Feeding FAQ: 4-6 months – Breast Feeding

My 18-week-old baby is waking hungry several times at night

My son was a happy contented baby pretty much since starting on the routines. He took to them immediately and always slept at the times suggested. I had to wake him after an hour in the morning, had to wake him after his lunch time nap and he always took a good nap in pram or cot for the afternoon. He was progressing well at nights, was pushing his 4am wake-up from his 10/11pm split feed and 1 day (August 10th – 11 weeks) he actually slept to 7am. At 12 weeks he started waking more in the night and we thought maybe it was because he was still swaddled and struggling to get his arms out. We stopped swaddling but he started waking maybe 2 times in the night a few nights a week. He would be breast fed at all times with some top ups of expressed breast milk (he would take maybe 1-2oz ) and a bottle of expressed breast milk at the 10/11pm feed. At the beginning of September he was still sleeping well in the day (he was a happy contented baby – no crying) and settling well at 7pm – waking naturally between 10 and 11pm, but at night he would wake twice: at 2am and 5am or 3am and 6am. Then a week or 3 into September he started waking at 12.30am, 2am, 4am, 6am and would have to be woken at 7.30am.
He would rarely settle without a feed at the night time wakings. (I never knew how much since it was a breast feed but the few times my mom stayed with him he would eat around 2-6oz at each waking). We tried water one night, but that only got him to last for 30 minutes before he was crying again. I decided to not feed him at 4am and let him cry one night for 12 minutes, I went in, gave him his dummy to settle and stroked his head – then he cried for 8 more minutes and went to sleep.
The next night it was the same thing but 5 minutes and 2 minutes. I was coping because my mom would take him in the morning (happy baby again) and I would sleep for 3 hours but when my mom left on Sept 14th I just lost it due to exhaustion. So I put him on SMA White at the 10/11pm feed and he stopped the 12:30 waking immediately. Around this same time his daytime sleep started going awry. He would wake up after 45 minutes of his lunchtime nap and would only settle with some more milk. Then his 7-10pm sleep went awry – waking up at 8.30pm for more milk then again at 10- or 10.30pm. I was getting to the point of doing controlled crying until I went to get him weighed and realized that his weight gain (which had really slowed down since hitting 12 weeks) had actually stopped. A couple of nights ago I tried offering him 4 oz of expressed breast milk after his bath (I usually give him a breast feed) and he had 3.5oz and when I expressed afterwards I only got 2 oz. That night he slept until 9.40pm so I figured he must have been hungry. I started topping him up with expressed milk at the lunch time nap for the past 2 days and now he sleeps an hour and a half.
Right now his nights are just exhausting me. He sleeps from 7-9.40pm-ish; he has 5 oz when he wakes 9.40 (sleepy feed) then we keep him awake until 11pm; yesterday he had another 4 oz and went to bed at 11:20pm half-swaddled with draw sheet. For the past week he has been waking up every hour and half and will mostly only settle with milk – not even a dummy will do the trick. I am confused now because of his weight gain (or lack of it) that it could be hunger BUT how can he be hungry at 1 or 2 am when he drinks 7- 9oz at 10/11pm split feed? The other thing could be he has associated feeding with sleeping. So over the past 2 days I have tried to wake him up after feeds to burp him and put him down awake. I let him whinge and cry for about 10 minutes and then pick him up and he gets really sleepy. When he is almost going to close his eyes I put him in the cot; he then opens his eyes and moves a little, but goes straight to sleep. The other day he really went for it at lunch time and after 25 minutes I went in and he was all red in the face and his face was wet with tears, I immediately started to cry and picked him up and he let out a huge burp (not sure if he had it before all the crying).
I am so exhausted; I know its affecting my milk supply and all the expressing has made my nipples sore. The below is a sample of yesterday. Weaning was started at 17.5 weeks. His feeds are listed below:
– 6.30am: breast feed, 1side, ½ second.
– 7.30am: top up breast feed.
– 10.30am: one side
– 11am: 3/4tsp baby rice and ½ cube of pear
– 11.45am: 3ozs expressed feed
– 2.15pm: breast feed (5-6mins)
– 3pm: 2ozs expressed followed by another 2ozs greedily at 3.30pm
– 5.15pm: 1 side, ½ second.
– 5.40pm: ½ tsp baby rice
– 6.30pm: 3-4ozs formula or expressed
– 9.40pm: 5ozs formula, sleepy feed, wakes fully after burp.
– 0.40pm: 4ozs formula
– 1.30am: small breast feed 3-5mins, asleep by 1.45am
– 3am: small breast feed 3-4mins, asleep by 3.20am
– 5am: large breast feed 6-8mins, settled until 7.50am.
He weighs 15.6ozs. He naps from 9-10am, 12.15-1.45pm, 3.20-3.30pm 4.45-5.15pm.

To help to get your son more settled and content there are several things you can do.
The first is to check your own milk supply. It would appear by the amounts of top ups your son is needing in the day, it may well be low. This is not uncommon and can easily be upped again if you follow the plan on p52 of The Contented Baby Book. Many mothers find that after about 12 weeks their supply seems to drop. The reasons usually are that you are doing much more than you were in the first few weeks and you are tired after three months of night feedings. You may not be paying so much attention to your diet and drinking in the day and so the supply begins to drop causing the vicious circle of a growing baby demanding more and you becoming more and more exhausted. In your case also you are now having to cope on your own after having had help from your mother and this can be difficult and lonely to cope with. Being upset and stressed will affect your milk supply. By following the plan and making yourself really rest between feeds you should notice an improvement. Try to really focus on your needs and your baby’s needs for a few days. With resting and eating properly you will be much more able to cope with helping your son to learn to settle on his own.
As you have already introduced formula there is no reason why you should not continue to do mixed feeding. It often works well for mothers, and it is better to breast feed for 70% of the time rather than having to give up completely through exhaustion.
Continue to formula feed at 10/11pm and also replace the expressed feed at 6pm with a formula. This should help you son be more settled in the evening, so helping you to relax
and get some rest.
The problems you are having at night with excessive small feeds could be a habit that is developing as he settles quickly after these short feeds. The way you dealt with the 4am night waking was the right one. Sometimes babies do need a “push” to get them through for a longer stretch at night. Rather than eliminate all the feeds in one go use the “core night” method. This is explained fully in Gina’s Complete Sleep Guide p 42. Basically you need to stretch your son’s night out gradually so you eliminate the feedings one by one. Before trying this it would also be a good idea to get him more awake before he feeds at 10pm. In your notes the first half of this feed appears to be a “dream feed”. Although he is now 18 weeks he may still need some time awake at this time of day in order to sleep a longer stretch in the middle of the night. Rather than feeding him as soon as he stirs around 9.40pm let him come round fully. If you give him a formula feed at 6.15pm he should settle well for the evening and may begin to need waking at 10pm again. Bring him downstairs into the light and offer him the bottle once he is well awake. Let him have his 5oz bottle and then give him a 15-20 min break with a quiet kick. Change him and offer the second half of his feed in his darkened room so he settles back to sleep again. At his weight a full feed is 8ozs so you know he is able to go at least 4 hours until he needs another feed. If your husband does this feed and settling make yourself go to bed earlier having expressed and get some sleep.
When he next wakes, if it is 3-4 hours or less since the last feed, offer him some cool, boiled water to see if he will settle. He may only settle for another hour, or even less but the idea is to push him gradually into sleeping a longer stretch before needing another feed. This obviously means you may have several disturbed nights but if you make yourself rest throughout the day you will manage to get through this time. If he will not settle after being given water then feed him. The feed will be smaller as he has received the water and so he then should be able to settle for another stretch. At the next waking offer him a feed. The idea of the core night is to drop the feeds one by one. Once he has slept a longer stretch after the 10pm feed for a few nights don’t go back to feeding him if he should wake earlier; always try some other way of settling: cool, boiled water, a cuddle or a dummy if you are using one. This is how you gradually get him to go longer in the night. Once he has slept onto 3/4am for several nights then you consider those hours from 11pm onwards his “core night”. Then begin to push him further so when he wakes at 3/4am try to settle him first with water then a small feed until he is sleeping to 5/6am. Again, he will need a feed at this time but his “core night” will now be from 11pm-5/6am. If he does wake in those hours you know that he does not need a feed but may need some help in getting back to sleep. The way you handled your son at the 4am waking: going in and reassuring him after 12mins, after 5mins, until he fell asleep alone, is the best way to deal with these night wakings. It is exhausting and can be much easier sometimes to offer a breast feed knowing he will settle back to sleep again. But in order for your son to learn how to settle himself back to sleep alone you will need to accept some crying.
He is too young for controlled crying, where you gradually lengthen the time between visits. Instead, go in after 10mins and reassure him in the way you did and then leave but check him every 10mins. The way you wrote of with him settling himself is how a baby learns. He “cries down”. He begins by crying loudly and then it gradually subsides as he settles himself and falls asleep. If you go in to give him and yourself a quick reassurance every 10mins you will both learn how to cope. A crying baby is not easy to listen to, but by knowing he can settle himself, even with some crying will benefit you both. Look in the Complete Sleep Guide p 39 for more details about this way of settling a young baby.
From your notes it seems you decided to start weaning at 17.5 weeks. The current recommendation is to wait until nearer 6mths. Although not all babies are able to do this and many mothers do decide to wean early it would be better to check with your health visitor or doctor about this matter. As you were feeling that your son was hungry it easy to see why you decided to start him on some solid foods and as his feeds are split between breast and bottle it is difficult for you to know exactly how much he is taking at each feed. A baby who is ready to wean should be having 4 to 5 full feeds a day. This is either 8ozs or two full sides at the breast. He would have been content to wait four hours between feeds but has become increasingly hungry earlier, or is not satisfied after his feeds. He may be chewing his hands excessively and having previously been sleeping and napping well has begun to wake earlier and earlier.