Sleeping FAQ: 4-6 months – Night Waking

Due to reflux my 4 month old needs more feeds but I need one stretch at night

My 4-month-old son has had reflux since birth. He has been taking Prevacid for the past 8 weeks and it has helped a lot. Although he has improved his sleeping at night, he has never slept through more than twice. He is up for the day around 7.30am or so. He can’t have a bottle upon waking in the morning because that is when he gets his Prevacid and he needs to wait about a half hour for his first bottle. He cannot take more than 4-5 oz at a time because of the reflux so I try to split the feed. He will take 3oz around 8-8.30am and then another 2oz before his morning nap which is around 9.30am and is anywhere from 35 minutes or I wake him before the hour mark. Then he takes some more formula – another 3-4oz around 11.30am and has a few tsp. of pear. Before his lunchtime nap around 12.30, I will top him up with another 2oz of formula. This nap is a problem. He will sometimes sleep longer if I leave him to cry after he wakes around 30-45 minutes into it. Otherwise, he is up after a short time. I will then give him another formula feed around 3pm and he will take around 4 oz. If he didn’t sleep well at lunch, I give him another nap at this time for 30mins. Then his next feed is around 5pm and he will take 2-3oz. He will usually nap again at 5 or 5.30 for 20-30 minutes. His bedtime feed is usually around 5oz at 7.15pm. He then goes to bed at 7.30pm and is really ready to go. At 9pm, in his sleep, I give him 2oz, otherwise he seems to have a worse night. At around 12.15am, my husband, who stays up late, feeds my son a 6oz bottle in his sleep. We have noticed that without the 9pm top-up, my son is awake at midnight and then again by 4.30am. With this 9pm top-up he seems to make it to midnight and then has made it to 5am or so. We would like to have him sleeping from this 12.15am feeding until 6 or 7am. I feel that because of his reflux, he can’t take too many ounces at one time and therefore he needs to be fed earlier in the morning. But I would like to see a 6 hour stretch at least. If I try to feed him more at a time, he gags and then throws up. We have tried feeding him at 11pm but that just makes the whole waking-up thing earlier too. We were going to wean him slowly from the 2oz 9pm top-off after a few weeks and see if he can make it to midnight without needing that. His sleep pattern seems to be 4 hours and then 4 1/2 hours and then 3 hours for the night. When he does wake at night, I always give him 15 minutes to settle himself. Some days he naps okay and others are terrible. Please advise us as to what we should do. He does not use a pacifier – he would like one but we only use it to calm him during the day, and for in the car. There is no rocking or holding to sleep. He puts himself down with about 10 minutes of awful crying at every nap and bedtime but at least he is doing it himself! He sleeps on a reflux wedge and in a full swaddle or else he will hit himself in the head and wake up yelling.
In total he is averaging 28-30ozs in 24 hours. He weighs about 15.5lbs. He was recently weaned on the advice of the paediatrician having pears at present to be followed by barley in another week as my son easily becomes constipated.

In order to get a longer stretch in the night, move things very slowly. Once you have eliminated the need for the 9pm feed you could begin to move the next feed back very slowly to nearer 10.30/11pm. This will help him begin to have the longest stretch in the middle of the night. Do this by waking him 5-10mins earlier every three to four nights so that the adjustment comes very gently. If you notice this is beginning to affect the time of the next feed then give him a few more days to become adjusted to the new timings before moving it back again. He should begin to manage a stretch between 11pm and 6am.
For a baby of his weight he should be taking about 38ozs of milk in 24 hrs so work towards increasing his daytime intake a little. This will help him to go longer at night, which at his age he is capable of doing, even with the problems that reflux can bring.
You may find that by starting his day earlier, waking him at 7am for his medication, then beginning to feed at 7.30/7.45am you can give him a slightly bigger top up at 9.30am. Now that he is having solids as well as milk at 11.30am, watch he does not cut back too much on the top up offered afterwards before his lunchtime nap. He may be waking through hunger at this time. To help him take a larger feed at 11/12am, offer him his milk at 11am, followed by the solids at 11.30am and then a further top up at 12.15pm. Make sure he is not overtired when he goes down at this nap, which is another cause of he waking after 30- 45mins. Allow him 20 mins to resettle himself, but go in and check him after 10mins to make sure he is still swaddled and comfortable in his cot.
Again bring his next feed forward slightly by offering it at 2.30pm so his feed at 5pm could be nearer 4ozs. If he still needs a further nap try to fit this in around 4.30/5pm so he is ready for bed at 7/7.15pm. Once you have eliminated the 9pm feed he should be more ready to have his late feed around 11pm, especially if you shift all his timings in the day. The few extra ozs you manage to get in the day should really help your son begin to stretch his night a little.

These changes will take time to fall into place which is why it is best to proceed really slowly so he gradually becomes used to them.