Four month old baby girl waking every hour

Question: Hi Heidi, My four and a half month old is waking nearly every hour. Up until about a week ago, she was waking about every 3-4 hours, which I was actually fine with. We keep the room quiet and dark, but I give her a quick feed every time she wakes.

I felt that she needed the feeds every 3-4 hours (I know babies can go a bit longer than that at this age, but she has reflux so I have always tried to give her more frequent, small feedings).

However, now she is up every hour and nothing but nursing will get her back to sleep. My husband has tried to soothe her (holding, rocking, shushing, etc.) while I left the room, to no avail. He eventually just had to let her fall asleep on his chest.

When I nurse her she falls back asleep very quickly, but with her waking every hour I fear this is instilling bad habits and possibly causing her to get most of her calories at night.

We have a consistent bedtime routine (bath, lullaby, swaddle or sleepsuit, nursing) that I normally start at around 6pm and put her down asleep (nursed to sleep) around 7pm.

I have never really had success getting her to sleep any other way but nursing(for naps, we will also babywear and walk her to sleep and throughout the nap, but for obvious reasons can't do this overnight!).

We have dark shades on the windows and white noise (rain sound as well as a fan) going all night. Her naps are variable but lately she has actually been napping fairly well, 2-3 naps of 1-3 hrs each (total naptime around 4 hrs max) and we usually keep her wake time to no more than 2 hours, though the last wake time of the day is sometimes longer.

She does not take bottles or pacifiers. She normally sleeps in a cosleeper attached to our bed. In desperation I have tried bringing her into our bed in the wee hours of the night, which makes things a bit easier on me (she still wakes frequently to feed but at least I don't have to pick her up and put her down each time), but I worry is just creating even more of a dependency since she can nurse pretty much constantly that way.

I do want to keep her in our room (we don't have a separate nursery at the moment) and do not want to consider any cry-it-out methods until at least six months. Normally during nightwakings she just stirs and vocalizes softly but when I have tried holding off on nursing her to see if she can self-soothe and resettle, it'll escalate to crying within a couple minutes.

I don't need her to sleep through the night (even the 5-hr stretch definition) but going back to sleeping even 3 hours at a stretch would be great. Please help!

Thanks,
Robin

Heidi's Answer: Dear Robin, a sleep retrogression as you are seeing is very common around 4 months … a growth spurt, big physical and mental developmental steps combine with maturing of sleep patterns in a way that even stirs the very best sleepers.

What your daughter was doing, sleeping 3-4 hours was actually really good and I am glad to hear you went with your instincts to feed her smaller portions frequently, especially in view of the reflux. And that you were fine and relaxed with that, well done. The good habits you have installed in this way will also help you go back to better nights smoothly.

A good idea also to have your husband take over, or at least try and soothe her to avoid a nursing moment.

To go back to sleeping longer stretches again as soon as possible, i.e. when the growth spurt settles or soon thereafter:

1. Keep up the good bedtime routine, schedule, self soothing practice, sleeping environment, … all the good habits you had before. Now is a moment when many parents start doubting what they'd been doing and start 'slacking' or completely give up on them.

2. Do not hesitate to nurse once or twice extra at night in the upcoming week. Two weeks if you feel the need is still there.

3. Do arrange with your husband that he takes into account a number of awakenings to help her settle. To make this easily doable, decide for yourself when you will nurse. This can be after a minimum of 2-2,5 hours after the previous feed, or you can decide to nurse 'every second awakening', …

Since your plan is to avoid too frequent feedings (which will indeed make her feed more calories than necessary at night, as well as may cause reflux problems), it is fine if she has to settle on his chest. The main goal is to not have her feed every time.

Once it will be needed (after the growth spurt and/or later on when she's nearing 6 months old) and if she'd still need his chest to settle on, you can work with the gentle self soothing method to increase her sleep independence.

4. Furthermore, it is good to compensate for part of the growth spurt needs by increasing her food intake during the day.

That does not mean 'stuffing before bed'. On the contrary, it is best to gently increase by spreading extras throughout the day. You can do this by insisting a bit longer at each feed, always ensuring the first breast is well emptied before going to the next, and offering the second after a brief pause.

You can also squeeze in an extra feed somewhen during the day. That will allow you to keep up with the anti-reflux small portions, and still increase her calories during the daytime, and not just at night.

Good luck, if you keep your good relaxed approach and add these basics and growth-spurt-survival techniques, you can go back to the longer stretches soon.

I'd love to hear how things work out in the next weeks.

Kindly,
Heidi