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Multiples in School

To separate them or not? Parent Tips.

 

A concern of raising multiple-birth children is whether or not they should be together in the same class or separated and which would benefit each child’s personal development.  In some schools there may or may not be enough classes of the same grade to facilitate each child being in separate classes so the decision is moot.  Also some school systems have the blanket rule that all multiples must be separated.  In order to assist you in making the decision regarding placing your children, the following offers consideration for both separating the children and leaving them together.

Pros to Separation

Although there is no substantial evidence to support the policy that multiples must be placed in separate classrooms in order for them to grow and develop as individuals, there are some circumstances which would indicate that separation is advisable.  Here are some examples when separation may be in the best interests of each child:

  • constant “togetherness” is hindering the development of social skills in one or more;
  • a “division of labour” exists;
  • insensitive comparisons by teachers or peers have led to feelings of inadequacy in one or more of the multiples, “your brother can do his math, why can’t you?”;
  • the multiples form a “power unit” which is causing disruptive behaviour, won’t stay in their seats, throw objects at each other, constantly talking to each other;
  • the kids use their status to exploit, cheat or play tricks, e.g. bullying, exchange places, blame their sibling or others;
  • one or more of the multiples appears to resent the lack of privacy resulting from sharing a classroom “She won’t leave me alone,” sullenness on the part of one;
  • one multiple proves to be a constant distraction to the other;
  • in opposite-sex multiples, the female (usually) is overprotective or “mothering” of the male co-multiple;
  • in skill-grouped classrooms where the abilities of one multiple are far above those of his co-multiple; and
  • the multiples WANT to be separated.

Evaluations/observations of multiples’ behaviour and development need to be regularly as well as annually monitored as issues can be evident in one year and absent the next.

Cons to Separation

Sometimes there are valid reasons for keeping multiples together:

  • major emotional upheavals may have occurred within the family, e.g. death, divorce, moving house, illnesses, etc and the presence of their co-multiple can be a calming factor;
  • only one classroom is available;
  • unequal education due to two different teachers employing different teaching methods and each multiple’s learning abilities; and
  • multiples are at or near the same skill level in a skill-based classroom.

Recommendations regarding school placement:

  1. It is not recommended to separate multiples who want to be together. Forced separation can damage self-esteem, inhibit language development and delay learning.
  2. It is not recommended to automatically separate multiples in their first year of school. There are many firsts in primary school: lining up, waiting your turn, noise levels, day run by a clock, away from Mom and Dad, new routines, etc. so why should they also be separated from each other at such a young age? Separation can add to the stress of starting school and may actually increase the multiples’ need to be together.
  3. All multiples need as much independence as they are ready/able to handle. Multiples flourish when allowed to separate on their own timetable. Together or not can be evaluated each year. As the multiples grow older, they will have input as to whether or not they should or want to be together.
  4. Encourage multiples to choose separate classes and preferred activities as they gain confidence in the school situation.
  5. Decisions as to whether or not the children should be together needs to be made by a team approach: the parents, teachers and principal. Educators need to realize that parents know their children best and for an easier transition to school, a parental opinion needs to be considered.
  6. If multiples are in the same classroom, they can still be in separate settings within the classes.
  7. Especially if your children look alike, make it easy on the teachers and students and dress them differently so that they are easily recognized and seen as individuals;
  8. Parent/teacher interviews need to reflect how each child is doing as compared to the other children in the classroom and not in comparison to each other.
  9. You may wish to indicate you would like an interview per child. Sometimes teachers expect one interview to talk about the multiples together and that can be confusing and unfair as comparisons tend to be to each other rather than their peer group. When compared to each other, one or more is usually presented as “better” than the other(s).
  10. In middle school, I didn’t point out that my girls were twins as they were in separate classes and wanted them be evaluated on their own merits across the board. In a phone conversation with a teacher, my inner voice was letting me know it felt uneasy about the way the conversation was progressing. I felt the need to say, “You do realize that she is a twin?” (my girls do not look or act alike at all). “No,” she said, “I just assumed one failed. That explains a lot.” Without my speaking up, my one twin’s file would have reflected her as “Failed” for the rest of her school journey. Recognize when to speak up and when to let things be as normal and individual as possible.
  11. It is recommended that class placement in classes be evaluated on a case-by-case basis, reevaluations occur on a annual basis and that parents, teachers and principals are included in the decision-making. As the children get older, it is also recommended that they have their input considered as well.

 

Pat Preedy (UK) provides this important note for Parents:  “The critical thing is developing “mature dependence” starts as soon as the children are born.  For multiples who are mature dependents, it actually doesn’t matter whether they are together or apart – they function as individuals and enjoy being a multiple.”

 

Sources:

Multiples in School, Multiple Births Canada, www.multiplebirthscanada.org

Placement of Multiple Birth Children in School, A Guide for Educators, Multiples of America (formerly National Organization of Mothers of Twins Clubs, Inc.) www.multiplesofamerica.org

 

Additional Resources:

Web Site:  www.twinsandmultiples.org, Educational Web Site for Multiples in School, Pat Preedy, M.Ed., B.Ed. (UK) and Professor David Hay (Australia)

Books

Parenting School-Age Twins and Multiples, Christina Baglivi Tinglof, 2007

Understanding Multiple Birth Children and How they Learn, John Mascazine

The Joy of Twins by Pamela Patrick Novotny, 1988

Twins, Triplets, and More, Elizabeth M. Bryan, 1992

The Art of Parenting Twins, Patricia Maxwell Malmstrom and Janet Poland, 1999

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Mastitis and Blocked Ducts

The following is general information only. If you have any questions about any aspect of your health, please consult your physician.

Mastitis and/or Blocked Ducts are obstacles many, but not all, nursing women face once, or maybe several times, while nursing. Both are caused by babies or pumping not completely draining the breast(s). Here are some ideas on how to handle them.

Mastitis

Is a bacterial infection of the breast that can occur in breastfeeding mothers. It is different from a blocked duct, which has similar symptoms. A blocked duct feels painful, is swollen, red and a mass can usually be felt within the breast. Mastitis has these same symptoms with the addition of fever and greater pain. It is easy to get the two mixed up. The added sign of a fever is the key that it is mastitis. It is important to see a physician if you have fever, breast pain (in one or both breasts) and redness for more than 24 hours, as antibiotics will need to be prescribed. Once antibiotics are prescribed improvement will be noticed within 2-5 days. Continue your course of antibiotics until they are finished or there is a chance the mastitis will return.

NOTE: If you need antibiotics, it must be effective against Staphylococcus aureus. Amoxicillin, plain penicillin and some other antibiotics are often prescribed for mastitis but are usually not effective. Effective against this bacterium are: cephalexin, cloxacillin, amoxnicillin-clavulanic acid, clindamycin and ciprofloxacin. The last two are effective for mothers allergic to penicillin. You can and should continue to breastfeed while taking these medications. There is no need to pump and dump.

Mastitis does not harm the babies and continuing to breastfeed will speed up the healing process. If you cannot put babies to breast because it is too painful, try pumping as best you can and bottle feed the milk to the babies. This will also help keep your supply up.

Blocked Ducts

These (there may be one or more) can also be very painful, skin becomes “hot” and as lump(s) can be felt when massaging the breast. For treatment of these, hard, deep massage at the point of the clog while baby is breastfeeding can be used. It is painful but the only way to pass the clog is through massage to move it along, and then baby nursing will clear the duct. The released clog will not hurt the baby. There is no need to pump and dump with blocked ducts either.

It isn’t unusual to have one of multiple-birth babies be a stronger, deeper sucker than his/her sibling(s). Another idea for getting rid of a clog in a duct is to place the stronger sucking multiple on the “offending” breast, with his/her chin on the lump. Sometimes the baby can unblock the duct during the nursing session.
Other ways to relieve the swelling for both Mastitis and Blocked Ducts:

  • Heat applied to the affected areas helps healing;
  • Massage in a hot shower;
  • Rest helps with infection;
  • Fever* helps fight off infection;
  • Medication (aspirin, ibuprofen, others) for pain can be helpful; and
  • Two external ways to help with swelling and hotness:
    1) thinly sliced raw potatoes in the bra, and
    2) cold cabbage leaves directly from the fridge in the bra helps sooth. Believe it, they work!!

*Because of so many medications now available, parents get worried around a fever, and so they should. However, a fever has a purpose. The body heats up in order to kill off the infection. But that being said, IF YOU ARE IN ANY DOUBT AT ANY TIME, CONSULT YOUR DOCTOR as he or she is in the best position to properly diagnosis what is going on for you or your child/children.

Adapted from a Guide on Mastitis from The Ottawa General Hospital, and Handout #22 Blocked Ducts and Mastitis written by Jack Newman, MD, FRCPC.

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Simultaneous Breastfeeding (Photos Included)

Did you ever think you’d ever be considering nursing two babies at once? Probably not. I know I didn’t. Also known as tandem nursing or breastfeeding, simultaneous feeding can be an effective way to get both babies on the same schedule, and save you a significant amount of time in the long run!

Settle yourself in a comfortable spot and have both babies within reach. It isn’t unusual to have one baby who is a better sucker than the other. If this is you, latch Baby A, the “better sucker,” on first. When the Baby B is ready to be latched, take your free arm and place it over, around ultimately underneath Baby B with your palm supporting his head. Lift Baby B to your breast and you an focus on making sure he is properly latched. With practice, you will be able to hold your settled Baby A in place with your elbow to leave your lower same arm free to help latch Baby B. Make sure that you bring the babies to you and not you to the babies or you very soon get a sore back. Good posture is essential.

When nursing triplets, you might have Baby C in a chair on the floor in front with a propped bottle of breast milk simultaneously feeding. OR as an alternative and if that Baby C is not fussing, you may wait until Babies A and B have each nursed at least 10 minutes, then put Baby C to the each breast for 5 MINUTES each side. The demand will quickly increase your supply. Keeping a record of which baby fed where will be essential, and at the following feed, Baby C will be one of the ones to be tandem fed at the breast. In other words, rotate them each feed. The Jumelle Twin and Baby Tracking App will help you easily keep track of which baby fed when, where and for how long.

Ask anyone nursing multiples, and they will tell you that simultaneous breastfeeding is also a challenge, requires focus and patience and everyone practices getting latched and fed. It is worth the effort though and as the babies mature, things get easier. As a mother of multiples, you likely have questions about how to most effectively feed your babies. Sometimes the responsibility of feeding more than one baby can feel overwhelming, and you may worry that you won’t produce enough milk. Despite its many challenges, simultaneous breastfeeding is a great time saver! It will get your two babies on the same schedule, and can therefore be worth the effort. If you plan ahead and receive the support you need, you can certain successfully breastfeed two babies. If at any time you are feeling overwhelmed or worried about your babies’ weight gain, see a certified, registered lactation consultant who is familiar with simultaneous breastfeeding and she can properly assess what is going with you and your precious bundles.

Following are some drawings and photos which demonstrate a variety of positions for simultaneous breastfeeding of two babies/toddlers through a combination of holds: cradle holds, football holds, one lying down and then in a saddle hold while the little ones sit on Momma’s knees. Finding what works for you and your babies will make things run smoothly. Keep in mind that as the babies grow, by necessity, you may need to look trying other positions.

It may be that back-to-back feedings are what works best for your family, even from time to time.

If you find one or both babies are scratching you and pinching your breasts as they feed or maybe poking at each other, this is normal behaviour but it is also painful. A couple of hints to handle such a situation is to either put socks on their hands before each feed (they stay on better than mittens), or wear a nursing necklace for the babies to fiddle with. Some Moms wear two necklaces in case of competition. The idea is to provide some distraction to stop the painful behaviour.

 

0 comments on “Keeping Singleton Siblings, Entertained During Multiples’ Feeding Times”

Keeping Singleton Siblings, Entertained During Multiples’ Feeding Times

It is only natural to wonder and worry about how to cope with or entertain young singletons while nursing or bottlefeeding newborn multiples.  It is difficult to imagine how that scenario might work and, in fact, you might tend to be leaning towards anticipating some chaos and upheaval as you try to figure out how to spread yourself around.  If this resonates with you, your feelings are normal.

Feeding times may run more smoothly depending upon the age(s) of your singleton(s).  The younger they are, the more likely they will require some type of attention from you, especially while you are least able to provide it.  Things may run more smoothly if there are at least two older siblings as they will have each other to connect with and play.  While an older child may take the opportunity to act up when you are tied up feeding the babies, there are some families who will have no issues at all during feeding times.

Simultaneous feeding of the babies, and depending upon how premature they were, may take anywhere from 20 to 30 minutes at each feeding session.  If you are feeding the multiples back to back (i.e. one after another), it may take closer to the 30 minutes per session. This is an approximation of how long a period an active, older sibling(s) may need some entertaining.

Here are some of those ideas for you to consider regarding entertaining your older child.  Mixing up the activity from time to time can help your singleton avoid getting bored with any set activity.

1.  Use one of the larger twin-nursing pillows which are wide enough to safely accommodate two babies so they can nurse or bottle feed while you have two arms free to engage with your singleton if you need to.

2.  Choose a location to feed the babies that will allow him/her access to you or be near you.  You might choose the couch, or the living room floor, with you leaning back against the couch for back support.  A child-size table and chair can be located near you for his/her special activity.  Some parents like their large bed. Keep in mind that beds tend to be soft and may not have enough back support for you to nurse the babies without your back going into spasm.

Mother nursing twins with older child nearby

3.  Set aside a special toy(s) or activity (colouring, crayons, building blocks, plasticine/play doh, [paints are potentially too messy], etc.) which only appears while you are feeding.  Having items already stored in plastic containers makes for easy accessibility as you get ready to nurse hungry babies.

4. Have an closed drink box or sippy cup handy so there is a drink available.   Consider some small snacks (cheese cubes, apple slices, crackers).

5.  If s/he is not toilet trained, have a pull-up diaper nearby in case you need to do a quick change.

6.  You can read together or put a story on a recorder that s/he could listen to beside you.  You might discuss the story after it is completed should the babies have not finished feeding.

7.  When you are done nursing, give him positive feedback, even if his behaviour is not quite perfect with helping you feed his babies.  Any negative behaviour should disappear as he learns the routine, notes the special attention focused on him even while you are feeding the babies, and the re-enforced positive feedback afterwards.

8.  For an older child with more advanced hand-eye coordination, consider offering them “sewing” cards, paint by numbers sets or working on a puzzle as a creative activity.  Maybe a child-focused iPad or tablet, which only comes out at feeding times.  You know your child best if these more advanced activities would be appropriate or of interest to them.

Does all this sound scary and seem over whelming?  No doubt, but give yourself and all your children a little time to get the routine in place.  Be patient, keep your child in the loop by explaining what is going to happen and make this time fun, upbeat, special and something to look forward to.  Things will generally move forward in no time at all as you all learn what to expect.  Making your older child(ren) part of the solution rather than part of the problem is helpful and letting him/her know that his/her co-operation is a huge help to the family can quickly bring him/her on board.

Reviewed by Bonnie Schultz

0 comments on “11 Breastfeeding Tips”

11 Breastfeeding Tips

NOTE: The following suggestions on breastfeeding multiples are provided as information only. If you have any concerns about your particular situation, please check with a Lactation Consultant or your doctor.

Your breasts are going to make milk anyway, so why not give it a try and see where it leads? You may be pleasantly surprised!

  • If you run into any difficulties breastfeeding, get help right away. Don’t wait. Sometimes the answer(s) is very simple and a consultation with a Lactation Consultant may identify the problem and have everyone back on track very quickly.
  • Yes, enough milk can be produced for two or even three babies. Milk production is based on demand and supply. Frequent nursing stimulates breasts to meet nursing demands. Three things postively impact milk supply and production: a) frequent feedings of the babies; b) healthy eating, drinking and snacks; and c) keeping stress levels as low as possible.
  • Simultaneous feedings help get babies on the same schedule and saves an enormous amount of time. Most mothers of multiples feed simultaneously or one after another. Your babies will let you know which method works best for them.
  • Breastfeeding twinsAlternate breasts at each feed. It will be necessary to prepare a schedule so that you can remember who ate at which breast and when. By alternating breasts two important issues are addressed: a) one baby may be a better (stronger) sucker than the another thus stimulating the breast differently. Therefore, alternating breasts encourages both breasts to produce enough milk; b) when a baby only nurses at one breast, the lower eye doesn’t get equal opportunity to focus, look around and strengthen (an older nursing baby [i.e 6 months or so] will always look up, make eye contact and smile at you – it makes one’s heart turn over with love). Alternating breasts gives each of the baby’s eyes a chance to perform properly.
  • It isn’t unusual to have one baby who is a stronger sucker . When settling down for a simultaneous feeding, put the stronger sucker to the breast first then spend time settling and arranging the second baby. Keeps everyone happier.
  • For triplets or more , it may be necessary to introduce some formula before the milk supply is fully established. There are a couple of choices within this situation: a) top up each baby after a breast feed; b) feed two by breast and one by bottle, alternating who gets which at each feed (a schedule will need to be kept for equal opportunities). A helpful idea for increasing breast milk with triplets is to feed two babies, at each breast, followed by the third one on each breast. S uch a routine provides optimum opportunity to increase milk supply to meet the demand.
  • If you can, pump after each feed , collecting and freezing pumped breast milk for bottle feeding. Label and date the bottles. Following is a guide for storing breast milk:
    At room temperature – 10 hours
    In the fridge – 8 days
    In a fridge freezer – 2 weeks
    In a deep freeze – 6 months or longer

    Previously frozen breast milk can be kept in the fridge for 24 hours. Do not refreeze previously frozen breast milk.*

  • Never microwave breast milk . The high temperature affects its nutritional value. Breast milk defrosts very quickly in a bowl of hot water in the kitchen sink. The milk itself need not be hot, room temperature will do.
  • Using a twin nursing pillow is a real advantage. This larger pillow can comfortably cradle two babies at a time and allows burping/changing one while the other continues to feed.
  • Breast feeding is a learned art , for both mother and babies. Be patient, give it time and, if necessary, get some help.
  • Babies hit a growth spurt at about 6 weeks. As a result, they may feed more often. Many Moms interpret shorter times between feeds as they don’t have enough milk. Consequently, they become discouraged and quit nursing. Continuing to nurse will soon rebuild the milk supply to meet the demand. Don’t give up too soon.

Mothering Multiples: Breastfeeding & Caring for Twins & More, by Karen Kerkhoff Gromada, La Leche League International, 1999

Other Resources

0 comments on “Breastfeeding Premature Multiples”

Breastfeeding Premature Multiples

A singleton gestation is based on 40 weeks, twins on 38, triplets on 36 and quads on 34. Many multiples are born prematurely, from days to weeks early.

For parents of multiples wishing to breast feed their babies, the extent of the babies prematurity can impact breast feeding success. Mother’s milk provides superior nutrition, protects against disease and enhances infant development. In short, it is perfectly made for babies, especially when they are premature. While premature birth complicates the breast feeding of these infants, with knowledge, patience, perseverance, and good support systems in place, breastfeeding can be successful and any amounts of breast milk they can receive is beneficial. Following are some ideas and suggestions to help you, your partner and premature infants successfully breast feed.

  • Whether or not you have decided to breast feed your infants, your breasts will produce milk. This early milk is called colostrum and it contains high levels of antibodies and other substances that protect babies against infection. Therefore, pumping this colostrum and feeding it to the babies makes a lot of sense, and will ensure that they benefit from its important life-supporting properties.
  • One of the last things to develop in the few weeks before birth is the sucking reflex. Thankfully babies can learn how to suck and swallow and that is one of the reasons you will sometimes see some babies in the nursery with a soother. They are practising sucking and swallowing. If the babies are a few days or even weeks premature, you may be able to put them to the breast right away and with a little coaxing, trials and patience, they will learn to latch on and suckle. If the babies are very premature (4 or more weeks), you will have to pump as they will be too tiny and weak to take the breast.
  • At the beginning of each feed a baby gets the foremilk. This stimulates and releases the hindmilk, which is higher in fat (for growth) than the foremilk. It is important that either nursing or pumping lasts long enough to stimulate the let-down of the fat rich hindmilk.
  • When expressing breast milk, expect to pump 8 to 10 times in a 24-hour period. It is helpful to also pump during the nights, as if you were getting up to breast feed term babies. This round the clock pumping will help you establish your milk supply.
  • Once nursing or pumping has been established, supply and demand keeps breast milk forming and flowing. The more the babies feed, or you pump, the more milk your breasts will produce to meet the demands of your growing babies. Remember: make sure you pump frequently, drink lots of fluids and keep your stress levels low. All of these affect the quantity of milk available for your babies.
  • Your doctor, healthcare provider, lactation consultant, doula or midwife can help you decide when to transition from expressed breast milk to putting your babies to the breast. Factors that can help decide when the time is right, will depend on each babies’ ability to suck, breathe and swallow. Each baby will reach this goal at his or her own rate.
  • Premature infants are notorious for falling asleep before their wee tummies are full. While it is wonderful to hold and cuddle each baby, it is important that their tummies be full. You may need to encourage them to continue feeding by undressing them, holding one outstretched in front of you to encourage burping in case that is giving him the feeling of being full or moving them around in your arms to discourage sleep.
  • Initially breast feeding may be a challenge with your premature infants. Don’t give up! Take your time, choose a relaxing place to feed, stop and begin again if need be, and don’t be afraid to ask for help. Talk to the nurses in the NICU unit, check in with a lactation consultant. Babies aren’t born knowing how to breast feed and sometimes with a small adjustment from a knowledgeable source you can all be back on track very quickly.
  • You may wish to begin feeding your babies one at a time until you feel comfortable. If you take this route, the milk stimulation in one breast may also cause a let down in your other breast. Having a sterile container nearby to catch any let-down will make sure that not one drop of your milk is wasted.
  • This double let-down can have a silver lining when feeding two babies simultaneously. It isn’t unusual to have one baby be a stronger sucker than another. Put your best sucker to the breast first then you can spend a little more time adjusting your second baby, plus s/he gets the benefit of the simultaneous let-down without even working hard for it.

Resources

Breastfeeding Your Premature Baby, La Leche League International

Web Sites

Multiple Births Canada, Breastfeeding Support Network
Breastfeeding Online
Dr. Jack Newman, The Newman Breastfeeding Clinic
La Leche League International

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Breastfeeding Multiples: Pumping Tips

There are a variety of reasons why a mother might want or need to pump: for preemie or sick infants; to increase her milk supply; to maintain her supply; for when she goes back to work, to name some.

The purpose of this article is to address some of the situations when Mom may need to pump for her babies, and to offer pumping tips.

  1. Begin regular pumping as soon as is possible after their births. Short, frequent sessions are better than long, infrequent sessions.
  2. Choose a quiet, private spot with comfortable seating.
  3. Moms of multiples will usually double pump for efficiency and because they are typically set for simultaneous letdown. Using a double pump will allow you to take advantage of the simultaneous letdown. In addition, double pumping saves a lot of time rather than pumping one breast at a time.
  4. When nursing one baby, pumping the other side takes advantage of the simultaneous letdown. This may help with better milk production so that one multiple, who may be having difficulty breastfeeding, also has enough milk available. Getting organized for such a scenario may take a little practice.
  5. It may be helpful to establish the proper ‘mood’ for expressing, have photos of your babies around you, perhaps listen to a tape of soft music.
  6. Dad/Partner can massage Mom’s back, shoulders and neck to help with relaxation. Bring her a drink, keep Mom company, wash, sterilize pumping bottles/tubing so they are ready for the next pumping session.
  7. It is important to surround Mom with proper support to ensure a successful pumping session.
  8. Eat nutritiously, rest, minimize stress levels and drink plenty of fluids.
  9. Typically newborns breastfeed 8 times or up to 12 to 14 times in 24 hours. Simulating a newborn’s feeding routine helps produce more milk. While each pumping session may take 10-20 minutes, the length of time will vary with each woman. Continue to pump as long as you have a good flow.*
  10. The opposite will also help with milk supply: pumping when there is low or no flow, helps stimulate the breasts for the next day.*
  11. Keep a record of the date and time of pumping and how much is collected. This will clarify if pumping is occurring often enough to keep the breasts stimulated to produce.
  12. To keep on a newborn’s nursing schedule, set a timer during the night to ensure that you wake up and pump at appropriate intervals.

Storing and Handling Expressed Breast Milk

Most Neonational Intensive Care Unit’s (NICU) have procedures in place for storing and handling expressed breast milk. If your babies are in the NICU, you will need to acquaint yourselves with their regulations. Ask the staff if the hospital provides sterile containers for expressed milk. Your hands will need to be thoroughly clean as will all parts of the pump that come in contact with your milk. Sterile containers will need to be clearly labeled with each baby’s name, date of expression, and perhaps a hospital identifying code prior to being placed in the refrigerator. If you are on any medications at all, you may need to also note what they are on the container label.

Breast Milk can be stored in clean, sterile containers:

  • At room temperature (25C or 77F) for 4 hours
  • In a refrigerator (not the door) for 48 hours [fresh]
  • In a refrigerator (not the door) for 24 hours [frozen]
  • In a refrigerator freezer compartment for 2 weeks
  • In a freezer compartment with a separate door for 3-4 months
  • In a deep freeze for 6 months

Frozen breast milk takes no time at all to thaw in a saucepan filled with warm water. Do not heat breast milk on a stove or in a microwave. Do not refreeze breast milk.

Sore Nipples

If nipples become sore during pumping, make sure that your nipples are properly centered within the suction cup. It is easy to become distracted during pumping and inadvertently shift the equipment. Some mothers report that applying a small amount of modified lanolin cream is helpful. If problems continue, contact a Lactation Consultant or La Leche League member. Don’t wait for the pain to become severe.

Types of Pumps

  1. Electric: efficient, thorough, expensive, can be rented by day, week or month
  2. Battery: good for occasional pumping or not near electrical outlets, not as efficient as electric
  3. Manual: takes a long time to pump, not practical for women who pump often, inexpensive
  4. Hand Expression: difficult for some to master, inefficient, helpful for emergency such as engorgement.

Available Pumps

Medela double pump, lactina, the Avent is is a good manual pump for double pumping.

Some considerations: Find out about the level of suction of the pump. Some can be very strong and some inefficient. Are the instructions for using it clear? Does the company have a 1-800 number if you need to ask questions? Some drugstores and hospitals rent pumps, which can be quite expensive. Some Lactation Consultants offer rentals. Check out the Yellow Pages. Do your homework to find out what works for you.


With input from: Erin Shaheen, Child Birth Educator and Mom of 4 breastfed babies, including twins; and Valerie Lavigne, Chiropractor and Mom of 3 breastfed babies, including twins.

Bibliography

*Mothering Multiples: Breastfeeding & Caring for Twins or More!!! by Karen Kerkhoff Gromada, La Leche League International

Resources

Multiple Births Canada, Breastfeeding Support Network

Multiple Births Canada’s Breastfeeding Multiples Fact Sheet Series
Guidelines for Transporting Breast Milk to NICU
-Breastfeeding Multiples: Fathers/Partners
-Breastfeeding Multiples: Nipple Pain & Vasospasm
-Are My Babies Getting Enough Breast Milk?
-Breastfeeding Multiples: Resources
-10 Tips to Successful Breastfeeding

La Leche League International

Additional Reading

Multiple Blessings, Betty Rothbart, Hearst Books, 1994
Your Premature Baby, Nikki Bradford, Firefly, 2003
The Joy of Twins and Other Multiple Births, Pamela Patrick Novotny, Crown Trade Paperbacks, 1991
Feeding Your Baby the Healthiest Foods: from breast milk to table foods, Louise Lambert-Lagacé, Stoddart, 2000

0 comments on “Guidelines for NICU”

Guidelines for NICU

It isn’t unusual for twins, triplets or more to be born preterm (i.e. before their due date) and having to spend days, weeks or even months in the Neonatal Intensive Care Unit (NICU) as a result. For those families wishing to breastfeed, it is possible to do so by pumping and bringing in breast milk to the NICU to be fed to their babies.

To ensure the best quality milk for your babies, here are some recommended collecting and storage guidelines of breast milk. Remember that every drop counts and whatever is collected is the best thing for your infants. If you have any questions regarding your milk supply or how to conserve it, be sure to ask the NICU staff.

Storage and Sterilization

  1. Purchase some bottles and labels to store the milk. The bottles need to be boiled and sterilized before each use. Bags are not appropriate for storing milk in the NICU.
  2. Clearly label each bottle, including the babies’ names, date and time that the breast milk was collected.
  3. Ideally prepare bottles of 1 ounce, 2 ounces or 4 ounces, if you can, for storage.
  4. Do not overfill the bottles as breast milk expends when it is frozen.
  5. Make sure all pump material is properly cleaned and sterilized between uses.

Storage Times of Breast Milk for Preterm Infants

Storage time
Freshly expressed milk Room temperature 25C or 77F 4 hours
Refrigerated milk (store in back not on door)4C or 39F a)Refrigerator (fresh milk)

b)Refrigerator (thawed milk)

a) 48 hours

b) 24 hours

Frozen Milk (Store at back, not in door. DO NOT REFREEZE) a) Freezer compartment inside refrigerator door

b) Freezer compartment with separate door

c) Deep freezer not attached to refrigerator

a) NOT RECOMMENDED

b) 3 Months

c) 6 months

Transporting Milk
(freshrefrigerated or frozen)15C or 60F
Packed in insulated cooler with ice or “ blue ice” 24 hours

 Transporting Breast Milk to NICU

Fresh breast milk can be refrigerated and transported to the NICU on ice or “blue ice” packs in a little insulated cooler. Once at the NICU, give your labelled breast milk to the nurse in charge of your babies to be placed in the refrigerator or freezer.

If you have any questions regarding these procedures or about breast feeding in general, be sure and talk to the nurse in charge of your babies. Hospital staff will be most happy to answer your questions and help you at any point.

If you have any questions regarding pumping or storing your breast milk, do not hesitate to discuss them with the nurse or lactation consultant.

Your breast milk is important to your babies. Save ALL the milk that you pump.

References

  1. Lots and lots of great, supportive, every-topic-you-could-think-of information and resources on breastfeeding, www.themilkmeg.com
  2. Hamosh M, Ellis LA, Pollock Dr., Henderson TR and Hamosh P. Breastfeeding and the working mother: effect of time and temperature of short-term storage on proteolysis, lipolysis, and bacterial growth in milk.Pediatrics Vol. 97, issue 4 pp. 492-498
  3. Lauwers J, Shinskie D., Counseling the Nursing Mother: A Lactation Consultant’s Guide, 3rd edition p.351
  4. Riordan Jan, Breastfeeding and Human Lactation, 3rd edition. p.378-382

From Valerie Lavigne, Mom of three breastfed babies, including twins.
Adapted by Lynda P. Haddon, Multiple Birth Educator,www.jumelle.ca 
Reviewed by Erin Shaheen, Child Birth Educator, Mom of 4 breast fed babies, including twins.

Other Resources:

Multiple Births Canada Fact Sheet: Breastfeeding Multiples: Pumping Tips

0 comments on “Vanishing Twin Syndrome (VTS), Part 2”

Vanishing Twin Syndrome (VTS), Part 2

This article is for information and overview purposes only and does not represent every possibility or situation.  If you are concerned about any aspect of your pregnancy, please consult your doctor as affects your particular situation.

The use of diagnostic ultrasound imaging has made it possible to determine as early as five or six weeks that Mom is pregnant. Ultrasound (US) picks up the fetal heartbeat(s) allowing the medical team to also determine how many fetuses are present. In some cases, two or more fetal heartbeats can be found leading to excitement and some trepidation for the expecting parents. The use of US to determine pregnancy at such an early stage, however, has also identified another issue which might occur known as Vanishing Twin Syndrome (VTS).1  For women experiencing VTS, during a subsequent US (up to about 12 weeks gestation), one or more fetal heartbeats may no longer be found. The empty sac may, or may not, be visible on the screen.

In years past, women had their first US after the 12th week of gestation therefore eliminating the possibility of knowing that they were initially carrying more than one fetus. The availability of US as early as the 5th week of pregnancy has allowed researchers to conclude that the rate of multiple-birth conception is much higher than previously thought. It is estimated that one in eight people may have started as a twin, but only one in seventy pregnancies actually resulted in a twin birth.2  VTS usually has no symptoms, but sometimes a pregnant woman might have unexplained bleeding, cramping or passage of tissue in the week(s) in her first 12 weeks of pregnancy. Such symptoms could indicate the loss of a multiple pregnancy, a blighted ovum, or in some cases nothing at all. Not all cases of VTS are associated with any outward signs and many women continue with an uncomplicated pregnancy and the birth of a healthy child(ren).

VTS does not just occur with twin pregnancies, but can occur within higher order multiple sets as well. The loss of one, or more, embryo in the first trimester can be emotionally devastating for expecting parents. For example a couple was 8-1/2 weeks pregnant with triplets when they registered for a multiple-birth prenatal class.  When they arrived for the class at just over 13 weeks pregnant, they advised that a subsequent ultrasound had shown that they were now carrying two babies, and an empty sac had been visible on their latest ultrasound.  The couple had a difficult time because two other couples in the group were carrying triplets and they realized they were no longer part of that special group.  In such cases, referral to counseling may assist expecting parents in dealing with their early fetal loss and allowing them to celebrate in their continuing pregnancy.

Risk factors for experiencing VTS are generally unknown but seem to include a maternal age over 30. If the vanishing fetus occurs in the first trimester, as it does in most cases, no medical intervention is usually necessary. The mother, the placenta or the surviving co-multiple may absorb any miscarried fetal tissue within a few days.

VTS does not generally affect the ability of a woman to conceive again, although there could be underlying genetic or health issues that should be explored with a physician.

While VTS usually poses no problem physically for the mother or the surviving child(ren), it is not uncommon for mothers to have feelings of disappointment, grief and loss as they had anticipated and looked forward to a multiple-birth.3  As the pregnancy continues with at least one healthy child, these mothers may be told that the loss isn’t important or to focus on their healthy baby. It can be difficult for mothers to find acceptance or a safe place to grieve this loss as family and friends fail to understand that a unique parenting experience has also been lost as well as a much-wanted child. Women and their partners experiencing VTS are encouraged to seek counseling if feelings of depression, sadness, or anxiety continue.  Local and national parenting support groups may offer networking opportunities for parents who have suffered from VTS.

Vanishing Twin Syndrome (VTS), Part 1

See Part 1 of this article, Vanishing Twin Syndrome (VTS)

References

1) De la Fuente, G., Puente, J., Garcia-Velasco, J., & Pellicer, A. (2011). Multiple pregnancy vanishing twin syndrome. In Biennial Review of Infertility (pp. 103-113). Retrieved from http://link.springer.com/chapter/10.1007%2F978-14419-8456-2_9?LI=true

2) Heim, S. (2007) It’s Twins! Charlottesville, VA: Hampton Roads Publishing.

3) American Pregnancy Association. (2007). Vanishing Twin Syndrome. Retrieved from http://americanpregnancy.org/multiples/vanishingtwin.html

Additional Resources

Mothering Multiples, by Karen Kerkhoff Gromada, La Leche League International

The Art of Parenting Twins, by Patricia Maxwell Malmstrom and Janet Poland, Ballantine Books

Twins! Pregnancy, Birth and the First Year of Life, by Connie L. Agnew, Alan H. Klein and Jill Alison Ganon, Harper Perennial

0 comments on “Grandparenting Multiples: Hints, Do’s and Don’ts”

Grandparenting Multiples: Hints, Do’s and Don’ts

Lynda gratefully acknowledges the support and input of two Exceptional Grandmothers, Adiva Sotzsky and Sue Purdon, in preparing this article.

I love the bumper sticker that reads “If I had known what fun having grandchildren were, I would have had them first!”

Grandfather with twinsBasically that says it all. A time of their lives that many parents look forward to is to the time they will become Grandparents. While we have enjoyed (and asked ourselves along the way “What the heck am I doing?  I am useless at this!”) the journey of raising our own children, the time of becoming a grandparent, is an exciting and natural progression in Life’s Journey. But wait a minute, there’s more – not only are you to become grandparents, you are to become grandparents to twins, triplets, quadruplets or more. It doesn’t get more exciting than that?

As parents yourselves, you have “been there, done that” and when your grandchildren arrive, it can be very tempting to rush in, offering advice, shortcuts, feedback and opinions regarding parenting style to the new parents. Add to that the 20/20 hindsight of your own parenting experience, and of course you have lots to offer! Who wouldn’t want to share their years of experience with the ones they love and to help them avoid some of the mistakes you made? After all children don’t come with instructions.

Grandmother with multiplesAh, if it was only so simple. Grandparents are an important part of the childrearing equation but grandparents also walk a very fine line. It isn’t unusual for grandparents to either attend the births of their grandchildren and/or to at least move into the family home for a few weeks after the births to help the new family establish routines and get accustomed to their roles as round-the-clock caretakers. The more difficult part of the equation for grandparents, is to support the family while allowing the parents (i.e. their own children whom are now parents) to discover their own balance, make their own mistakes and find their own comfort levels. Grandparents need to remember that, while their children’s parenting choices may not mirror their own, these new parents have a right to learn in the their own manner and also benefit from the expertise and helping hands around them. It is a wise grandparent who knows when to be loving, sympathetic, caring and when to also hold his/her tongue.

Children greatly benefit from contact with the different generations. As a result of such interactions, children have a first hand “peek” into their history, roots and Family Tree, learning about “the olden days” as stories from their grandparents’ lives unfold. We all like to know about our roots and where we come from and children are no exception. Such stories from grandparents offer a sense of belonging, comfort and continuity. Along the way, the grandchildren can also enjoy some special attention from their grandparents. Prolonged bedtimes, favorite foods or the relaxation of parental rules and regulations make the grandparent-grandchild relationship unique.

There is no doubt that being a grandparent is a rewarding and exhilarating experience. But (yes, there is a “but”), there are some very important points to be aware of which can help grandparents be an important, loving, caring, sharing part of their grandchildren’s lives.

Being grandparents to multiples involves some additional layers of which even the most involved grandparent needs to be aware. The following hints and tips have been prepared to assist you in being the best support system you can be, while remaining a positive, caring and extremely important person in not only your grandchildren’s lives, but in the lives of their parents’ as well.

Congratulations on becoming the Grandparents (or Great-Grandparents) of twins, triplets, quadruplets or more!!!

Before your multiple-birth grandchildren arrive, educate yourselves so that you can get an accurate idea of what having twins, triplets or more entails. There are many excellent books on multiple births available which can enlighten you as to what the parents are facing.  You can find some of the titles here.

You may wish to talk to other parents or grandparents of multiples or join your local Multiple Birth Support Chapter. They have regular meetings, educational speakers, can recommend appropriate Internet Sites and much more. Many Grandparents have taken my Multiple Birth Prenatal Classes to learn firsthand how they can be the best support they can be to the new parents. Grandparents have taken the classes and passed along the information and handouts to their children who live in areas of Canada with no such prenatal support systems. They have even sent prenatal information Overseas to their families posted abroad. How’s that for commitment?  Educating yourselves before the babies’ arrival will assist you in becoming a positive and supportive Grandparent and a tremendous asset to the new parents. 

If you are parents of multiples yourselves, you already have a pretty good idea of what the parents will be facing. Nevertheless, it will be important that you remember to be supportive to the parents and not try to compare your own parenting experiences with their current one. Even in one generation, times and parenting practices can change. It is important to remember that the new parents need love, support and their own chance to parent. They don’t need judgments or unsolicited remarks.

Which leads us to: Don’t give advice unless you are asked. Remember that everyone is learning and doing the best that they can. The parents are no doubt already feeling overwhelmed and somewhat out of control. In the heat of the moment, unsolicited advice or judgmental comments will not make things better. It is very tempting to sometimes speak up and offer advice, but the wise person knows when to keep quiet. If you really feel that you may have a piece of helpful advice, wait until a quiet moment and express yourself using supportive, caring and loving words.

Here’s another important rule: Don’t judge your children’s parenting style. The advice and experience that you have accumulated cannot be denied, but it is important to remember that you remain the Grandparent and not the parent. If you do step in and either comment or “take over”, you will be undermining the parents’ authority with their children. While you may not agree with the parents’ choices or decisions, they ultimately, have the final say.

You have an important contribution to make each time you visit. The new parents are on duty 24-hours a day (remember?). They may be sleep deprived, falling apart at the seams, overwhelmed and feeling very guilty about it. You might take the initiative and suggest that the parents take a little break. For example, suggest they go for a walk around the block, to a movie or a local coffee shop for some relationship time. Or you may offer to take one baby for a walk in order to change the family group dynamics for a short while. Even these small respites can be valuable for everyone in the family.

If you are in doubt about how to help out, ASK what you can do to assist. Let the parents tell you what they need. It could be anything from throwing in a load of laundry, preparing a meal, bathing a baby or just listening. Do not underestimate the healing power of listening (with no judgments, of course). You can no doubt remember how overwhelmed you felt at times. While the feelings of being overwhelmed will have not changed, parents feel much better when they feel heard and someone is sympathetic to their situation. Listening goes a long way to getting one back on track in order to tackle the task at hand (Gosh, that lesson can be applied in many other areas of our lives too!).

You may look around and see some jobs that might be done. DON’T WAIT TO BE ASKED. Clean up the kitchen, throw in a load of laundry, pick up a crying baby, make a nutritious meal, cut the grass or shovel the snow. Sometimes an overwhelmed parent can’t voice what they might need but can appreciate someone taking the initiative. 

(Author’s Note: These two previous points seem contradictory and you are right, they are! What you need to evaluate is when to ask what is needed in the way of help and when to be proactive and take on a task without being asked. You will also need not to be critical or act as if you are “taking over.” Didn’t I warn you that you walk a fine line? I have faith in you – you can do it!)

Do not “fight” the parents for the babies. If you live a long distance away and your visits are few and far between, you will relish every moment with your grandchildren. However, “fighting” the parents for the babies’ care, will not win you any brownie points. More often than not, the parents are trying to establish a routine with their babies. Having you step in and try to “wrestle” one away from them, will only make things unpleasant for all of you. If the parents are involved with the children, perhaps offer to do a job around the house (e.g. wash the kitchen floor or vacuum a room or two.). You will be a hero and there will still remain lots of time to interact with and care for the babies.

If you live within driving distance and it is possible, set aside one day a week to come into the home and look after the babies, allowing some personal time for Mom & Dad and any siblings. This is extremely helpful during the initial few weeks after the babies’ arrival. Such was the case with one family and Mom felt secure in that she knew that every Thursday her parents would make the 2-hour drive to her house to care for the babies, feed them, bathe them and do some laundry. All she needed to do that day was to nurse them. If things got hectic earlier in the week, she knew she only had to make it until Thursday when she would receive some much needed adult conversation and loving support. As the children grew, they too began to look forward to their Grandparents’ visits.

Make a nutritious meal. Double the recipe and put some away in the freezer. It is very difficult for parents with twin, triplet or quadruplet newborns (and sometimes singletons too) to have the time to cook meals. This could work out very well as you all sit down to share the meal, stories and the day’s events with each other.

This Rule is a Golden One: Do not play favorites amongst your grandchildren. In reality, it may be that you do prefer one grandchild over another but IT IS ESSENTIAL THAT YOU DO NOT LET YOUR PREFERENCE SHOW. Children pick up very quickly if they are the favorite or not. To not feel like a favored child is extremely difficult on a child’s self-esteem and can result in long-term negative feelings and even to bad feelings and jealousy between the children themselves. Treat each grandchild equally. Every grandchild deserves to feel cherished and loved by all of the adults in their lives.

If you live in the same area as your children and grandchildren, you may be able to take a baby/child home overnight on a rotating basis. Be sure and have age-appropriate toys, books and clothing on hand. Find out what interests each child and gear your play towards his/her interests. You will need to be prepared to engage in appropriate age level play. Each of you will benefit from this one-on-one time and you will learn much about your grandchild that you never would have noticed in the group setting. (WARNING: In the process, be prepared to rediscover your own inner child as rhymes, stories and songs come back to you from your own and your children’s childhoods!)

If you do not live in the same area as your grandchildren, learn to work the computer! Once you get the hang of it, you will enjoy this rewarding and very easy way to keep in touch. Connect to Skype or Face Time and e-mail and write to your grandchildren often. You will make important connections that you, and they, will cherish for a lifetime. The Internet is a wonderful medium for sharing uptodate photos of your grandchildren with friends and family. With a scanner, photos can quickly and cheaply be sent so you can see the changes in your grandchildren as they grow and thrive. Computers today are user-friendly and it takes no time at all to learn how to work your way around them. My 85-year old mother and nearly 89-year old father-in-law were regular computer users and our children thought their grandparents were “cool” for knowing how to use them. Shop around for competitive prices and give it a try.

Remember that your multiple birth grandchildren are individuals even though they share the same birthday. They will not necessarily have the same interests, talents or abilities. Keep in mind their uniqueness, individual interests and capabilities, especially when buying them gifts. Grandparents often like to be fair and spend equal amounts of money on each grandchild. Depending upon what you are purchasing, it may be more advantageous to focus on their individual interests rather than the amount of money spent on each gift. 
 Or if you feel strongly about spending equally, make up the difference in price of gifts with a cash top up.

Speaking of gifts: Don’t necessarily feel that you need to purchase the same gift for each child. Variety gives the children a broader toy/book base from which to choose. However if you notice that each grandchild prefers a particular toy, you may purchase two (or three or four) in order to reduce any arguing over it. In such cases, put each child’s initial on the bottom of the toy so that it is clear to all who owns it. We all know that a child often wants the exact toy that their sibling is currently enjoying. By putting initials on the toy, you can patiently explain that his/her toy is on the shelf and ready to be played with. You might also consider purchasing a game that everyone can play together. Be prepared to join in if you choose this latter route.

Don’t be overly worried if you cannot tell your multiple birth grandchildren apart if they look quite a bit alike. Even monozygotic multiples are not completely alike despite what you hear. Focus on their differences and not how alike they are. Spending time with each child alone will enable you to quickly recognize those differences (e.g. hair whorl, a mole or freckle, shape of earlobes, body language.)

Grandchildren love to hear about their parents especially when their parents were young. So dust off those memories, give them a good shake to get rid of the cobwebs and reconnect to your own experiences with your own children. You will love sharing every second and your grandchildren will love listening (WARNING: Habit forming. Be prepared to have to repeat your stories time and time again.).

Don’t forget singleton siblings of your multiple birth grandchildren. As you can appreciate, they will need extra love, hugs and encouragement as they make the transition from “centre of the universe” to big brother or sister. Your attention, inclusion, patience and understanding can be very important at this critical time in their young lives as they adjust to the new family structure. Your ongoing support will provide them with the reassurances that they continue to be an important and much loved part of the family.

Make sure that you are aware of the many unique Safety Issues around multiples. Two, three or four toddlers can physically accomplish many tasks that a singleton could not. Together they can push a chair across the kitchen floor in order to climb up on the counters. One child will have “the plan” and the others will help carry it out (how they communicate “the plan” to each other remains a mystery). Remember when you are looking after them that when one falls down and skins his knee, you remain responsible for others at the same time. While attending to the child in need, you will need to be aware of the proximity of his/her co-siblings. The consequences of not doing so could be dire. To learn more about safely looking after your multiple birth grandchildren, check out the article Multiples and Safety. Being aware of the possible pitfalls ahead of time could save someone’s life. You may want to think about taking a First Aid Course before the grandchildren visit you.

As we age, it may be necessary for grandparents to take any of several types of medication, e.g. blood pressure control pills, daily aspirin for heart problems, diabetes control medications, vitamin supplements, iron pills and/or many others. Over the years your home has also become less “child proof” and some of these medications may be found on bedside tables. When your grandchildren are visiting, make sure that all medications have been collected and have been put out of reach of their exploring hands. Many children are poisoned each year by ingesting medications that they have found while visiting Gramma and Grampa. Don’t let your grandchildren become one of those statistics.

There are often two sets, or more, of Grandparents (and sometimes even Great Grandparents) in the equation. If this is your situation, don’t compete with each other as to who is or who can be the “better” grandparents. Don’t bother with who gave the better or bigger gift or even who spent more hours with them. Negativity takes a lot of energy. Don’t make the parents have to choose sides. To follow this path will cost all of you in many ways. Take your energy and focus on the beauty of the gift of grandchildren that you share in common. You are all important to your grandchildren and to their parents. Each grandparent provides unique experiences for their grandchild. Take this time and opportunity to experience harmony, family, loving, and caring. Everyone will benefit.

There is an African proverb: It takes a village to raise a child. Each of us can make a positive difference in a child’s life. It would be tragic to not take these opportunities to do so. Grandparents and great-grandparents are an integral part of the support system that children need so they can grow and flourish.