The Journey to Sleep Despite Middle’s Reflux

Oh geez.  It’s been a month since I posted anything.

Why, you ask?

Sleep deprivation.  That is why.

Thankfully that all seems to be turning around.  Last weekend Baby Middle turned 6 months old.  We gave him a few teaspoons of avocado as his very first food.  To my delight, he actually slept for 7 consecutive hours that night!  He has been pretty consistent with those long stretches of sleep ever since then.  It’s been absolutely amazing!

I wanted to talk a little bit about what’s been going on with him for two reasons.  The first reason is because I just want to remember, and I know I’ll forget by the time he’s older!  Isn’t it c-r-a-z-y how quickly we moms forget things?  Things that we swear we will never forget, we do.  I’m so guilty of that!

Anyway, the second reason is just to empathize with other moms who may be having a tough time getting rest.  I feel your pain.

Baby Middle was such a challenge.  I began to worry when he was about 6 weeks old that he wasn’t sleeping well.  By that time you can usually expect to see some good long stretches, at least on some nights.  His sleep was getting worse, not better, and by 3 months I was really becoming frustrated.  When he turned 4 months old, I was beginning to truly unravel, and by 5 months I would say I was pretty close to feeling downright depressed.  Sleep deprivation can really take a toll on a family.  I can say that in my 5 months of being exhausted, it affected every area of my life.  I barely had the energy to take care of my baby, therefore everything else fell to the wayside.  It took a toll on my body, the way I parented my other child, my marriage, etc.  I had a part time job that I completely quit.  I didn’t even respond to any work related calls or emails during that 6 months.  It was just plain hard.

Of course there are a million reasons why a baby may not sleep well.  Maybe his parents aren’t proactive about helping him learn the skill of sleeping.  Maybe he doesn’t have a good place to sleep.  The schedule could be off.  He might be hungry.  Cold.  Hot.  It may be too light in his nursery.  He may need to swaddled.  Unswaddled.   Or he could be uncomfortable.  Maybe he’s gassy.  Maybe he has reflux.  Maybe it’s his ears.

Again, the possibilities are endless.  Middle was a loose cannon.  He was just such a fussy baby, and so often it seemed that the only way to calm him down was to lie down and nurse him in a dark room.  It became obvious right away that a schedule was not going to solve our problems.  Initially I tried a lot of gentle sleep training methods, such as standing next to his crib and talking softly to him and patting him while he tried to go to sleep.  There were many nights where I would let him lie swaddled next to me and return his pacifier dozens and dozens of times in the pitch black dark.  He would grunt, snort, cough, and cry, but he rarely slept.  There were nights that I would become so frustrated that I would just let him cry.  It rarely worked, and eventually I would be so frazzled and guilt-ridden that I would return to him and take it from the top.  At 3 months I called a sleep consultant.  She (we’ll call her Nancy) advised me to put him back in his swing until he was 4 months old.  Nancy also gave me a flexible feeding and nap schedule, and told me to follow it as closely as I could.

I had prayed that his sleep would improve by 4 months.  By no means did I expect him to sleep until the morning, but I was desperately hoping for a 5-7 hour stretch.  Unfortunately, 4 hours was about the longest he would go.  He’d sleep from about 7 or 8pm until 11pm or midnight, but then he would be awake every 1-2 hours after that and stay awake for hours.  He seemed to only fall asleep while nursing, but the moment I unlatched him, he would wake up and scream.  It was so very difficult, because I never got to sleep for more than about 1-2 hours at a time before I would be trudging back to his nursery.

At the time I was asking for advice quite a bit, and many people advised me to simply cosleep with him.  I hesitated for two reasons.  First of all, I honestly just didn’t like the idea of having to sleep with a baby in the bed.  I love baby snuggles as much as the next person, and I’m not opposed to cosleeping at all.  I just didn’t want to be stuck.   Second, I was battling a recurrent case of thrush.  Thrush is a really painful issue that some breastfeeding mothers face, and it makes feedings extremely painful.  Nursing a baby all night long in bed would have been torture during that time!

So at four months of age, when Nancy told me he was old enough to be formally sleep trained, I was on board.  To be honest, I was tired of second guessing my every move and glad to relinquish control to the expert.   Nancy and I had a 45 minute session on Skype to discuss Baby Middle.  She promised a custom sleep plan just for him and our family.  I was so relieved.  I totally trusted her!  She seemed so knowledgeable and understanding.  Her title as “Certified Pediatric Sleep Consultant” seemed pretty legit, and the testimonials on her website were impressive.

Let me first apologize for not thanking you and sending you the one million dollar check you truly deserve. You truly performed a miracle in our lives. Callie has been sleeping consistently since the third night of your consultation. We are forever grateful.

– an example of Nancy’s testimonials

Armed with a 16 page sleep plan for Baby Middle, we began Night 1 of sleep training in mid-December.  She instructed us to put him to sleep on his back, without a swaddle.  I was really, really hesitant to do that because he had been sleeping swaddled in his swing.  He still had a very active startle reflex (his arms would sort of jolt and wake himself up) and I also worried because he had never rolled from his back to his tummy.  Nancy promised that if we just let him become motivated enough, he would roll onto his tummy by himself and eventually learn to sleep face down.  When I asked her why I couldn’t just put him down on his belly to begin with, she warned me of all of the babies that die of SIDS each year and stressed that he had to figure out how to roll on his own.  She warned me that the first night would be the hardest, but that I really did not need to cave in.

I’ll spare you all of the gory details, but suffice it to say that we followed her instructions and it was a really bad night freaking train wreck.  Our son was not able to roll.  She had us go in every 15 minutes and return his paci to him, but that was all we were “allowed” to do.  From 7pm-3am we followed her instructions of going into his nursery every 15 minutes.  He fell asleep here and there but never stayed asleep for longer than ten minutes.  It was absolutely terrible.  Oatmeal and I finally looked at each other and said, “Um, this lady may be certified and reputable and an expert, but she is NOT here.  This is NOT her baby.  This is OUR baby, and this is RIDICULOUS.”  Oatmeal rolled Baby Middle onto his tummy and patted his back gently until he fell asleep.

For the remainder of the 10 day plan, we just put him down on his tummy to begin with.  Nancy seemed to disagree with us on this point, and in fact she even wrote me that “he should be capable of rolling at this age” in an email.  She didn’t seem to care when I mentioned that my older child didn’t roll until she was much older, either.  But we forged ahead and followed her every instruction.  Every hour of our day was planned out, as outlined in her 16 page custom sleep plan.  Here is just one section that I copied and pasted.  As you can see, there really wasn’t much for me to do other than follow instructions!

Nap #1:

Occurs between 7:30am-8: 30am. We don’t want to miss his biological sleep wave. So, even if he sleeps until 7:00am we will put him down by 8:30am. I would never suggest a nap to start before 7:30am or after 8:30am.

We must work on Middle’s wake times as much as sleep times. We want him napping on his biological sleep waves. During sleep training, try very hard to make sure the first 2 naps are in his crib, follow a feeding schedule and make sure to avoid car trips if he doesn’t nap well.

Nap #1 Times:

• If Middle wakes before 6am then we will leave him in his crib until 6am without checking in, nurse upon waking and give him a 7:30am nap.

• If Middle wakes between 6-6:30am, nurse upon waking you will do an 8:00am nap

• If Middle wakes at 6:30-7:00am, nurse upon waking, you will do an 8:30am nap.

 

Now to be fair, I think that the results of following this sleep plan would have been amazing had we used it on, say, Baby Poppyseed.  It just didn’t work for Baby Middle.  It was around day 3 or 4 that I began to really worry.  Middle had slept in 4 hour stretches prior to the sleep training, but now he slept in only 2 hour stretches.  He had learned to go to sleep unassisted, and could even put himself back to sleep after about 10 minutes if left to sort it out, but he literally never slept for more than a few hours.  Ever.

After the first week of sleep training, we stopped following all of the rules.  Sometimes you just need to hold a hand or pat a back.

After the first week of sleep training, we stopped following all of the rules. Sometimes you just need to hold a tiny hand or pat a little back.

Nancy was very confusing.  I was reporting to her each and every morning with every detail of the night before, and she became less and less helpful.  One time she said, “Lola, you need to stick to the schedule.  Do not return to him before the 15 minute mark or he will not learn to self soothe.”  In the next email she said, “I’m concerned that he might have reflux.  Have you taken him to your pediatrician lately?”  In the very next email, she contradicted herself with this little gem: “Lola, his issues are entirely behavioral.  He will sleep if you follow this plan as I have given it to you.”

At the end of the ten days, he was sleeping worse.  It was the week between Christmas and New Year’s, and I truly felt like a zombie.  A worried zombie.  I no longer felt that I had given birth to a stubborn baby.  I was certain that something was wrong with my child.  Nancy wasn’t much help.  She continued to respond to my emails, but I could tell she had somewhat thrown in the towel.  She suggested that my breastmilk might be to blame and asked if I would be willing to switch him to formula.  Well, if you know me at all you know that I have a very deep love for breastfeeding.  The thought of switching to formula was devastating.  I shed quite a few tears at the thought.

I returned to my pediatrician, who examined him and proclaimed that he was just “an outlier.”  She sympathized with me, telling me that she is mother to five children, and that she had been in my shoes.  I asked her about the possibility of Middle having reflux.  She responded that while he may have mild to moderate reflux, she did not treat reflux unless it was quite severe.  I also asked if I should try to give Middle formula for a few days.  Middle’s doctor seemed appalled that Nancy had suggested this.  She shook her head and said that breast milk was the best thing for my baby and told me to forget any other notion.  She only said I needed to continue avoiding dairy and other common dietary culprits, but made me feel so much better about breast feeding him!

I left that appointment feeling both relieved and defeated.  I couldn’t stop worrying that something may be missed.  I waited a few weeks and took him to see a pediatric ENT.  I am SO glad that I went, because he was diagnosed with several issues that completely explained our troubles!

  • Diagnosis #1:  Mild laryngomalacia.  I had to google that one, and I welcome you to do the same.  The doctor recommended no treatment plan and said he would grow out of it.
  • Diagnosis #2:  Moderate reflux.  The doctor was not sure that he had it, but recommended a 6 week trial of Prevacid as “a test and a treatment at the same time.”
  • Diagnosis #3: He failed the hearing test on one ear, and the doctor said that it is due to a lot of fluid behind that ear.  He noted that the fluid was not infected, so the best thing to do was simply to wait 6 weeks and get it checked out again.   We are actually going back to the ENT this week to have that ear checked.

Now if you know anything about me, you know that I’m just not going to give my child medication for 6 weeks unless I am 100% sure it is necessary.  I remembered our pediatrician saying that she did not treat with medication unless the reflux was quite severe.  She stated that she looks at weight gain as a big indicator of reflux.  If a baby is gaining well, she does not consider that to be severe reflux.  Well, Middle is HUGE.  He is gaining just fine and always has!   In addition to his weight, Middle was a pretty happy baby after he got past the 3 month mark.  He was colicky as hell until then, but after 3-4 months he was quite content during the day, as long as he was fed and loved on.

After some looking around online, I found that the American Academy of Pediatrics also advises that doctors not treat infant reflux/GERD with medication unless it’s extremely severe.  I read over and over again that the first thing a physician should do is counsel the suffering baby’s parent on dietary issues (if breastfeeding) and sleeping positions.  Our doctor literally did not ask one single thing about how Middle was eating, if I had addressed my own diet as a breastfeeding mom, or recommended sleep positioning options.  I wondered to myself why the ENT would skip the first steps and immediately prescribe medicine.

I was torn.  My gut told me that giving him the medication was not the right thing to do.  I worried about the side effects, the amount of time he would be on the medicine, and the fact that the ENT wasn’t even sure it was reflux to begin with.  On the flip side, I was exhausted.  Beyond exhausted. It had been over three months since I had slept for more than 2 hours at a time.  My average nightly sleep intake was probably 3-4.5 hours.  I was sort of desperate.

To make a long story short, I decided to try the medication for 1 week and see if it even worked.  And it did.  Middle had been sleeping for 2 hours at the most, but on the 4th night of medication he slept for 7 consecutive hours.  He continued that for the next few nights.  So I had my answer!  Reflux was the culprit all along!

I returned to his pediatrician for a followup and had a really long discussion with her.  I had done lots and lots of reading, and I wanted to ask her if my concerns were valid.  Were my worries about side effects completely overblown, or did I really need to consider taking him off of the medication?  I repeatedly read that reflux medication work by reducing the baby’s ability to make stomach acid.  This relieved the reflux symptoms, but unfortunately it also means that the baby does not absorb nutrients as well as he would.  A baby is growing more than he ever will again, so absorbing nutrients is important.  Stomach acid is there for a reason!   I also found a study that followed adult patients who took reflux medication for 8 weeks.  The medication helped in the short term, but when they stopped taking the medicine their symptoms returned with even more severity than before.  There are some researchers who speculate that the infant population would be no different.  Perhaps a baby given medication is more likely to suffer from adult reflux.  (These were some of the studies that led the American Academy of Pediatrics to change their guidance on treating infants with medication!)

It was a really difficult decision, but I decided to stop giving Middle the medication.  A few days after his last dose, he stopped sleeping for 6-7 hours and began sleeping in perfect 2 hour intervals again.  I had thought long and hard about what to do if and when that happened, because I certainly didn’t want to cause him any pain.  We decided to move him back into our bed after midnight so that he could night nurse. He is still a breast fed baby, and breast milk is a natural antacid.  For the next month we all got a little bit more rest.  I could finally cosleep with him without feeling like I was creating a monster or establishing bad habits, and by that time I had successfully treated my painful case of thrush.

IMG_7769

My sweet baby sleeping soundly in my bed.

Thankfully, Middle’s pediatrician supported my decision to discontinue the Prevacid.  I have not yet been back to the ENT, but I have an appointment with him in a few days.  I will just be honest when he asks me why I did not follow his advice.  I may even print out some of the articles that I read to show why I made the decision I did.  I want to be sure to let him know that I respect and value his opinion and vast knowledge of the topic, but that I just didn’t feel that it was the best decision for my baby.  Hopefully he moves past the topic of reflux and we are able to address his ears.

I should also mention that around this time I began taking Middle to the chiropractor twice a week, eliminated even more foods from my diet (garlic, onions, and broccoli in addition to the gluten and dairy), and even tried a few homeopathic remedies recommended by a naturopathic doctor.  I’ve given him probiotics since his first month of life, and I added an additional prebiotic supplement as well as an infant digestive enzyme.  I really was trying EVERYTHING!

So after a month of cosleeping with Middle and getting a little bit more rest, it was time to give him solid food.  I cannot say that he is sleeping perfectly or even coming close to sleeping through the night, but there has been a significant improvement.  I guess the avocado simply helps thicken up the milk, so it’s less likely to get projected back up into his esophagus while he sleeps.  He also began sitting up unassisted, so he spends much more time upright.  I think that really helps a lot too.

Overall, I am so thankful that we have seen this slight improvement.  Sometimes he sleeps for 8 hours, and sometimes he only sleeps for 3, but it’s BY FAR better than before.  I feel much more relaxed and far less anxious.  Nap times and bedtimes are no longer torture!  I pray that as he grows, his little digestive system matures and he outgrows the reflux completely and naturally.  I actually have a feeling that babies have suffered from reflux since the beginning of time, but only in the last few decades did it become a diagnosed and medicated issue.  Perhaps it is even our society that has caused this – we are all taught that if our baby is fussy or doesn’t sleep well then we must medicate him or her.  Maybe it’s just the name of the game called nature.

Who knows?  I’m just thankful that we seem to be on the other side of it, and I pray for all of you moms who need your rest.  I’m serious, I really will pray for you tonight.  I’m so sorry if I said or wrote something hurtful when Poppyseed was a baby and sleeping so well.  I was so sure that a baby’s sleep patterns were a result of parenting.  I have certainly been put in my place since then.

In case you’re interested, here are a few resources I found on reflux that helped me make my decision.

Gastroesophageal reflux:  Management Guidance for the Pediatrician

Separating Fact From Fiction in Pediatric Medicine:  Infant Gastroesophageal Reflux

Not all Reflux in Infants is Disease, According to AAP

How to Treat Acid Reflux in Babies Without Drugs

Naturally Treating Reflux, Heartburn, and Stroke Prevention

More Evidence to Support theory that Reflux is Caused by Bacterial Overgrowth

 

 

 

 

 

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Comments

  1. I feel your pain! My son did not sleep through the night until he was 10 months old!! Our pediatrician explained to me that when babies have reflux, they gain weight quickly because they nurse a lot. In order for them to “wash down” their reflux, they nurse even if they aren’t hungry and its like a vicious cycle. I debated medicine just as we’ll and finally gave in. I felt like he was miserable and apparently he was! He was a different baby 24 hrs later. Hope everything works out and you get some rest!

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