Struggling with naps

[Tammy2402]

My son will be 3 months in a few days. We have been basically following the easy schedule for since he was 3 weeks with some modifications if needed. He has always struggled with naps. I put him down after play when he starts to show signs of sleepiness which is usually after 60 to 90 minutes of wake time. He goes down slightly awake and usually falls asleep on own. He tends to sleep anywhere bt 20 and 45 mins before waking and crying. At that point he will occasionally return to sleep with some help but often needs to be held. Then by the time he falls asleep he only has a few minutes till it's time to eat. I'm torn as to whether to let him sleep longer increasing the time between feeds or wake him even tho he had a very short nap. He has reflux and spits up a lot too which I assume is most of the reason he wakes up and can't return to sleep quickly. Any suggestions or advice would be appreciated.

[creations]

Hello and welcome to BW forums

At 3 months we'd expect the A time (activity, so time awake including feeding, nappy change, anything that is not sleep) to be around 1hr 20 to 1hr 30 so it looks like sometimes your LO gets this amount but other times he doesn't. You might have more success with naps if you watch the clock a little more and aim for the 1hr 30 A time between each sleep.

Reflux can be terrible for disturbing sleep though so even on a perfect A time LO can still wake because the acid is coming up, it's more uncomfortable to be lying down and can wake them when they need more sleep.  If your LO is not medicated for this you might consider seeing the doc to discuss trying some medication to see if it helps as it seems you've been struggling with short naps for a long time now.  Other things which may help are using a cot safe wedge or cot blocks to make an incline to sleep on.

If he falls back to sleep I would let him have a good sleep, he will wake when he is ready and/or when he is hungry enough to wake for food.

hope this helps, please feel free to ask more questions or for clarification.

[Tammy2402]

Thank you, Yes that helps. He is on medication which helps his symptoms but he still spits up during naps which wakes him. Another question, he sometimes does get a good nap going after being up for 1.5 hrs, If this happens should we wake him to feed him after the 1.5 hr mark (making it a 3 hour cycle) or let him wake on his own?

[creations]

If your LO's reflux is medicated then I would expect the spitting up during naps to have stopped so he can get a proper sleep.  What medication and dose is he on?
If he is often getting short naps and then manages a longer one, personally I would let him nap for as long as he needed. He must be quite tired if his naps are disturbed from reflux spitting waking him. I would just be ready to feed as soon as he wakes.  Babies are generally good at knowing their own needs and if he gives priority to sleep for one or two naps then it's because he needs the sleep more than the food at that point.  Some LOs manage longer than 3hrs between E from a much younger age, and some don't, if your LO can go that bit longer so he can sleep then don't worry.
If your EASY cycles go off track (which often they do anyway) towards the end of the day do the feed when it is due or when he wakes and then do another at BT even if it has not been 3hrs between E.  This is what I always did and I think everyone here does, always a BT milk feed regardless of when the last milk feed was (even if it's only an hour).

[Tammy2402]

He is on zantac 2 ml a day. From what I have been told meds only help the symptoms it doesn't stop the spit up

[creations]

What's your LOs weight please?  I'm going to ask someone to check this out for you.
Are you breast or bottle feeding?

From what I know the meds really ought to settle him enough so that he isn't spitting up mid nap and effecting his sleep so much.  You might perhaps need a different dose or maybe a different formula (for reflux) or a formula thickener if you are bottle feeding. My DS also had ranitidine (same as zantac) and in addition a carobel thickener for his milk, this type of thickener can also be prepared for babies who are breast fed and it is given mid BF and again at the end of the BF. I am sure there is something that can help your LO be less disturbed by the reflux.

[Tammy2402]

He was 10.5 lbs a few days ago. I just went back to work so he currently gets breastmilk bottles most of the day and I nurse when I can. We Did a trial of hypoallergenic formula to see if it was an allergy but it didn't help. We also tried thickening with cereal but he just spit that up too which made more of a mess.

[creations]

We also tried thickening with cereal

Perhaps you can look into the carobel thickener which will work for bottle or breast feeding rather than the cereal?

I'm asked our lovely Laura (lolly) to stop by as she is so knowledgeable on reflux.  Hang in there.

[Lolly]

Hello! Ok, so at 10.5 lbs he's 4.7kg, the normal dosing range for ranitidine is 1-3mg per kg so a 1ml dose is top dose for is age. Some Drs will prescribe the max three times per day. If you don't think the ranitidine is helping he may need a different class of drug to stop acid production.

Is he getting the whole dose? Ranitidine is disgusting stuff, I have some tips to get it all in if you  are struggling. I agree with Creations that a thickener may be useful, cereal is a bit of an out dated way to thicken now and could cause digestive issues itself so a medical thickener like the Carobel would be better.

Have you got the cot elevated? My babies had wedges in their cots so they weren't sleeping flat, there are things you can do with towels under sheets to keep them from slipping or rolling around the cot.

HTH - if you want to know the tips for meds and sleeping just say!

Laura

[Tammy2402]

Hi, thanks for the response! yes he sometimes spits the medicine out. I thought the dosage was 5 to 10 mg per kg? But anyway tips to give it to him would help. His bassinet is elevated at a 30 degree angle we actually have him harnessed in it so he doesn't slide but we would like him to get into his crib at some point so tips for sleeping are greatly appreciated.

[creations]

Hi, sorry you've been waiting a couple of days.
I'm afraid I have no tips about how to get the meds in or to stop them being spat out as my DS just took his no problem (I didn't realise until he was much older just how bad that stuff tastes but he's never complained!!).
I'm sure Laura will be able to help you out.

[Lolly]

Sorry to not come back sooner!

For the meds if you haven't got one, you need a 1ml syringe. They are really thin so much easier to get in their mouths. We laid them on the floor and using the thin syringe get it in their mouths as far to one side and as far in as possible.Then we squirted a tiny bit at a time in and let them swallow before giving the next tiny bit. It does take a while at first, but if you don't put too much in at one time they can't spit it back out. Also getting to the side helps to bypass some taste buds I think. Wiping their face with a damp cloth between squirts helps to swallow too. We found that it only took a week or so for them to get used to the taste and then they would take the whole dose in one squirt.

Check the strength of your syrup - the most usual strength is 150mg per 10ml. The dose range is 2 -4 mg per kg x 2 per day, the bigger dose you mentioned may be the total amount per kg in 24 hours, split into divided doses. Many Drs will only prescribe 1-3mg per kg x 2 per day for under 6 months. Ranitidine is very weight sensitive and needs adjusting frequently, my two both needed the full 4mg per kg for it to have any impact. DS was on 4mg x 3 per day at one point.

For the cot, we used a wedge under he mattress and they slept on a wedge too. We used rolled towels under the sheet in a U shape so it was like a nest. They laid in the U part so it went from armpit to armpit and stopped them sliding or rolling off the wedge. I had a fitted sheet first, the role towels and then a flat sheet tucked under the mattress and over the towels to keep them in place. A rolled towel under their bums can work too so its like a ledge that stops them sliding down.

HTH and makes sense!

Laura

[Tammy2402]

Thank you for you response. Since I last wrote, we have changed medications to Prevacid. It has seemed to help with his reflux however we are still struggling with nap times. He continues to wake up 30-45 minutes after being put down. He goes down slightly awake and does great falling asleep initially. We have been attempting the sush pat method and it worked a few times however most of the times his cries escalate to screams and he needs held. 90% of the time if we hold him he falls back to sleep, so I assume he still needs the rest. There have been a few times where he does not calm down even with holding and rocking. So then I think is he hungry? even though he ate less than 3 hours ago? 

So my questions are how do I help him nap longer and how do I know if he is crying bc hes overtired or bc hes hungry?

[creations]

Could you post a recent days EAS times please? If you don't have them recorded you can spend a couple of days recording them and then post.  If you can use a format like this we find it helpful:
WU (wake up) 7
E 7
A 1hr 30
S 8.30 - 9.00 tried to resettle with shush/pat until 9.30
E 10
A 1hr 30
S 10.30 -
... and so on through the day. Then include:
BT (bed time)
DF (dream feed)
NF (night feeds)
NW (night waking which is not for food)
..up to the next WU time

If it is less than 3hrs since the last E time you will need to judge if he wants food because it is helping with discomfort of reflux or if he has used up a lot of calories from crying very hard (maybe when you were trying to resettle the nap) or if he is not really hungry.  it's okay to feed a little early if he needs but perhaps don't always automatically think it is hunger...it is also okay for him to be awake and not eat until his E time if he is not hungry until then. This means your EASY might be more like EASAEAS which is fine.

You can also try W2S (wake to sleep), here's a link:
https://babywhispererforums.com/index.php?topic=223809.0
have a look at  naps option 1.  It doesn't work if your LO is UT (under tired) but can be helpful to teach LO to sleep longer and how to transition from one cycle to another if the activity time is suitable.

hope this helps

[Tammy2402]

Well one of the issues we are having Is not having a consistent wake up time. We follow EAS from the time he gets up but it's not the same time everyday. He doesn't consistently sleep the same at night (sometimes 4 sometimes 6 hours between feeding) And bc he has to take his medicine 30 mins before he eats on an empty stomach in the am.. his wake up time varies bc it's dependent on when he has his night feeding. For example last night he ate at 430 so we couldn't give his meds until 730 at the earliest but the night before he slept until 6 am so we gave his meds then. Does that make sense?

[creations]

Yes that makes sense. Lots of young babies have irregular WU times in the morning too, and sometimes it's best to let them have that and alter the day accordingly, for some people they prefer to set the WU time to make each day more predictable.  Either is okay so long as it works for you and LO.

Could you just record what happens for 2 -3 days and post the times?  It doesn't matter that each day is different, just record whatever happens and I will have a look over those 3 days and how they relate to one another.

[Tammy2402]

Yes I will do that and get back to you in a few days! Thank you for your help!

[Tammy2402]

So this is what it looked like from Friday to Sunday.
Friday
4:20 Nighttime wake and feed
7:40 Wake take meds (need to wait 30 minutes prior to eating)
8:15 feed
10:00 fell asleep in car seat work up at 10:37, picked up swaddled put down in rock n play (sleeps in this due to incline for reflux) began crying at 10:45 attempted to rock/shh the rock n play (rocking instead of patting because of the position he is in in the rock n play) for 10 minutes however cries escalated so picked up and patted/rocked until asleep then back down at 11:23 however cried again shortly after
11:30 feed
1:00 down for nap awake but drowsy
1:29 woke up, rocked in rock in paly for 10 minutes back to sleep for 5 mins, began rocking again for 15 mins
2:45 feed
4:55 down for nap woke up at 5:20 attempted rock and shh however cried an needed held from 5:43 to 5:48 back down and awoke at 6:10
6:15 feed followed by bedtime routine
7:30 bedtime
10:15 modified dream feed

Sat
2:50 am nightime wake- feed
6:45 woke on own, gave meds
7:20 feed
8:51  nap
10:30 feed
12:00 nap, 12:43 woke up, rocked and shh without picking up for 15 mins
1:50 woke and feed
3:15 nap, 3:45 woke up, shh and rocked for 15 minutes in and out of sleep needed rocked in rock n play until next feeding
4:50 feed
6:05 fell asleep in car seat, 6:20 taken out, swaddled and put down for nap
8:00 woke him up for feeding followed by bedtime routine
9:00 bed
11:00 dream feed

Sunday
6:10 he woke on own, gave meds
6:40 feed
8:00 nap
9:40 feed
11:30 fell asleep in car seat, moved to rock n play for nap
1:30 feed
2:55 nap 3:40 woke and needed rocked in rock n play until 4:15
4:45 feed
6:30 nap 7:10 work and rocked in rock n play for 15 mins
8:05 woke him up for feeding followed by bedtime routine
8:45 bed
11:30 fed

Sorry if that is confusing or too much info.
We try to keep him in the rock n play if he wakes in the middle of a nap and just rock it until he calms and then leave. We almost always put him down awake but falling asleep/drowsy. time between feeding and naps are activity times with play and engagement. His naps seem to be getting slightly better with not always having to go in to calm him (sometimes he is waking and putting himself back to sleep) but we still have trouble with about half of the naps. I would also like to get on a consistent bed and wake up time but I am having a hard time doing that when I have to give his meds 30 minutes before he can eat in the am.  Any advice would be appreciated!

Thanks!

[creations]

From what I can see the A times are quite variable from as little as 1hr 25 to more than 2hrs.  Could you watch the clock over the next few days and aim to have him asleep at 1hr 40 A time. So time it from when he wakes and start your normal wind down with the aim of him nodding of for nap 1hr 40min later.
Lets see if that helps at all.

With the morning WU, I would think that if he has a feed in the night and it hasn't been quite the 3 hrs you would still be ok to give his morning meds on WU, if it was say 2hrs after the feed.  it look like you are mostly ok giving the meds in the morning anyway as the last night feed is more than 3hrs.  It's ok that you need to wait 30 min before the milk feed, still count the A time from when he woke not from shen he ate or finished eating, hope that makes sense.  LOs can often stretch a little more than the 3hrs when they are asleep so it shouldn't effect the day too  much.
Mine wouldn't eat when he first woke up anyway, always had to leave it 30-60 min before he'd take a proper feed or he'd just spit the bottle out and push it away or clamp his mouth shut!