Gradual withdrawal and naps

[sosleepdeprived]

I am new to this site so apologies if my question has already been answered somewhere else! (I had a look but couldn't find it)

We've started using the gradual retreat method two nights ago with our 11 month old boy. He's been having sleep issues since month one due to reflux and multiple allergies (napping for only 20mins at a time and waking up every hour or so at night). Although we're still trying to get reflux and allergies under control I'm so exhausted that I've decided to try and sleep train him again but with a more gentle approach (I've tried CC a couple of months ago but didn't work and I don't want to go through it again).

I know that his bad sleeping is due to being overtired (at least partially). However there is nothing in the world that I can do to make him sleep longer! He won't take a dummy, won't sleep in a pram/car and even if I let him sleep while nursing he'll still wake up after 20mins and won't be able to go back to sleep!

I know what I need to do at night but I'm a bit confused with naps. I've read somewhere that you should let the baby go to sleep by themselves twice for an hour and if they can't then help them so that they get two decent naps a day. Well, yesterday we failed! I gave him an hour break and even though he was exhausted he didn't fall asleep. So after the second attempt i resorted to breastfeeding and when he was drowsy I put him in his cot and patted his back untill he fell asleep.

He slept for 40mins. Knowing that he is tired and really trying to avoid him getting OT (he then can keep waking up every 30mins at night) I used the same old method for the last nap of the day - which lasted only 18mins. Needless to say he was cranky the whole evening.

Am I doing the nap thing right? Is there anything else I could do to make sure he doesn't get so OT before bedtime?

Any advice would be greatly appreciated as I'm at my wits end and seriously need more sleep (and so does the little boy!).

[becj86]

Hi, welcome to BW

As I'm sure you're aware, there a likely a few things contributing to your LO's poor sleep:
1. reflux - lying down HURTS! that makes sleeping tricky.
2. CC - having tried this may have damaged his bond of trust with you, so he may not feel safe going to sleep, may feel scared in his bed, etc. Its important to help him see its a safe place by spending some happy awake time with him in his bed creating some pleasant associations.
3. Routine not quite right for him.

I think to be really honest, its going to be hard to get him sleeping independently lying flat in a cot without getting his reflux properly under control. Sometimes, eczema and other itchy skin conditions go along with this - anything like that happening for him? Any other medical issues we need to take into account? Is he gaining weight, growing and meeting milestones ok? This FAQ has some tips for helping a LO who is suffering with reflux: https://babywhispererforums.com/index.php?topic=654.0

I don't quite understand what you've written about what you're trying for naps. What I'd suggest is that you're heading for one nap in the next 2-12 months, so you probably want to *aim* for at least one long nap in a given day.

Its hard to know how to change a non-existent routine, so I'd start something like this and stick to it for a week, then we can try to tweak things if we have enough information:
7 - wake
11 - nap (ideally this one is long - ie. 1.5hr though I know that sounds like a pipe dream at the moment)
3:30/4pm - nap (generally this one would be shorter)
7:30 - bedtime

One of the hardest traps to avoid here is to keep trying to get him to sleep so he won't be OT. He already is really chronically OT by the sounds of it. If you can keep his routine reasonably consistent, he has a better chance to self-regulate and take the sleep he needs. If things are changing all the time, he can't do that.

Is there any way that he will sleep reliably? It doesn't sound like it, but if there is, please use that (never mind if its a prop) until his reflux is controlled enough for him to sleep comfortably. If that means BF to sleep, do that. The most important thing now is to get sleep into him in a suitable pattern so he can get used to sleeping at regular times for a decent amount of time and that will eventually recover him from the OT. 
In terms of how to calm him to sleep, I'd go with shush/pat or find a variation he will tolerate. This might be stroking his face and singing or holding a hand on his chest and saying your sleepy phrase over and over or playing white noise.
Start using a wind down routine - can be really short if he's not a fan but just go through the same process before sleep each time so he's learning that sleep time is coming.

What are you doing through the night? How does he sleep at night at the moment?

[sosleepdeprived]

Hi, thank you for getting back to me I really appreciate it!

He has no eczema - he gets delayed reactions to allergens so he keeps vomiting really badly if he eats something he's allergic to. He is currently on medication for his reflux but I don't think they work they way they should. We are awaiting pH probe test to see how bad his reflux is but I'm not sure when we are going to get an appointment.

He currently wakes up between 5/6am - even if I do manage to get him back to sleep at 5 it will only be for a max 30mins. He is tired 1.5hr after he wakes up (irrespective of whether it is before his first nap or after any other nap). I do manage to keep him up for up to 2-2.5hrs but anything after that he gets seriously OT and grumpy.

Should I therefore schedule his naps like suggested below and hope that his body clock will eventually adjust to the rings and he will be able to sleep better and won't get OT or should I move them forward to let's say 8am and then13/14?

In terms of his sleeping there is nothing I can do to get him sleep longer. I can't even get him back to sleep once he wakes up despite him then crying and screaming that he's tired and he won't play - just throws his toys around and keeps pulling his ears. I don't know what to do anymore!

At night he often wakes up anything between 20min and 3hrs. Some nights hell wake up 4 times only others 10! I do try to resettle him in his bed but this never works. Rocking won't work either and I need to bf him. My husband has some.luck sometimes but quite often the little one won't stop crying unless I bf and he can go on for over an hour - my husband can't keep doing this all night as he needs to sleep.

We do have a wind down routine before naps and bedtime but it never really calms him down - he is such an active and alert baby. It is there to just prepare him for sleep but it won't make him slow down.

[becj86]

I'd make the naps say 10 and 2:30 with WU at ~6 and a BT at 6:30. I think they need to be far enough apart that he can at least be tired enough to sleep a proper nap.

Really, I know he's very OT but putting him down for sleep so soon after he wakes in the morning isn't helping - it compromises the quality of the sleep he gets early in the morning too (it does, even for a baby without reflux, etc.).

re: pulling his ears - has the doctor had a look in them? That can be related to middle ear infections which could be an issue if he's refluxing up into his mouth while he's lying down.

I do try to resettle him in his bed but this never works. Rocking won't work either and I need to bf him.

Yeah, this sounds very typical of reflux - he needs the milk to soothe the burn. Does he have a dummy?

It may well be worth checking whether he can have a more effective medication, checking the dosage, etc. Dosage is weight-dependent, so as he gains weight, he'll needs more meds. I can recommend a routine but honestly, I don't think his sleep is going to get a whole lot better until his reflux-associated pain is under control.

Does he sleep sitting upright-ish, say in a pram? Have you tried a carrier or sling so he can sleep on you but you're still able to do things?

[sosleepdeprived]

 Hi,

I've been trying to get him on the routine with naps at 10am and 2pm (give or take40mins) and bed time at 7.30 for a week now. I do realise that it's probably a bit too early to see great improvement but in fact he is starting to behave worse than before.

He is constantly tired, pulling his clothes/hair/ears all day long (I had his ears checked over a week ago and all clear). He is constantly grabbing my breasts - his ways of telling me it's nap time. He is very moody and goes through stages of being very hyperactive to crying all the time and throwing toys around. When he wakes up from a nap I can see that he is still tired but I can't get him back to sleep. It then takes him about 30 - 60mins to calm down.

I can't tell that his naps have improved. As a matter of fact they are very random - sometimes he will nap for 50mins other times for 20 and there is no real correlation. I am really struggling to keep him awake and active for more than 3hr but I'm trying so that he gets used to the routine.

His bedtime has also gotten a lot worse. Although before we got to the point where we could put him in his bed drowsy and he would roll around for 30mins and finally fall asleep, it is a complete diaster now. He keeps crying and crying and wont calm down. It feels like we are back to night 1 of gradual withdrawal.

In terms of your other questions, I've tried baby carrier and I've been using it since his birth really but he fell asleep in it only a couple of times and again for roughly 20mins. He doesn't sleep in pram or car.

I've tried introducing a dummy several times but he hates them all and uses them more like teethers than soothers.

I will still carry on with the routine hoping that it will get better soon but it is so heartbreaking to see him so constantly tired and not being able to do anything about it.

[becj86]

Can you ask for a trial of reflux medication while you await the testing?

The 20min sleeps are usually pain. 50mins will be UT. I think +/- 40mins may be a bit too much of a leeway to see much difference.

[sosleepdeprived]

He is on reflux medication, in fact he's been given stronger medication and dosage to see if it's reflux related but no change. He is on the new meds for over 2 months now. My understanding is that there are no other medications that he can be prescribed - the only alternative at this point would be an operation.

[becj86]

And the dosage has increased as he gains weight?

I've asked a for another set of eyes in case someone else can think of other things you could try. I'm not sure how active it is, but perhaps you could post for some reflux-specific experience on the colic, reflux and crying board: https://babywhispererforums.com/index.php?board=13.0 There are mums around here who've had LOs with awful reflux and they may be able to give you some ideas of ways to help him sleep - things that worked for their babies.

[Lolly]

Hugs - I've had 2 refluxers, neither as bad as some of the kids here but sleep was an issue for my first.

Can you tell us what medication he is on, what his weight is and what the current dose is?

How are feeds? Is he bottle or breast fed?

Laura

[sosleepdeprived]

Hi Laura,

Two refluxers! I feel your pain - one is more than enough to deal with!!

He is currently taking omeprazole 10mg once a day and domperidone 1.5ml three times a day. His current weight is 9.7kg.

LO, for the past two months, going through a phase of not eating any veggies or meat. He is also very reluctant to try new things so feeding him in a nightmare. I guess this could partly because a reason why he is demanding to breastfeed so often during the day although I do try to limit it as I don't want to create another vicious circle.

How did you deal with your LO's sleeping issues? And how long did they go on for?

Also I don't know whether this has something to do with DS's reflux or whether it's his way of calming himself burt when I put him to bed he increasingly bums his head against the mattress and/or turns it from side to side (lying on his tummy). Last night he's been doing it for over 40mins at 4am and eventually started crying. Is this normal?

[Lolly]

I just had a look at the Crying over Spilt Milk site which is an excellent resource so I have a few questions!

Is the omeprazole the suspension form? If it is, are you shaking it well, giving it with breakfast and getting a new bottle every week or so?
https://www.cryingoverspiltmilk.co.nz/wp-content/uploads/2015/02/Omeprazole-suspension.pdf

At nearly 10kg the low dose range is 7-15ml of the suspension so there's plenty of scope for the Dr to increase his dose. Babies metabolise omeprazole faster than adults so do better on a split dose, but each dose needs to be high enough to be effective on it's own. I would imagine that 10mg twice daily would be a better dose but the Dr needs to sort that for you.

Are you dairy free or have you tried going dairy free at all?

Have you got his cot tilted or have you got him sleeping on a wedge? If not thats an easy thing to start and can make a difference. We used rolled towels under the sheet to make a U shaped nest to stop them rolling off the wedge which worked really well.

Feeding issues are common with refluxers, my son was awful at this age and started his slide down the centiles - I'm convinced it was because we never managed to control his reflux properly. If they are in pain they don't want to eat but drinking milk soothe their tummies for a while which is why he is requesting milk frequently I think.

The thrashing his head around could be pain/ discomfort related, my DD used to lift her legs and bang them down on the mattress when she was at her worst. It did stop when we got things sorted for her. She wasn't as bad as he was so she was a good sleeper, he didn't sleep through until all his teeth were through at 2.5+ (sorry!). They are both amazing at bedtime and sleeping now if it's any consolation

Laura