has an inhaler for the wheezing but it's a real schlep to get him to take it.

Sorry I also meant to comment on this. My DS had an inhaler, he was several months older actually, but we were advised by the hospital staff that if he fought the inhaler mask (ours is a rubber face mask attached to a "spacer" which is a plastic tube where the meds are sprayed and LO re-breaths the air/meds) that it was ok to hold it very close to, but not touching, his face, and that he would still inhale the meds even with that little distance there.  We found this helpful and gradually he got used to having it on his face.  We were also advised to give the inhaler this way (very close but not touching his face) whilst he was asleep. It was hard to get the right position but of course he could not fight whilst sleeping and he got his meds.

Another thing I found was that counting out loud seemed to help him focus and know that it was for a limited time.  He learned to recognise the numbers very quickly and stayed calm until the last number, but then right away squirmed to get away from the spacer.  These things need to be implemented as part of the routine, if you are firm and consistent LO will adapt eventually.  If he is awake then swaddling during the meds might also help to keep him from pushing the mask away and helping to calm him down.

[malibu_nikkus]

Hi there.  Ive been having a rough time just like you with short naps. As mentioned, for us, it was in fact undertiredness causing that short nap.  Focus on the first nap of day, trying to extend that wake time slowly.  Also, white noise has also helped to set the routine too. Our nights are still awful, but wanted to share our recent breakthrough.   Also, shh n pat made my guy angry. Standing back with my hand on his chest or just standing by the crib has worked much better. It will take trial and error but youll find a great approach that works for you both.

[Katet]

and has had an ongoing cold basically for the last 10wks meaning sometime he just wakes himself up coughing... he has an inhaler for the wheezing but it's a real schlep to get him to take it.

My DS1 is 13yo, & I wish I knew what I found out at 5yo - his breathing & ears were the issue with his sleep as a baby... long term it's caused jaw (& such orthodontic issues) In part it was all tied into his tongue thrust (need to feed/suck lots) & increased allergies - kind of chicken & egg stuff, he had bronciolitis 4 times (hospitalised 3 times) from 6-12mo.  I don't know what the direct solution would have been for DS1, but I did have a conversation with the ENT when it was all unfolding, that had he seen DS1 for issues as a baby he would have had him checked out for sleep apnoea, as that what was possibly why he woke so frequently as well as the other issues. Long term it's been "fixable" but poor DS1 has had pretty extensive orthodontics & looks like he may need nasal surgery & I had to deal with poor sleep... but these are all "newer" ideas as it's only because of a comment from the ENT that I looked into it a bit more. 

So it may be worth pushing harder with medical people for breathing to be an issue with his sleep.

[mrsginafrica]

Thanks so much for your help. It is SUPER helpful; especially about UT as that's something I hadn't considered as he was seeming to be tired - but yeah, then napping 30mins!

I will try extending A time for the next few days to 2h 30 and see how we go. I also need to definitely stop rocking up to sleep during day as it's a) exhausting and b) not a habit that needs to continue at this point.

My husband is home for the next week so he can help out too! I give up a little too soon... ;-)

One question re:creating new sleep habit - he's quite an 'alert' baby so I was actually considering controlled crying (i.e. popping in every 5mins) instead of shh/pat or PU/PD as he seems to get OS with those methods. Having said that I probably haven't been consistent enough for long enough to say for definite. Is that something to avoid completely or try anyway?

I will try routine methods and then if they also fail will also check out the ENT route as well as DD has an egg allergy so these things def run in the family!

[creations]

We do not agree with any form of controlled crying.
The Baby Whisperer ethos is about respect and support for your baby, about not breaking the bond of trust, and we can not support a method which involved any sort of controlled crying.  I also urge you not to take this route.
Research on why 'cry it out' and 'controlled crying' is NOT recommended!

[mrsginafrica]

THANKS thats really helpful. Instinct tells you not to walk away when they cry but I'm at the end of my tether and was looking for anything that would help! I'll try the routine switch for a few days and then next week start sleep training with Shh/Pat and PU/PD (although he is quite spirited he's also a cuddly one!) OH is around too so we can share the load ;-)

One question though - what happens if he is really crying and won't be comforted? Is there a point where he will just fall asleep anyway or a point where you say this isn't working? Or even if it gets so worked up he chokes/throws up?

[creations]

I understand that you feel at the end of your tether.  It is hard work caring for a young baby - you're not alone we've all found something or other hard to get through, that's what leads most of us to these forums.

If you could read through the routine again, stick to it pretty strictly on the Sleep times and when to increase the A time moving to the next routine, you will achieve your goal in a shorter time.  You will see (above) I have mentioned you can begin the sleep training by using a firm hand on LO in the cot and use a little rocking motion. This is what I did with my LO (he was younger but it never changed through all the phases of needing some additional support) as patting seemed to make reflux worse.  It is possible to do a WD in arms with a little rocking, put in the cot and continue to rock with the firm hand - AND to gradual wean this over time in the same way as shush/pat.
BW methods are not no-cry methods so prepare yourself for that, your LO has been feed and rocked to sleep for 5 months and will likely protest quite loudly at the sudden change in sleep arrangements - but you will stay with him throughout and by staying with him he knows he is being looked after, he is safe and you do not break your bond of trust.  he will not feel abandoned.

Try to put down for the nap (begin WD before the planned for S time) for either the full nap time or for 45 mins.  Tracy continued until pretty much the end of the planned nap time when establishing a routine.  Sometimes we suggest 45 mins simply because it can be very hard on the parent, taking LO out of the room doing a little A time and trying again might be preferable for you, although if he is almost nodding off at 45 mins I wouldn't give up then.
If LO short naps try to resettle the nap for 45 mins or until the end of nap time.  To resettle you can pick him up if he is very upset, calm him in arms then put down and continue with the shush/pat or firm hand and little rocking motion in the cot.  If he gets very upset again pick up, comfort in arms and when calm put down and continue to comfort in the cot.
It does work - really it does. Not all on day one but it will come.

what happens if he is really crying and won't be comforted?

You might not be able to comfort him or make him stop crying because he may have a lot to say about this sleep habit being changed on him all of a sudden - however you continue to stay with him.  It DOES make a difference.  It is not the same as leaving him to cry alone.

Is there a point where he will just fall asleep anyway

Yes eventually he will just fall asleep. Even if he misses a whole nap because he can't settle you will do the A time and then when the next nap is due you start again. And he will, at some point, sleep.

or a point where you say this isn't working?

Well it does work.
With a suitable routine and with support your LO will learn to fall to sleep independently with these methods.  Like I said, he might miss a nap or two but it is all part of the process and he will sleep and he will learn to self settle with confidence.  He will learn that you are ALWAYS there when he needs you so he is safe and because of this he will need you less - he will be confident in your return just as soon as he calls or cries for you.
As for if it is working for each individual nap - as above you might try for 45 mins or until the end of nap time. Your call.

Or even if it gets so worked up he chokes/throws up?

If you feel he is getting so upset you can take him out of the room and comfort him away from the cot/bedroom.  I would just keep him out for a few mins until he calms and then return to continue with the nap - unless it is very close to the end of nap time and E is approaching.
I would only take him out of the room in extreme cases though - the point of this is to show him it is nap time, he doesn't get to just shout about and then go to play - yk?

Hope this helps.

[mrsginafrica]

Thank you so much - this is really helpful. Thank you for taking the time to reply and help me out - I'm already feeling more confident (if still daunted!)

One FINAL question (sorry!) - are you saying I should increase A time and work on that routine whilst at the same time trying to sleep train at naps? OR try for the longer A time for a few days and continue rocking to sleep for naps? Basically, is the longer A time a helpful component in the sleep training or too much change in one go?

Cheers

[*Ali*]

I notice you mentioned he had undiagnosed tongue tie. Has that been revised now? How is his weight gain? Any problems with sore nipples, wind, being sick?

It's not uncommon for EBF babies to need top up feeds once A times get longer so he could be waking early from that first nap due to hunger. It has been 3hrs by that point since the last feed if I'm reading it correctly. Many EBF babies don't make it to 4hrly feeds until solids are well established after 6mo. It might help to offer a BF half an hour before the nap to make sure he's full.

Is the bedroom blacked oUT?  That really helps easily-overstimulated babies. Have you considered using white noise?

Do you have a baby carrier/sling? Maybe just pop him I there when you feel you can't face another cot nap.

[mrsginafrica]

I notice you mentioned he had undiagnosed tongue tie. Has that been revised now? How is his weight gain? Any problems with sore nipples, wind, being sick?

He had undiagnosed tongue tie in the early days but diagnosed at 14wks when the lactation consultant said he was too old/big to have it snipped but that it shouldn't be a problem going forward. He is a big boy! Must be around 9kg now and 6-9mo clothes already getting tight so feeding not an issue ;-) Wind/spitting up etc. I'd say is normal rather than a problem these days.

Is the bedroom blacked oUT?  That really helps easily-overstimulated babies. Have you considered using white noise?

Yes all blacked out but we only use this solution at night so far - going to try it for naps now... And have ewan the sheep for white noise ;-)

Do you have a baby carrier/sling? Maybe just pop him I there when you feel you can't face another cot nap.

Yep - an ergo baby which was a complete lifesaver in the early days. Definitely a good back up plan.

[mrsginafrica]

So... you're not going to believe this (or maybe you will!!!) but today we did 2h30m awake time starting at 6am. This was the schedule:

WU 6am (BF)
A 2h30
S 8:30-10 (perfect 1h30m) - took 5mins of light rocking in buggy (lying flat) and then asleep and no waking
E 10am (BF)
A 2h30
S 12:30-2 (another 1h30m) - took less than 5mins of rocking (again lying flat in buggy) with a small waking needing rocking mainly due to being accidentally woken
E 2pm (BF)
A 2h30
CN 4:30-5 (harder to get to sleep this time and woke up grumpy)
A 2h (bath at 6pm, BF, stories, feed-to-sleep)
BT 7pm

THEN - and here's the incredible bit - he woke just as I put him down in the cot. Dark room, looked at me so I quickly put my hand on his tummy firmly with a few light pats. He was getting more restless but clearly also trying to go to sleep (head turning away) so I removed hand and sat down next to the cot with my face slightly out of sight and kept ewan going. It took 30mins BUT NO CRYING and he fell asleep ALL BY HIMSELF!!! FOR THE FIRST TIME EVER!!!

This is a ridiculously successful day considering all we did was extend awake times and ensure feedings were consistently at 4h intervals. He's also having a small amount of baby porridge/puree (11am and 3pm) which was recommended to help the early reflux. Plus he's more than doubled his birth weight, sitting up well in high chair etc.

I can't believe it. I'm almost worried we've had success too early (that's the 'can it be true?' part of my exhaustion kicking in!) but let's see how the night goes and then try again for the same routine tomorrow!

WOOHOO.

[malibu_nikkus]

Ahhhh. Thats so wonderful. It is sooo encouraging when it just works. My guy is wmeasily stimukated too, so sitting next tomthe cot he seems to like best unless super overtired. I then roll him on his side, put my hand firmly on his shoulder.  Im so pleased to hear of this success. So, now you know, when the short naps start to creep in, its time to increase the wake time.  Enjoy your break now bub is sleeping. 

[creations]

he fell asleep ALL BY HIMSELF!!! FOR THE FIRST TIME EVER!!!

Whoop Whoop!
 

S 8:30-10 (perfect 1h30m) - took 5mins of light rocking in buggy (lying flat) and then asleep and no waking

Fabulous! 

S 12:30-2 (another 1h30m) - took less than 5mins of rocking (again lying flat in buggy) with a small waking needing rocking mainly due to being accidentally woken

Wonderful! 

Hurrah for a super day!
Well done you! And well done little man

I recommend you write this down on paper and stick up on your pin board or fridge - to remind you that it IS possible, it CAN be done and YOU and your lovely LO ARE doing it.  There are going to be times when things seem hard and it is lovely days like this which can really help to remind us that it's worth continuing with routines and sleep training even through the tough bits.

Yes - tomorrow same routine. It may work out the same and it may not.  He might cry but you will be there for him with a hand on him if or when needed, picking up for comfort if needed then down again and comfort in the cot (or pram).  Keep your aim in mind, to have hands off before he nods off - this might not be possible every nap or every day but it's the aim and you will get there if you keep going.

Ali - thanks for stopping by with great support, much appreciated xx