Q&A: waking in the middle of the night and screaming

Kate writes:

"Here's my question: My son, Brody, started sleeping through thenight at 4 months. He went 7 months without waking during the night. Suddenly, at 11 months, he started waking at midnight- we'll feed him and he'd go back to sleep. He'll wake again around 3-4 a.m., we feed him, and then he screams (and I mean SCREAMS) for 60-90 minutes before finally collapsing from exhaustion. We've tried everything- rocking him, gas drops, singing to him, CIO (which I hated), etc. Nothing has worked, aside from letting him sleep with either my husband or myself on the couch. Up until this point, he's never slept with us. It's been 3 1/2 months. Do you have any suggestions?
 
We do follow a very strict bedtime routine- dinner, then 30 minutes of playing, followed by a 15 minute bath, and a final bottle before bed at 8 p.m.
 
Is he too old to be sleep trained? If not, what method would you recommend?
 

Thanks for your help!"

            

I'm going to cut to the chase: I think your son has some kind of digestive problem of the reflux/heartburn/ulcer type.

Here's how I got there:

You've got the bedtime routine, so rule that out.

When he wakes up, it's not just to play, so I eliminated having the wrong nap schedule (some kids start waking in the middle of the night for playtime when they're on the verge of going from two naps to one because the sleep times are disturbing their body cycles).

It's been going on for 3 1/2 months, so rule out a developmental spurt, which would last a month or two, tops.

It happens every night, so it's not night terrors or nightmares.

He's waking up screaming from a dead sleep, which says to me that there's some kind of pain involved. Probably from lying flat, since he can only fall asleep on top of one of you.

My guess is that he's having some kind of stomach trouble while lying flat that makes him wake up and think he's hungry (so he eats again at midnight, and then again at 3) but then it just gets too painful and he wakes up and screams. You hold him upright for an hour, the pain goes away, and he can sleep again. That's the exact cycle I had when I had an ulcer 7 years ago. It hurts, but it feels like eating will make the pain go away, but then it actually just makes it worse.

I'm assuming he's getting a bottle of formula or milk at bedtime, then the same thing when he wakes up? During the day, does he get this same meal right before going down for a nap? If so, how are his naps? Or does he get bottles and then stay upright for an hour or so afterward? If he's staying upright, he won't have pain symptoms because all the acid will stay down in his stomach until digestion is in full swing.

You could try propping the head of his crib to see if he sleeps a little bit longer at an incline. If the pain is severe, though, that won't solve the problem.

The other thing I'm wondering is what changed at 11 months to make this start happening then. Did you change formula? Or switch to cow's milk then? If you didn't make any change in what you're feeding him at night, then I'd talk to your doctor to see if s/he can run some tests to see what's causing this. Since my experience is with ulcers, not reflux or heartburn, I'm thinking he maybe somehow got the bacteria that causes ulcers (helicobacter pylori), which they can find by analyzing a poop sample. But there's got to be a straightforward diagnostic path for reflux and heartburn, too.

I do not think this is a sleep problem. If it was, something would have changed in the last few months just because baby sleep changes all the time. It seems clearly pain-related to me. Try to watch and see what happens during the day when he has a bottle. Try propping the crib. Think back to anything that might have changed right before this started. Talk to your doctor (and emphasize the pain and screaming, so you don't just get the "let him cry it out" crap they sometimes try to hand you because they think you're just a "nervous first-time parent"). See what happens if you give him a banana or another food that is unlikely to cause reflux instead of a bottle in the middle of the night.

Then write back and definitely let me know what happens, because I'm going to be preoccupied with Brody's problem until I find out what the real story is.