4 month old infant with reflux sleeping is constantly interrupted

by Megan - Answer by Heidi Holvoet, PhD

Question: My son will be 4 months old in 4 days. He has been a poor sleeper since he was born and I believe it is due to his reflux. We start his bedtime routine (medicine, bath, baby massage, nursing) at six and most nights he will fall asleep at the end of nursing or within 20 minutes afterward.

Then I hold him upright for 20-30 minutes to help his food settle so he will have less reflux and also to continue burping him. Sometimes this is the last I hear from him until 12-1am.

Other times he will start pulling his legs up (while remaining asleep) and can sometimes settle himself and other times continues for several minutes which is when I will pick him up and burp him. If I wait too long to pick him up he is fully awake and no amount of soothing while he's laying down will help and it is a struggle to get him back to sleep after picking him up then too.

He will always wake up 3 times between 630 pm and 730 am will the usual timings about 12-1am, 3-5am and awake for the day 7-730am.

He also takes random naps, normally only wants to be awake for 1- 1 1/2 hours and then starts showing signs of sleepiness. He will then sleep anywhere from 20 minutes to an hour with the norm being 30 or 50 minutes. Sometimes he wakes up smiling and happy other times he cries right away (which makes me think he refluxed).

He also will not nap well on his back (20 min) and will sleep longer in his bouncy seat placed in his bed.

I can't find any good information about sleeping and babies with reflux so is any of this normal and/or is there any way I can make things better for him (and me)?

Heidi's Answer: Dear Megan,

I am sorry to hear your little boy is in such discomfort with reflux. I know how heart breaking it is and it's also very draining for you. So let's have a look at what we can do, because luckily there really are effective techniques that can help relieve him.

To answer your final question first: yes what you describe is normal, both for a 4 month old baby in general and then specifically for a baby who suffers with reflux.

Waking up 2, 3, 4 times at night is not at all unusual for a 4 month old. Digestive issues are quite often the cause along with illnesses (a cold, a virus, ...), early teething or general distress (over-busy day, too many triggers, ...). And on top of all these causes there are the important sleeping skills that still need to develop, such as self soothing.

All of this not to say that the reflux is not your main cause, but to show that it is not the only thing, and that several other things can also be playing at the same time. And the different causes influence each other too: self soothing will be much more difficult for a baby who is uncomfortable from reflux ...

So either way, relieving the reflux discomfort will be our first and main aim.

You mention medicine so I am assuming that you have regular health consultations with your doctor or pediatrician. It is important that you continue those and discuss with the doctor which medicine to use and in which doses.

Yet sadly, medication can relieve but most often does not take away all discomfort. But then again there are quite a number of non-medical things you can do on top of the medication.

Has your doctor suggested to thicken your milk? If not, discuss it with him or your pharmacist. You are breastfeeding which is the best you can do, so thickening the milk would mean extracting, then thickening and then cup/bottle feeding.

It is quite a hassle so it's best to discuss it first. If you can imagine doing this practically, it may be an interesting experiment. But if it will make things too complicated, you will create extra stress for both yourself and your son and that will have worse effects on his reflux and his sleep.

So see this as an 'optional option', depending on what your health advisors say and how you feel about it.

In each case, if you can, do keep up breastfeeding exclusively until 6 months. It's not only best in general but also best to reduce the effects of reflux as much as possible (because it is light and easier digested than any formula).

Moreover, while nursing, your son is close to you and probably utterly relaxing. That closeness and relaxing is easily overlooked as a helper in reflux symptoms but it actually is quite important. Part of reflux reactions are attributed to 'stress' – feeling so safe and close to you, less stress hormones are released, with positive effects.

That is also the reason why, if you do not already, I encourage you to carry your son in a baby carrier often. A good quality wrap offers all the baby wearing benefits you need and also provides comfort (no pain, no strain) for yourself.

In fact, you could combine this with setting up a more regular nap schedule, something that I also want to advise. Regular, and longer, naps will help him be more rested and relaxed, and that improves nights.

See the Baby Sling Trick for details on how to set up a regular nap schedule using the sling. For fully detailed nap help, you may find my Nap in a Snap! guide helpful.

Back to the milk. Some foods can increase baby's reflux sensibility. It is not always easy to deduce which ones specifically. But from your story, it seems that he sometimes has very little discomfort (when he'll sleep straight to midnight-1am) and sometimes wakes up in discomfort. That can be an indication that it is something you had on that day/afternoon.

You have two options: keep a food diary for a week or so. Or start leaving out certain foods. The first option will be more precise. But you can experiment with leaving out dairy or typical allergens. Or combine the experiments with the food diary.

Give every experiment at least a couple of days, probably more to see a real effect.

You already hold him upright for a good long time, which is really good. If you have the feeling he's not completely burped yet, you could put him down for a couple of minutes (maybe to change his diaper) and then pick him up and hold/burp him a bit further.

Good luck!

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