Help to get back in the EASY track

[fim105]

Hi all
I have posted other threads about naps and GERD but I need some help with easy. I recently transitioned my now 6 month old into 4 hour easy but we have lost our way and I'm not sure how to get back. His naps are pretty non existent in the day now and he is becoming more unsettled at night. I am trying to introduce solids too but with his disrupted naps and activity times find it hard to fit it all in.  Everyday seems to be different but today EASY was as follows ( we still smdo one feed at 4 am)
A 7:30
E 8:15?(didn't want bottle at 7:30)
A8:45 inc solids
S 10:00 ( slept til 10:35 then ssh/pat and pu/ps til 11 slept fir ten minute
Y
A 11:10
E12:00
A 12:30
S: 15:00
A 15:40
E 16:00
A 16:15
Bed 6:45 inc bath and bottle
Stirred at 1:30 and 2:30 am patted back to sleep
E 4:18

As you can see we are all over the place!!i need help with where to start and if activity times are too long or short. He has started going down for naps on his own and self soothing but will wake after anything from 15-30 mins then it's a battle with shh/pat to get him to sleep any longer.

Any advice would be gratefully received. May aims are for a better routine to help with longer naps and less night stirrings.

[creations]

Hi there
Is the reflux under control now?  What meds is your LO on and have you had the dose checked?
The naps really are short, do you ever try W2S?  Have you tried it in the past?
The second activity time in your EAS is super long 11.10am - 3pm, almost 4hrs which is particularly long for this age. If you see 15-30 min naps after a very long A time like this then it is likely to be cause by OT.  In your sample he actually slept 40 mins though which is one full cycle which indicates to me inability to transition between sleep cycles for some reason. The reason could be OT or pain possibly, or it could be he hasn't yet learned to transition and needs help learning, or an external noise or temperature waking him - numerous possibilities really.

I would suggest moving directly to an A time of 3hrs, using W2S or resettling naps if they are short and trying to get LO to sleep at least one good nap in the day. If you don't have the time/energy/patience to resettle both naps aim for the same nap every day as this builds a habit on that nap.  Once one nap is in place you will be able to focus on the other.

hope this helps

[fim105]

Thanks for replying creations. His reflux is more under control on ranitidine and we have switched to goats milk. He is on 2.5 ml of ranitidine. He's been on this for two weeks.
I've never tried wake to sleep, I have always ssh/patted but I will try this and starting in 3 hour activities.
Last night he woke 2-3:30 and then slept through to 6 when I fed him I put him back down after expecting him to sleep for 30 mins but he sleuth through til 9 now all over the place again.
Should I wake him in the future? He's just fine doen with a cough and cold so I felt he needed the sleep?
In the night he often stirs and can go back to sleep on his own so I think he can transition between cycles?and he has started self soothing for naps but like I said can't stay asleep. I'll try 3 hr activity times from tomorrow and let you know how I go

[creations]

I am not all that familiar with various allergies or infant milk formulas but if your LO is intolerant or has an allergy to cows milk protein then the goat milk formula is not likely to be a suitable substitute - have you discussed this with your paediatrician?  It's just that I see on the NHS (UK) website that goats milk formula is not suitable for LOs with a cows milk protein allergy.
With the naps being so difficult and so short I do wonder if there is still discomfort - do you feel the reflux or any allergy is under control fully?

Here's info on W2S, see naps option 1 as you do not actually wake baby up.
https://babywhispererforums.com/index.php?topic=223809.0
It's worth a try for a few days.

Should I wake him in the future? He's just fine doen with a cough and cold so I felt he needed the sleep?

Sometimes the day is thrown off by a late wake up but if LO is poorly and you feel he needs the sleep then I'd probably let him sleep and prepare yourself for whatever happens next, expecting the day to be off track.  If it was a regular thing waking late in the morning I'd suggest looking again at routine and perhaps deciding on a morning WU time to get things more consistent.

In the night he often stirs and can go back to sleep on his own so I think he can transition between cycles?

night sleep is a different skill to day sleep so although it's a step in the right direction being able to transition between cycles at night is not the same as learning to do so in the day.  W2S is one method of teaching him this skill and habit to stay asleep.

I do think though that perhaps another chat with the doc/paedi might be needed.

How many doses of ranitidine per day is he having?
What's his weight now?

[fim105]

Hi thanks for replying. I think the reason for the switch was the lower lactose content but I'll certainly discuss with dr we are awaiting allergy testing. He is on two doses a day 2.5 mg and his weight two weeks ago was 18.2 but I'll get him weighed agsin tomorrow. I do think he's reflux is better but not 10o%.
I didn't know that about sleep and naps so that makes sense that he can't settle himself so I'll try w2s and the longer activity times.
Last night he slept through in two 30 min naps til 4 am but then would t go back til sleep til 6-7:30 💤

[creations]

Thanks for the info. I've just asked for someone to check over the dose for me/us on that.

Are you in the UK?  Was your LO seen by a paediatrician?
When is the allergy testing expected, do you have a date or on a waiting list?

The reason I keep asking about meds and milk etc is that it sounds to me like your LO is still having some discomfort causing sleep problems. He is sleeping very little indeed and there may be nothing you can do about that until his reflux is totally controlled. You can try to help him sleep of course but I would keep expectations low for now and stay open to the possibility that his routine may not get fully on-track until other issues are fully resolved.
For now try the W2S as we've said, it's worth a try, and if you can get *any* additional sleep for him then that's also worth it - in arms if necessary. I know it's not the goal but he must be a very tired boy with only two 30 min naps.

[Buntybear]

H there it is unusual for a 6 monthly to be on goats milk formula I think. It is not something I have come across although I EBF through our allergies so I am no expert. Normally there would be a switch to a soy milk (although not ideal if there is a protein allergy as the protein in soy are similar to those is cow/goat milk) or a comfort milk (aptamil pepti) or even hypo allergenic milk like Nutramigen. xx

[Martini~]

Here for suspected allergy for milk protein they would prescribe bebilon pepti or nutramigen.

[fim105]

Thank you all so much for your support, I am based in the U.K. I think you are right about the GERD today it has been awful and he's been in a lot of pain. I have only seen my gp about it who would refer me to paediatrician I think as it's been so long. We are on the waiting list for allergy testing which I think could take some time. I was going to call my gp tomorrow after I've had him weighed to discuss dose of ranitidine and I could discuss different milks as clearly the goats milk is not working. There are lots of food allergies in my husbands side including my husband which is why we are also pushing for this test.
I feel so sad for him as he desperately tries to be happy through the pain and discomfort. I am lucky he sleeps at all at night 
I did try w2s today which he did wake on but went back to sleep for another 30 mins. He only sleeps for 30 mins max in pram or car seat so he is a tired chap.

[Buntybear]

I think you would know if it was a true cows milk allergy so I would suspect a milk protein intolerance TBH. By cutting the proteins it may well help with the reflux too. Se what the GP says about milk. x

[creations]

I would ask for a referral to the paedi in addition to discussing things with your GP.  They have to refer you if you ask for it, then you are at least on the waiting list (which might be a long wait). If it turns out LO is much better as the appointment approaches you can always cancel it a week or so before and someone will be happy to take a cancellation slot.
My LO was fine with ranitidine and a milk thickener (cow and gate "carobel" ours was on prescription which was added to regular formula) but I've seen some LOs on the boards need other meds, maybe omeprazole?

I would imagine that by night time he is totally exhausted which is perhaps why he zonks out and gets a better sleep.

[Lolly]

Can I just ask you to check the strength of the ranitidine syrup please? The normal strength is 150mg per 100ml but I have known people have different strengths. It helps us know if the dose is appropriate as a 2.5ml dose for a 18lb baby is more than would normally be prescribed. 2.5ml is top dose (4mg per kg if the syrup is 150mg per 100ml) for a 9.5kg baby and 18lb is only 8.2kg.

Is the Goat's milk formula on prescription or just suggested by the Dr? If Cow's milk issues are suspected, as PP has said it's not suggested to use goat's milk or soy as the proteins are very similar so will cause the same issues. If the Dr thinks lactose is the issue (and it's rare but does happen in babies) then there are lactose free formulas which would be better or the comfort formulas are considerably lower in lactose than standard formula. Either way, it does sound like you would be better trying one of the hypoallergenic formulas rather than a cow's milk/ goat's milk based one.

Hugs - reflux is so tough.

Laura

[fim105]

Thanks for the response the dose is 150mg per 10 ml??the gp did say to up the dose to 5 MLS twice a day after two weeks if there was no effect? But Lolly if your suggesting that 2.5 ml is high then I would be over dosing him. The goats milk was a suggestion to try im not sure really why now but I will discuss with gp and request paediatrician letter, he did offer this last time but I thought things were settling. When you say comfort formulas do you mean the milks for reflux orcolc that can be bought over the counter? We are still using gaviscon too?

[Lolly]

Sorry - posted after a glass of wine last night Yes, 150mg per 10ml!

The 2.5ml dose is giving 37.5mg of the drug. Please, DO NOT give your baby the 5ml dose as this would be 75mg of the drug in each dose. This would be the top dose x 2 per day for a 19kg baby (42 lbs!!). Please see the Dr and get the dose checked ASAP, the max they should be prescribing is 4mg per kg - that can be given x3 per day but it would still be less than 5ml x 2 per day. A pharmacist would be able to check the dose too. I would ask to see a different Dr if that's possible (but that's just me ).

The comfort formulas are often called "Easy Digest", the reflux formulas are different again but you could try either - ask your Health Visitor before changing formula again though. The Easy digest are thicker than normal but not as thick as the reflux formulas. My two were both on Emfamil AR which we had on prescription but you can buy it, it was a bit thicker in the bottle but thickened further in the stomach to stop the reflux. I had previously tried an Easy digest  formula with both which helped for a little while. If you are using a thickened formula you won't need the gaviscon.

Laura

[creations]

If it was me I'd go to the pharmacist as soon as possible (like tomorrow morning) and ask for the dose check, you just ask to speak with the pharmacist and they are very helpful and often have more time to work things out too.  And of course go ahead with the referral but that will take longer.
My DS's GP also got his dose wrong, for us it was too low a dose (as he had gained weight and was older) and the GP was insisting it was the highest he could have for his weight and my DS was suffering and I was stumped about his poor sleep. It was ladies here who repeatedly told me what he really should be on - I then telephoned his paedi's receptionist and said I didn't need an appointment if the paedi was able to check and agree a new dose which they did the same day and called me back. The ladies here had been spot on and I knew I had the paedi's go ahead to increase to an appropriate dose immediately.
GPs are human and can make mistakes as any of us can. But it doesn't mean you have to accept the GPs word as final.