Do you feed at night with PUPD (for an underweight 7 mo preemie)?

[claredm]

I have an adjusted age 7 month old i.e. shes really 9 months but she was born 2 months early, so ~ 7 months.

She is naturally a good sleeper, and was doing great, with 1-2 night wakings, putting herself down for naps until an overseas trip and two illnesses.

Now, at naps, after I put her in her crib, I have to rub her back until she falls asleep (I assume this is too much of a prop as I have to do this each time).
And I'm breastfeeding to sleep at night.
Worse still she wakes every 1-2 hours at night (this has been going on for about 4 nights, before that though it was waking every 2-3 hours)
She's not sick and not teething.

I think it's time for PU/PD (I tried this in the past, but a hand to soothe was enough and it took only one day to get her 'trained').
My question is what to do about night wakings. She is the bottom 1% for weight, and continues to refuse all solids (her Dr says that is likely a premie baby related delay).
I don't think I can cut all the night feedings, but how am I consistent if I breastfeed her sometimes and not others. How does she not get a mixed message.  I had been thinking if it's been more than 3-4 hours I feed, but rouse her awake after the feed? But that doesnt solve the issue of mixed messages. Or do I wake her once to do a feed? (My previous dream feed attemps haven't been very successful - but maybe she was too sleepy and not hungry enough).
Note:
She only gets breastmilk - no forumla, and as stated above wont take solids.

She has a 3 hr awake time - 2 naps a day, which we just shifted to a few days ago (so she is a bit OT at the end of the day sometimes).
I BF her 30 mins after each nap, and a top up 30 mins before nap.


Thanks

[Katet]

At that age I'd do PUPd for the fist wake up and then feed any other WU... the fist sleep kept extending so the fist feed got later and subsequent feeds dropped off. That way I didn't feel like it was mixed messages

[becj86]

First off, PUPD can burn a LOT of calories, so I'd probably not do it with your LO, TBH.

Do you mind posting your EASY? Please include her NWs, as patterns there can help work out how the routine may be tweaked.

I had been thinking if it's been more than 3-4 hours I feed, but rouse her awake after the feed?

No, I'd just feed, burp and put her down - its night time.

Any medical issues she's dealing with?

She is naturally a good sleeper, and was doing great, with 1-2 night wakings, putting herself down for naps until an overseas trip and two illnesses.

This suggests to me that she *can* do this - she has the skills. There's some other reason she's not. It may be that things have changed too much recently and she just needs the reassurance that you're there and some consistency in her routine through the day and she'll settle back into a reasonable sleep pattern. I would think that using whatever method you used for sleep training initially is what you should use this time also.

Its absolutely reasonable that she would need feeds at night still if she's not taking any solids, so please don't just stop feeding at night. Keep talking with your doctor re: introducing solids, its important to get some solids in for oral development as I understand it.

how am I consistent if I breastfeed her sometimes and not others. How does she not get a mixed message.

Tracy's advice was to either feed immediately or do what you do to settle her until she falls asleep (don't stop and feed) - then even if she's been asleep only 2mins, feed when she wakes again.

It sounds like lots of things changed 4 nights ago - changed to 3hr A times and 2 naps; her night wakings changed too. Lets have a look at the EAS and see what's happening.

[*Ali*]

Personally at this age and with weight issues I'd just feed her when she wakes at night. I'd try to get as many calories into her as possible to help her growth catch up. I certainly wouldn't use pupd as it can involve lots of crying and wasted energy.

How many BFs is she having in the day?

[claredm]

Hi everyone

Thanks for all the input.

No medical issues aside from being small because she was 2 months early. She was in the NICU a month, but no problems since discharge.
We are working on the solids - (offering puree and finger foods each day) but she isn't a fan and so currently isn't really getting any calories that way. I've consulted with a pediatric feeding therapist, who has suggested a few things to try.

The Dr isn't worried about her weight, because despite being small she is maintaining her own growth curve. But yes I agree, I don't yet feel comfortable not feeding at night. She definitely takes a good portion of her of milk then.

I put an EASY below. I'm not very scheduled on the feeds - I offer at least twice during every awake time (more if she's fussy). She definitely is good at telling me if she doesnt want it or is hungry.
I'm ok with an wake up after 5am, but .... Today's 4.40am was a bit too much.

If I don't do PU/PD, do I just try to resettle her to sleep in her crib without picking her up? The bed time is the issue, as I used to BF her to sleep, and want to curb that.

Yesterday's EASY
5.20am awake and BF (she wasn't hungry so didn't take much)
7am BF
8.15am (Top up feed)
8.30-10.30 NAP (we follow the feed with stories, then into crib)
10.45 BF
12 - (offer solids, nothing swallowed)
1.15 (Top up feed)
1.30-2.45 NAP
3.15pm BF
4pm (offer solids, nothing swallowed)
5pm BF
5.30 (Top up feed)
6.00 Crib
6.45PM ASLEEP (She was OT and had trouble going down)
9.20pm wake + BF
12.15pm wake + BF
2.30am wake + BF (This feed she didn't take much, and perhaps I could work towards not feeding at this feed).
4.40am wake + BF (UP for the day)

Thanks for all the input!

[*Ali*]

Shush pat is normally the first port of call for resettling. Have you tried that?

[becj86]

1.30-2.45 NAP

Not sure if this is helpful, but this is likely a slightly UT nap if she's waking on her own, so if you were to increase the A time before the second nap just a tad, say 10-15min, you might get a longer nap and a shorter A to bedtime.

[claredm]

I will try to extend the awake time for the nap.

Last night she fell asleep at 5.45pm and then woke at 7pm, 9pm, 11pm, 1am and 4am

I'm working, and have a job requiring a high attention to detail, so this little sleep is a real problem

I'll try the shush pat to resettle

[claredm]

Just to update you.

I cut breastfeeding to sleep at bedtime, and instead rubbed her back/hand for presence. First night it took 1.5 hours, 2nd night 30 minutes, 3rd night 10 minutes. So we are getting there. An added bonus, is she now goes down easily for naps (placed into crib, and i just walk out).

I followed advice to try and resettle without feeding for the first waking (normally 1-2 hours after bedtime), and that seems to have helped. Last night she only woke twice (I BF both times) vs every 1-2 hours.

I extended the awake time to 3hrs15mins for all naps, and that has helped. She slept 2.5 hrs this morning.

We are working on the solids.

Thanks for all the help.

[becj86]

Thanks for the update, glad things are looking better, hopefully the improvement continues