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My 3 month old newborn has been waking up every 15 minutes to every hour during the night for 4 weeks and we have tried everything from Baby Wise to Baby Whisperer to the No cry Sleep Solution with no results.

In fact, she seems worse now more than ever! She refuses to be swaddled and we stick to the same schedule every day.

We bathe her between 6:30 and 7pm every night and she gets her last bottle between 730p and 8p.

She used to sleep an initial 3 hrs before waking and then wake every 1.5 -2 hrs. Now, most nights she does not sleep a 3 hr stretch initially and will just do maybe 1.5- 2hrs and then she is up like every 15-20 minutes most of the night with maybe a 1 hr stretch if we are lucky.

We are going crazy.

We have spoken with the pediatrician and we have taken her in to eliminate the possibility of her being sick.

She is on a combination of breast milk and soy formula and has been exclusively since she was born.

She takes 3 naps a day that last between 45 minutes to 1.5 hrs and feeds every 2 hrs (she won't go more than 2 hrs w/o a feeding- we have tried). We are exhausted beyond comprehension and we don't know what to do.

What can we do?

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Hi, and welcome to the site! We are actually not a forum. We're a question and answer site. I'm making a few edits to your question (answers should be posted here, not emailed privately to you). You may want to take a few moments to review our faq. I won't have a chance to answer until tomorrow or Monday, but I suspect you'll find other people here who can give you good answers before then. Best of luck! –  Beofett Jan 6 '13 at 0:44
    
Related: parenting.stackexchange.com/q/3899/2876 –  balanced mama Jan 16 '13 at 1:46
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6 Answers

This is my first time answering on this site, but your post really grabbed me. I am answering with the background of being a mum of a 6 month old boy, and a paediatric doctor in Australia.

Firstly, it sounds like things are really tough at the moment. Hopefully you will get some good sleep soon to recharge. I have a few suggestions, and will separate them out.

1) Share the load. I'm not sure if your baby is sleeping in your room or in another room, but arrange with your partner a system whereby one person is "on duty" for a certain part of the night, and the other gets some good quality sleep for a couple of hours. If your baby is in your room consider sleeping in another room (even the lounge room) so you get some uninterrupted sleep when you aren't "on duty". Having your partner take the first shift, and giving a bottle if needed will give you a good stretch straight up. Also, since she seems to be a good daytime napper, if you are still at home try sleeping when she does during the day. It isn't ideal for the long term but while things are crazy it may help you get through. Also, utilise your support network (family, friends, neighbours - anyone you trust) to come over and give you a hand. Maybe they can do the house work while you get a bit of happy playtime with your baby during the day (to remember that she isn't always crying) or visa-versa.

2) Total sleep volume. From your post it sounds like your baby is getting between 2.5 and 4.5 hours of day time sleep each day, which is great day time nap volume. Most three month old babies average between 10 and 16 hours of sleep per 24 hours, with the vast majority getting 12-14. If she has a natural sleep volume of 12 hours per day (for example), she will therefore be asleep for only 7.5 to 9.5 hours overnight after day time naps. So perhaps starting the night sleep later will give more time for YOU to effectively sleep while she is down. The number of 3 month old sleeping from 7.30pm through the night is small, and the parents are very lucky who get them! Perhaps try pushing back "bedtime" to closer to 9 or 9.30pm, and trying to get into bed yourself when she goes down. Then if she does have a 3 hour stretch straight up you will have gotten that too.

3) Eating. You said she is a mix of breast fed and bottle fed, but haven't specified how many of each feed type she takes over the day and night. It may be that she has become used to taking lots, or even the majority, of her daily milk intake overnight. At 3 months she is able to get used to drinking more during the day than night, but this may take some "training". To encourage more milk intake during the day, try to decrease night intake gradually. If she is "snack feeding" overnight (smaller, more frequent feeds) start by consolidating the feeds into 2-3 feeds only, by stretching out the gaps between feeds to a minimum time. For example, if she is snacking every hour or less start with perhaps minimum 1.5 hours between feeds for a few nights, and gradually stretch out to 3-4 hours (so eventually you are only getting up 2-3 times per night to feed). This does need to be very gradual, and try only stretching feeds out a further 15 minutes every 3-4 days. As she feeds less overnight she will start eating more during the day, but it will take time for her to readjust.

4) Making sure she recognises night vs day. Keep the room lights low, try to speak in a quiet voice and don't play games or be too fun when she wakes overnight. Easier said than done when you have a screaming baby, I know.

5) Settling. Besides feeding (which is very easy to fall back on every time she wakes overnight, but snack feeding can create a problem as outlined above) you need to work out what helps your little girl. Have a barrage of settling "tricks" already thought out to help settle her and to help keep you sane. Even if it may not settle her instantly, having something you are trying can stop the feeling of helplessness and frustration a little. I personally am a huge fan of the "Happiest Baby" settling technique (5 S's which you can google) - but this can stop working around the 3-4 month age. However, it may still work a treat, and reviewing the techniques may help. Consider a dummy (pacifier) if not already using one. Consider writing a list of things to try and sticking it in the room for when you are fuzzy headed overnight.

6) Sleep associations. Create positive sleep associations which will cue her at the start of each nap/sleep time and when she wakes overnight that it is sleep time. For example: swaddling, pacifier, white noise, small breathable snuggy (aka lovey or another small toy that cannot suffocate the baby). If she is sleeping better during the day than overnight try to work out what is different between the two (ie. light levels, noise levels etc).

7) Comfort. Ensure she isn't too warm or too cold overnight. Be aware that overheating is a SIDS risk, as is loose bedding. She shouldn't feel hot and sweaty to touch. Altneratively, if her face is cool she may not actually be too cold - slip a finger down her suit to feel her chest, if it is warm then she is just right. Don't judge if she is cold on her hands or feet as these are often cooler. Consider getting a room thermometer can experimenting with different amounts of clothing/bedding for different temperature ranges. There are baby monitors with temperature alarms if you think that may be an issue, but it is an expense you may be able to do without. Also, don't forget to make sure it isn't a nappy (diaper) needing changing or if she has vomited on herself etc.

8) Work on self settling. It sounds like she might need you to help her go back to sleep each time she wakes overnight (infant sleep cycles are about 45 minutes long). Try to put her in her bassinet/cot when she is settled and drowsy but not actually asleep. If she falls asleep in arms, jostle her on putting her to bed so she wakes up and sees she is in her bed (but hopefully not wake up so much she will get distressed). She will eventually get used to falling asleep in there and not need to cry for you to help put her back to sleep each time. Alternatively, cuddle/rock/feed her to sleep each time, but you will then have the issue of her needing you to go back to sleep at each sleep cycle. If you want to co-sleep make sure you read and implement safe co-sleeping practices. I personally do not recommend or think co sleeping is safe below a minimum age of 6 months due to SIDS risk, but this something you need to decide as parents.

Quite a long answer, but I hope this helps. Good luck. I'd love to hear back how you go.

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Fantastic first post! Welcome to the site :) –  Beofett Jan 12 '13 at 1:48
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Welcome to the site! What a Wonderful Answer! –  balanced mama Jan 14 '13 at 22:56
    
+1 for everything except the later bedtime. While that may work for some babies, for others it will lead to overtiredness. For reference I'd point to Marc Weissbluth's Healthy Sleep Habits, Happy Child (since I'm not a pediatrician) where he talks about the importance of an early bedtime starting around this age for keeping in line with circadian rhythms. Plus if a child is waking to eat at night then the actual amount of time in the crib is less than the time from bedtime to natural wake-up, so bedtime must be that much earlier to compensate. –  justkt Jan 15 '13 at 14:27
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You're in a tough spot. It's hard having a 3 month old. If you're feeding her every 2 hours-- then she's waking up-- it may be that getting more milk into her will help her sleep longer. Try feeding her for 10 minutes, then burping for 2-5 minutes, then feeding for 10 minutes more. Then burp her again and top her off with another 5-10 minute feed. If you can get her to empty full breasts completely or take at least 3-4 ounces of milk, she may sleep longer.

If she's fed and has a clean diaper, and she isn't sick, then it's okay for her to be awake. As long as she has an opportunity to sleep, then if she needs it, she will sleep.

If her pediatrician says she's growing well, then she's getting enough milk and sleep.

It sounds like the problem is that you aren't sleeping. If she's fed and dry, and in a safe place like a crib, then it's okay for you to sleep. You have to take care of yourself so that you can take care of her.

It's also a good idea to ask friends and family who have cared for infants to help.

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Understanding that it is really difficult to sleep with a baby in the background crying, 5un5's sentiment here is accurate. If you can have some one else be on "patrol" for a night or two so you can catch up on sleep that at least you will feel a lot better! –  balanced mama Jan 6 '13 at 14:54
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If she sleeps longer during the day than at night, I would focus on what's different between those two. Perhaps she doesn't like sleeping in absolute dark? Maybe she doesn't like absolute silence? Is she maybe covered more (i.e. possibly too warm) at night? Or maybe she's too cold? Does she sleep in the same place as during the day? If not, does she sleep equally long if you put her to nap wherever she normally sleeps at night?

My son was also a frequent waker and I found that he sleeps better when he's in bed with me. His cot was connected to our bed, and once the wakings got too frequent (around 3 or 4 AM), I would just pull him over, nurse him, then let him stay next to me for the rest of the night. This changed when he was around 5 months old, when he slept far better if there was nobody else around him. Sometimes the little ones just need more contact. (If you opt for this solution, take care to Google for some safety measures first, as not all types of beds and covers are adequate for safe co-sleeping.)

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This sounds a little like my daughter when she was around this age. She was an every two-hour eater, and she's still more of a snacker than a meal-eater. I know if you've got a kid who's a two-hour eater it's VERY difficult to break them of that, but it's usually because there's an underlying issue involved.

Could she have acid reflux? Not every child with reflux spits up...some kids have silent reflux which is what my daughter had. She would take a feeding, and a little bit later she'd start to get uncomfortable and cranky--sometimes even in the middle of the feeding. She NEVER took more than 4 oz at a time even when she was 12 months old. If this happened to be in the middle of the night, she'd be up in the middle of the night. It seemed to be worse at night because she slept on her back, of course. Naptime during the day was hit-and-miss. Sometimes she'd be ok, and sometimes she wouldn't. Many times naptime was better because I could actively hold her and allow her to sleep on her tummy some because I was right there watching her the whole time. Not possible at night.

According to this article, acid reflux in babies peaks at around 4 months so you're daughter is right there. You might try some simple reflux tricks just to see if it helps. Elevate her crib mattress slightly by stuffing a pillow under it. Keep her up-right for 15-30 minutes after a feeding (yes, this is a pain if you have a kid who eats every 2 hours, but it does seem to help some). Make sure that the nipples on the bottles you're using aren't flowing too fast. Swallowing too much air while taking a bottle can exacerbate the problem, and make sure you burp frequently while feeding. If that seems to provide some relief from the problem, then you might talk to your ped about it next time you're at the doctor.

Hope some of this helps and you get some relief!

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This also sounds like my daughter at the same age, except that my daughter was exclusively breastfed or fed pumped milk and took about 5-6 45 minute naps daily. We could not get her to nap longer until she was much older.

For my daughter the issue was entirely developmental. She entered a phase called by one book, The Wonder Weeks, Wonder Week 19. The wonder weeks according to the reserachers behind the books are leaps in cognitive development. During the leaps, which start to last up to 6 whole weeks with Wonder Week 19, babies are crankier, clingier, and cry more. They also may have trouble eating, sleep poorly, and have a host of other challenging behaviors for both parents and themselves. The reason is that their entire worlds are being turned upside down as they suddenly discover new things and develop leaps in their mental capacity. The good news is that your child will aquire fun new skills around week 17. The bad news is that fussiness and poor sleeping for this phase can last from week 14 until week 20!

According to the theory of infant development I read in the book Bedtiming around the same time (4 months or so) is when children experience a doubling in their working memory. This fits with what my pediatrician told me, which is that children around this age suddenly develop the memory to know how they like to fall asleep. That means sleep associations are preserved from sleep period to sleep period.

Sleep associations, best described in Ferber's book Solve Your Child's Sleep Problems are a huge reason for waking at night. Unless you put your child down awake and your child puts him or herself to sleep, your child associates some action on your part such as rocking or bottle feeding with sleep. That means when your child has a partial wake-up at night, something everyone does, your child needs your intervention to get back to sleep. Changing sleep associations is done through sleep training. The No-Cry Sleep Solution which you tried can work over several weeks if done very consistently, but other methods tend to work more quickly. Any form of sleep training should only be done once basic medical causes for waking such as MSPI and reflux are ruled out and with a pediatrician's OK. That includes even gentle methods such as pick-up/put-down from The Baby Whisperer and No-Cry Sleep Solution methods. Many pediatricians OK the Ferber method or another method of sleep training that allows for less comforting at 4 months. The sleep training method you choose to create proper sleep association is entirely up to your family and your parenting style, if you even chose to do so.

Note that just because your child doesn't go more than 2 hours between feedings during the day doesn't mean that the child can't learn to go longer at night. My daughter was quite the snacker during the day for most of her infancy but learned to stretch feedings at night early on based on my using other soothing methods at some of her night wakings and implementing cut-offs before which I would not feed her unless she was not soothed by any other method. A feeding cut-off is critical if you chose to begin any form of sleep training, as you want to use the sleep training method to encourage the child to return to sleep independently at any wake-up that is not to eat.

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Reading your question I could not help by remembering the time when my youngest used to keep us awake at night for about a year... She started teething early, walking early (11 months)... and was like in a hurry to grow up. These were stressful times for her as a baby I assume... and for us, as parents it was really difficult. What we did was to take turns, each would wake up on his turn to care for the baby. In the cold winter months we placed her crib right beside our bed so we would not have to get out of our warm bedroom. One thing we did notice is that there are some basic principles to teaching your baby to (unless there are any real reasons for crying). Babies need to be taught the difference between night and day and that sleep time is at night. having a "ritual" you go through with your baby every night at sleep time would help a lot: that would teach the baby that whenever(for example) you listen to quite music, rocking in your arms, after having a warm bath and feeding... it is time to relax and fall asleep. I used to sing to my baby at bed time, talk to them in a relaxed voice, tell them it is night and time to go to sleep... etc... night after night, same ritual...

One final thing: eventually your baby will get used to sleeping through the night :) and you will have similar memories to the ones I have of these difficult sleepless nights.

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