Interesting TED Talk and comparison of Moving Forward and Moving On.
Interesting TED Talk and comparison of Moving Forward and Moving On.
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.
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:
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.
Sometimes there are valid reasons for keeping multiples together:
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.”
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
Web Site: www.twinsandmultiples.org, Educational Web Site for Multiples in School, Pat Preedy, M.Ed., B.Ed. (UK) and Professor David Hay (Australia)
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
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.
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.
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:
*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.
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.
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.
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
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!
Previously frozen breast milk can be kept in the fridge for 24 hours. Do not refreeze previously frozen breast milk.*
* Mothering Multiples: Breastfeeding & Caring for Twins & More, by Karen Kerkhoff Gromada, La Leche League International, 1999
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.
Breastfeeding Your Premature Baby, La Leche League International
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.
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.
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.
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.
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.
*Mothering Multiples: Breastfeeding & Caring for Twins or More!!! by Karen Kerkhoff Gromada, La Leche League International
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
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
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.
|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
(fresh, refrigerated or frozen)15C or 60F
|Packed in insulated cooler with ice or “ blue ice”||24 hours|
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.
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.
Multiple Births Canada Fact Sheet: Breastfeeding Multiples: Pumping Tips
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.
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
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