[Quraish Behari]

Hi Emma,

I’m sorry for missing your reply on the 9th. We didn’t see this come in at all hence the delay.

Thank you for the questions. They’re also helping us get a better understanding of the nuances involved.

Apologies in advance for the length of this reply.

You mentioned your little one is having 3–4 naps per day, sometimes only 10 minutes long, and at most 45 minutes. Can you clarify what you mean by this? – We get her to sleep about 3 to 4 times during the daytime hours. This is a mixture of contact nap, or putting her down. Each “time” is defined as multiple tries and may involve her falling asleep, then stirring within 5 minutes, then falling asleep again, us intervening and then finally in a deep sleep. More often than not, this is on us because when we transfer her, she wakes within 10 mins.

It’s probably worth noting that she will fall asleep on us regardless of the lighting and noise conditions (within reason) of the environment. We have the same challenge in a dark room as we do a bright room and it appears to us that the lighting doesn’t seem to bother her. We’re not the experts though but thought it best to mention.

• Is she having 4 naps of around 10 minutes each in total? – No. During the day, when she has fallen asleep on us (upright or cradled), as soon as she is put down in a Dockatot or Crib thereafter, she will nap for at most 10 minutes. The amount of time we hold her varies from 10 minutes to 45 minutes. If she naps on us without being put down, she will sleep for between 20 minutes and 45 minutes if we don’t attempt to put her down.
• Or is it that she sleeps for about 10 minutes when laid in the DockATot or crib, then wakes, and you hold her for the rest of the nap? – Yes. Sometimes she goes right back to sleep once picked up. Sometimes she doesn’t go back to sleep once picked up so we go into her next wake window. Sometimes the dummy helps, sometimes it makes her more frustrated.
• Or are you needing to re-settle her every 10 minutes during the nap, with the total nap lasting 30–45 minutes (or longer) with your assistance? – That is correct, when we persevere. But if she is left to settle without being picked up and if she happens to fall asleep again, that will last for between 5 to 10 minutes before she stirs again. This is repeated multiple times. We have also left her while stirring to verify that she is actually awake and not transitioning between cycles. And oh boy is she awake 😉
• I’m just trying to work out when she’s napping on you how long she will stay asleep for? – A minimum of 10 minutes before waking up without the ability to get her back to sleep in the worst case. A maximum of 45 minutes in the best case. However, in general she does sleep for a longer time when contact napping.
• I’m just trying to work out when she’s napping on you how long she will stay asleep for? – Hopefully the answers above answer this one. Let us know if we missed it.
• You also mentioned she tends to stay awake after her morning feed and may have a short play. That suggests this might be the best time to try the settling pyramid, as she’s alert. I was a little surprised to hear she stays awake then, since her morning wake window becomes quite long after the medication, feed, and upright hold. – Yes, this was our concern. We are worried that by the time she has an opportunity to sleep that she has become overtired. The earliest window for her to go down for a sleep is 2 hours after waking in the morning.
• It’s also worth noting that at 9 weeks, it’s very common for babies to fall asleep while feeding. As she gets older, she’ll naturally start staying awake after more feeds, because her sleep pressure will build more slowly. – Do we need to be concerned that falling asleep while feeding at this stage is forming an association?
• Lastly, I want to reassure you, it doesn’t sound like falling asleep on you is currently affecting her sleep overall, especially given that her overnight sleep sounds really good for her age and with severe reflux. – She does has a better night time sleep. That started improving in week 6.
• You mentioned you lay her down at night and she goes to sleep – just to confirm, is she already asleep in your arms when you put her in the crib, or is she awake when you lay her down? – She is already asleep. We have tried to put her down when drowsy and implement the pyramid. We have unfortunately failed at every attempt so the attempt thereafter results in her sleeping on us before being put to bed. She does stir a little (20 seconds) when put into the cot but falls asleep shortly thereafter.

We weren’t sure if the below would be useful but we have logged as much as we can regarding the history. Below is a summary of the different attempts at a remedy to help our little one. It may provide some more context:

Everything we’ve tried to help with the reflux and motility issues

Formulas

· NAN OptiPro/Infant → NAN AR (gas/cramp) → S-26 Gold AR (partial benefit) → Novalac HA → Novalac Allernova/Allernova Smooth (thicker, but bottle refusal/cramp) → Similac Soy (first feed good, then gassy/thin) → Neocate LCP (accepted, thin; xanthan-thickened Neocate rejected) → S-26 Gold Comfort (currently 25/75; accepted with careful technique).

· Aminova (amino-acid, naturally thicker) rejected outright.

· Planned: S-26 Gold AR / Novalac AR Digest if Comfort isn’t enough.

Medications

· Nexium: 2.5 mg od → split → 5 mg/day (3 mg AM + 2 mg PM), 30 min pre-feed.

· Domperidone (Motilium): ~1.0 mL q8h → 1.1–1.2 mL → targeting ~1.35 mL q8h (0.25 mg/kg) 25–30 min pre-feed.

· Tried & stopped: Gaviscon Infant (alginate) → bloating/slow emptying.

· Once-off/occasional: Bennett’s colic mixture (sedating; not continued); Colic Calm once; simethicone considered (not yet started during this summary period).

If you made it this far, thank you again,

Quraish and Helen

• This reply was modified 6 months, 3 weeks ago by  Quraish Behari.
• This reply was modified 6 months, 3 weeks ago by  Quraish Behari.
• This reply was modified 6 months, 3 weeks ago by  Quraish Behari.

[Quraish Behari]

Hi Emma,

Thank you so much for the reply. We can’t express how amazing it is to have some assistance from you.

1. It sounds like you have a consistent wake-up time of between 6:30am and 7am, is that correct? If so that is fantastic!

Correct! She does on every 3rd of so night get up to feed at between 2am and 4am. We haven’t been able to figure out why yet.

2. Just wanted to check that the medication Nexium, is only given in the morning and the Motilium/Domperidone dose is given in the morning and again in the afternoon? Are you required to give her any other medications prior to her other feeds during the day?

5mg Nexium once a day in the morning 6:30-640am 1 hour before a feed. 1.4ml Motilium/Domperidone three times a day 30 mins before a feed, 7:30am, 4:00pm, 12:00pm

3. Is she starting to stay awake following daytime feeds?

Sometimes. If she isn’t upset and crying she has a small play window (10 minutes max). She is on her back on a play gym or seated in a babybjorn. If she is upset then putting her down results in 2 minutes of bewilderment before fussing and crying. Once that happens she only calms if we pick her up. The majority of the time she falls asleep in our arms after a feed in the upright position with her head laying on our shoulders.

4. Based on what you have written, it sounds like you might be standing up in the bedroom while she is awake lying in your arms and you’re swinging her gently and shushing and tapping her until she falls asleep. After she has fallen asleep, you’re then gradually stopping the swinging, then the shushing and then the tapping. At this point, you are laying her down in the crib and then using the settling pyramid to help her go back to sleep if she wakes up. Is that correct?

Yes that is correct, we have a nursery setup. Dark room. 18 degrees at the moment consistently. White noise. Closed door. Crib with a wedge underneath the mattress to help with the reflux situation.

5. You mentioned her wake windows are currently 1.5 to 3 hours. Do you notice whether she falls asleep – even briefly – during feeds or while you’re burping her afterwards? At this age, babies typically have short wake windows, and because her feeding routine takes quite a while, it’s very likely she’s getting small pockets of sleep during that time. These brief naps during feeding or upright holding could be reducing her overall sleep pressure, making it harder for her to fall asleep or stay asleep during formal nap times.

Yes she does seem to dose off while feeding. We have watched for her swallowing as you’ve recommended and she continues to swallow. If she stops, we stop the feed let her lie in the same slightly upright position in our arms for a minute or two before lifting her to burp. We only do that to allow the milk to settle before shuffling her about to avoid any reflux issue. We will then after burping (if there is a burp) go back to the original position and continue the feed. Because she is tired she tends to start rolling her eyes back during most feeds during the day except for the first feed.

6. Are you able to let me know how many naps she is having per day?

3 to 4 naps per day. All naps start as contact naps with a few attempts to put her down and failing. At least 1 nap where she will sleep in her Dockatot or crib. Times vary with 10 mins intervals mostly. Sometimes there will be naps that last longer to the tune of 30 mins or so. There will be the odd occasion where she will sleep for 45 minutes. We have only had a 1.5 hour nap once since week 2. We have very little consistency during the day. We attempt to put her down at the same times but with her reaction the recovery and calming sometimes happens quickly and sometimes not which throws the entire schedule out the door.

7. Do you remove the pacifier before she falls asleep or does she sleep with the pacifier? If she does sleep with the pacifier have you noticed if the reason she is waking briefly after you lay her down is because the pacifier has fallen out?

We don’t. If the pacifier is in when she falls asleep removing it usually results in her getting upset and the normal calming techniques seem to fail. So re-inserting is the usual practice if she will accept it at that point. That said, we do try to remove it as much as possible before we put her down.

She does wake when the pacifier falls out her mouth after having gone to bed with it.

[Quraish Behari]

Hi Emma,

Final update from us: Despite weeks of trying we were unable to get out little one to fall asleep in the crib for more than 20 minutes. It seems this may be a symptom of her severe reflux issue. Contact naps in a carrier during the day is the only way she will get more than 20 minutes of sleep.

The pyramid helped in some part as she’s now hit the 4 month sleep regression during what used to be a fairly consistent night time sleep routine of waking at 2am then 6am.

Encouragingly, her development has been on track and motor skills, communication and milestones seem to be going well.

Thank you for the assistance. And should another parent be experiencing similar challenges with motility and reflux, the unfortunate truth for us was that we had to settle for a night time sleep that was fairly good at one night time wake up and an early morning wakeup. Daytime sleeping was just not on the cards for us. Good luck and I’m pretty sure it’ll settle.

[Quraish Behari]

Hi Emma,

Thank you for the feedback and clarification. We have been attempting all of it over the last few days and hoped we’d have some positive feedback but unfortunately not yet. The reflux and cramping issues seem to be the main cause preventing her from remaining sleeping and once awake we have been unable to get her down again.

We will keep trying and feed back every few weeks so that there is at least a progress report for others that may have similar issues.

Thank you,

Quraish Behari

• This reply was modified 6 months, 2 weeks ago by  Quraish Behari.

[Quraish Behari]

Hi Emma,

Thank you again for the feedback.

We will definitely try the swaddling again and the correct pyramid procedure. Thank you for clarifying that for us.

One question we had was what would you recommend in terms of retries per sleep time for the attempts to put her down and use the settling pyramid before giving up and pick her up for that sleep which may need to be a contact sleep? We’re assuming it will take a number of tries over a few days to eventually get her used to habit and thereafter being comfortable with the new routine.

We will also give you feedback after trying for a few days.

Thank you again,

Quraish and Helen