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Singleton Siblings of Multiples – Older & Younger

It is normal for parents to worry about their singleton child(ren) when twins, triplets or more expected. Involved preparation for the singleton is imperative, but there are no guarantees that there will be a smooth transition. In spite of the parents’ best preparation efforts, the new arrivals can be a challenge for singleton siblings, especially if they have been the centre of attention for some time.

Initially the multiples’ arrival may not impact the siblings too much but give it a week or 10 days and the realization sets in that Mommy and Daddy are not as available and there may be changes in behaviour. One 3-year-old singleton declared, “OK, that’s enough. Take them [his twin siblings] back to the hospital now!” Another 3-year-old yelled at his parents, “I only want one!” Reactions aren’t limited to the younger set: A 15-year-old girl put herself in foster care when her twin sisters arrived, and a 17-year-old young man didn’t speak to his parents for weeks staying in his room as much as possible when his siblings arrived.

Not all singletons react negatively to the babies’ arrival and some, especially if they are a little older, may react with delight and fascination. They can also be willing to help out and run little errands.

Here are some examples of, but not limited to, possible behaviour changes which may be exhibited by singleton siblings:

  • refuses to give up the bottle/reverts back to the bottle;
  • wishes to breastfeed again;
  • seeks attention when you are least able to provide it and rejects you when you are available;
  • there could be problems with toilet training, i.e. a set back or refusal to use the potty;
  • speech regression or refusal to speak;
  • clingy and/or excessively whiny;
  • plays rough with the babies;
  • may pinch, hit or bite them when alone with them; or
  • unresponsive to direction, refuses to co-operate.

There are some ways to support your singleton child(ren) and assist him/her in coping with the new arrivals:

  • avoid calling the babies, ‘the twins’ or ‘the triplets’. This label automatically leaves out any singleton children and gives the impression that those with this label are more special. Correct others each and every time they use the label. As the parents others will take their cue from you;
  • presenting the multiples as a package ensures they are perceived as a package. Continually dressing them alike and/or giving them rhyming names reinforces the “package” mentality and the singleton child(ren) is left out;
  • arranging special play dates or preschool for an older child allows him/her to have him/her own special time, activities and things to talk about;
  • include him/her in the decoration of the babies’ room—“What colour paint should we use, lavender or blue?” Limit the choice to two you can live with;
  • allow her to help put the babies’ clothes in the dresser drawers;
  • don’t get caught in the trap of using your older child(ren) as “gophers.” They can quickly resent being sent on an excessive number of fetches. This doesn’t mean they can’t help—“Could you please get Daddy a diaper for your sister?”—but don’t get caught in the habit of using them on a continual basis;
  • provide lots of positive feedback. “You were SO helpful today!” “You are so special to me and have been such a good boy/girl today.” “Thank you for being so patient;”
  • if there is bottle or toilet training regression, just go with the flow. Don’t make issues of it. Handing him a bottle even though he already can drink from a cup plays down the issue rather than having it escalate out of control and become a full-blown temper tantrum. It won’t take long for him to realize that he is not a baby and a bottle can be hard work. Leave the potty out in plain view, but don’t over focus on it;
  • set aside some time each day for her. It can be bath time, bed time and story, grocery shopping, play time but the important thing is for her to be the full focus;
  • if you can’t be available when he requests attention, buy a little timer and give it to him. Set it for 15 minutes (or what works for you) and say, “When the bell rings, we will read (play) together” and then try hard keep your promise;
  • if you can’t keep your promise, and there will be times when you can’t, let your child(ren) know that you are sorry and realize you have broken your promise but will make it up to them as soon as you can. Two things are important here:
    • 1) you have taken responsibility for your behaviour, and
    • 2) you have taught your child it is OK to take responsibility for one’s behaviour and there can be a new plan. Such an acknowledgement helps a child learn that others have limits and they were not to blame. Children tend to internalize things when they don’t work out as planned and see themselves as being “bad” for things not working. Clearing the air is important. But do try to make it up to them as soon as you can;
  • you can give your child(ren) some feelings of control in life by giving them simple choices: “What would you like to wear today, the red outfit or the blue?” “What would you like for breakfast, cereal or toast?”

Multiples in public cause a stir and attract a lot of attention. It will be important to include your other child(ren) in the conversation when necessary. A simple, “This is their older sister and she is such a help.” goes a long way to including the other child(ren). After some strangers had made a fuss about her triplet siblings and not even spoken to her, one 4-year-old asked her Mom, “Didn’t they see me standing there?” It is important to advocate for all of your children.

Splitting up the kids for an outing can provide a welcome change to the group dynamics. Take an older child and one baby to do groceries. It gives everyone a change of pace, or just one baby to do groceries. You are setting up value time for one-on-one getting to know each other.

Give your singleton child(ren) time to make the adjustment to the arrivals. Be as patient as you can. Just as it will take parents time to get into a proper routine, it will take a child(ren) time to adjust to the changes in his/her own routine.

Younger Siblings of Multiples

Some parents go on to have singleton children after the birth of their multiples. These singleton children are born into the situation and may have less adjustment to make as a result but there are no guarantees. When two or three siblings are all having a birthday party at the same time and you are not, feelings can be hurt and the tears flow. Patience and understanding works wonders. Some parents will buy that child a gift too. I am of the feeling that the world will not make room for you just because your feelings are hurt. Cuddling and words of explanation may be a better approach than expecting a gift on your siblings’ birthday and is an important learning tool that the world does always cater to you and those disappointments can be survived. Explaining that her birthday will come and she will get to blow out the candles on her own cake, separates the events and gives each child a chance to have a special day of his/her own. Who better to explain life’s realities than a loving parent?

Even young children can talk about their frustrations and if you feel that your younger child is struggling with the attention focused on the multiples, put the words in place to open a conversation. “I am feeling that you are may be a little frustrated by the attention going to your brothers. Would you like to talk about that?” You may be surprised by what you learn, have opened the channels of discussion, learned what the issues are and have an opportunity to talk things through. Win/win.

Sometimes an issue of the multiples ganging together and “bossing” a younger sibling occurs. If such is your experience, appropriate guidelines will need to be put in place so that the younger one is not bullied. Explaining to everyone that “Mom and Dad set the rules, not the kids” and “two (or three) against one amounts to bullying” can be helpful. Be prepared to go over these rules on at least a semi-regular basis and perhaps to have consequences in place when necessary, e.g. no TV/internet tonight, put 25 cents into the jar for each occasion.

It is human nature to adjust and most of us get over having siblings. Being guided by the loving adults in our life can make the journey more tolerable.

*Lynda’s Note:  If you are thinking of having another child and your multiples were spontaneously conceived (i.e. no infertility assistance), know that your chances of spontaneously having multiples again is increased by an additional 50%.  So, it will not be unusual to have another set.  Great to know ahead of time!!!

Additional Resources

The Singleton Siblings of Multiples, Multiple Births Canada, booklet 1999, 2001, 2007  www.multiplebirthscanada.org

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All About Teething

Teething can be a challenging time not only for babies but for parents too. It can be very difficult to witness your babies’ upset and uncomfortable. Some babies have a rough time cutting teeth, while others seem to have a much easier time of it. Teething can result in fussy, unhappy, sleep-deprived babies and parents.

Teething usually begins around 6 months of age. But it is normal for teething to start at any time between 3 and 12 months of age. By the time our children are about 3 years of age, they will have all 20 primary teeth. The lower front teeth usually make an appearance first*, while back molars are some of the last to erupt.

There are several signs that babies are teething. Note: It may be that your multiples will not all begin teething at the same time, and that is OK. Each child is different.

  • Crankiness/irritability/fussiness
  • Jamming hands or fists into the mouth and chewing
  • Pulling at ears/rubbing face
  • Swollen/puffy gums
  • Biting/chewing on things; everything goes into the mouth
  • Excessive drooling
  • Excessive crying, trouble sleeping
  • Diarrhea and/or very red buttocks
  • There may or may not be a fever, even a slight one, associated with teething
  • Usually after a tooth has erupted, there is a decrease in intensity of the symptoms until they cease.

teethingHow can I help my children get through teething?

Here are some suggestions to help soothe your babies:

Massage baby’s gum with a clean finger (make sure your fingernail is not too long) or a chilled, damp washcloth. You may see your baby “lean into it” as massage can help ease the discomfort.

Try a rubber, liquid-filled teething toy to relieve the need for chewing. Chilling the teething ring in the fridge can be soothing. You may need to try a couple of them before one is accepted.

Excessive drooling accompanies teething. Keep a bib on baby or you will be changing outfits every couple of hours, wipe face regularly to prevent skin irritation and change babies frequently at the first sign of any rash or irritation on their buttocks.

General Tips about Teething from Parents of Multiples

Teething babies will gnaw on just about anything they can get their hands on, so make sure that your home is thoroughly baby-proofed.

“I picked up one of the twins and he immediately sunk his mouth on my shoulder and bit down – hard! We both ended up yelling.”

Even when only one baby is teething, don’t sit him/her near each other to play as s/he can easily take their co-multiple’s hand, place it in their own mouth and chow down. One mother of boy/girl twins shared that her daughter was the biter and her son was covered with welts and red marks from being bitten, including one on his cheek.

If you are breastfeeding your babies, expect to have your nipples bitten and chewed on. It can be a surprise each time it happens.

If one, both or more babies are showing continued, extreme discomfort around teething, check with your family doctor. S/he may prescribe an infant painkiller for a time. Don’t give your babies any medications without speaking to your doctor first.

When Should my Children See a Dentist?

Generally a child should first see a dentist six months after the eruption of the first tooth. Seeing a dentist at an early age is the best way to prevent problems such as tooth decay, parents can learn how to support their children with dental hygiene, and the visit reinforces with children the importance of good oral health.**

*Teething and Your Baby: Symptoms and Teething Remedies
**When Should My Child First See a Dentist?

Lynda P. Haddon

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5 Secrets of Successful Parenting of Multiples

Children don’t come with instruction manuals and even though there are some wonderful books available providing hints and tips for successful parenting multiples, these hints and tips are missing the emotion that also occurs around a child’s challenging behaviour.  It isn’t unusual to feel discouraged, realize you were not as patient as you might have been, or raised your voice to an “outside voice,” or even to contemplate resignation from the position of parent – some days are just like that!  All parents get discouraged and wonder what the heck is going on with their own behaviour.  Sometimes speaking with parents with children a little older than yours is really helpful and allows you to see a possible light at the end of the tunnel.

Raising multiples has challenges, not the least of which is having two, three or four children of the same age, which does not ensure a one-rule policy will work, or that each multiple will respond the same way to the household rules.  Add to the mix the different sexes within the multiple set and things can be very bumpy indeed.

Here are some ideas and hints to help you with your parenting duties and hopefully make things run a little more smoothly in your household.  Keep in mind that this is not a complete list……

Keep Calm and Carry On – If you think you are really going to lose your cool.  Make sure the children are safe and step out of the room for a short while.  Take a bathroom break or make yourself a cup of coffee.  If the children are old enough to understand, indicate that you cannot talk about what is going on at the moment and you need to take a break and you will talk later.  There is no rule that says you have to have all the answers immediately.  Giving yourself a time out can be wise; get your act together and go back some time later for discussion and feedback.

The Same But Different – Do NOT compare the children to each other.  It can be difficult enough for singletons to be compared to each other, maybe you’ve had that experience yourself as a child.  Just because they have arrived in twos, threes, fours or more, they will not like the same thing at the same time, have the same interests, same abilities, creativities or skills.  Don’t let anyone else compare them to each other either.

Another point here – do NOT constantly dress them alike.  Big mistake, as the boundaries blur and they become a lump rather than distinct individuals.  Ask yourself “Am I dressing them alike because I like the attention it brings to me?”  If the answer is “Yes,” please carefully reconsider and think about the future for your children who will have to go it alone and who will be hindered by their reinforced presentation as a package rather than as their own person.

Mark my Words…. – There are conflicting thoughts on making you, as a parent, carry through and I have often read that once you’ve made a decision, don’t go back on it.  Mostly I agree with following through with discipline, but I found as my children got older and were able to explain why such-and-such happened, I sometimes felt I needed to rethink the punishment.  I had been making a decision from my perspective and with the explanation, it became clearer why the culprit (in my eyes) did what she did.  The argument against reversing your decision is that the children will see you as “weak” and try to take advantage at every turn.   For me each interaction needs to be assessed on its own merits and if there is a very good explanation, I have no problem with doing a flip with the punishment.

Joined at the Hip – Your multiples are NOT required to be together 24/7.  Encourage them to each have their own friends, hobbies, likes and dislikes.  They do not have to go everywhere together. Don’t go calling a parent who invites only one multiple to a party (that parent may not even be aware they are multiples – it is most likely not personal).  Each child is a separate entity and needs to have the time and space to separate from their co-multiple and be free.  In this way each can grow to enjoy their origins and also learn to fly on their own.

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Kangaroo Care For Infants

Definition

Kangaroo care has become increasingly popular for newborn infants, especially preterm or low birth weight, whereby an infant is held skin-to-skin against the chest of an adult, usually the parents.  Ideally kangaroo care will begin right after birth and continue for as long as is possible, although short periods of time are also beneficial to babies and parents.

Process

Kangaroo care - mother and twinsMom and/or Dad/partner are usually wearing an over-sized shirt, large hospital gown or loose clothing exposing their chest.  The nearly naked (diaper only) infant is placed directly on mother/father’s exposed chest and the shirt wrapped snugly around baby, drawing him into the parent’s chest where he settles and snuggles.  Instead of a shirt, a warm blanket can be used to cover the infant(s) on parent’s chest to draw her close.

Two babies, and sometimes more, can be held at the same time on a parent’s chest with support from a nurse or the other parent.  If there are tubes and wires on a baby, be sure and check with the nursing staff before going ahead with kangaroo care.  It is also good for the babies to be together.  Every hospital has its own policy regarding Kangaroo Care, so check with your hospital to find out what their policy is.

Benefits for Babies:

  • Father and newborn, kangaroo carehelps stabilize heart rate and regulates breathing
  • improves oxygen saturation levels
  • more rapid weight gain
  • helps maintain baby’s body warmth
  • babies easily accessible for easier breast feeding
  • helps relax and sooth babies, spends less time crying
  • more alert time
  • can hear heart beat, replicating womb experience
  • earlier hospital discharge
  • all newborns benefit from kangaroo care, not just low birth weight and/or preterm infants

Benefits for Parents

  • builds confidence knowing you are offering your infants intimate care and a loving start
  • early closeness to the babies promotes bonding
  • baby easily accessible for breast feeding (when with mother)
  • slows parents down to focus on their infants and less worry about other matters
  • can offer “closure” to having Neonatal Intensive Care Unit (NICU) babies

Bibiliography

 

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Breastfeeding Twins and Triplets

Breastfeeding twins and triplets? Yes, you can! Many women have successfully breastfed their twin babies, some for over two years.

We are all well aware of the benefits of breastmilk for babies and many wonderful and supportive ‘how to’ books have been written on the subject (some of those books are listed after this article). Even if your babies are premature, you can still breastfeed them. You can pump and take your milk into the hospital for feeding to your babies’. The nutritional content of each mother’s breastmilk is best suited for her babies’ needs. (Source: Side by Side, Breastfeeding Multiples – video, Calgary Foothills Pipeline Hospital).

Check lower down this page for some hints on breastfeeding triplets.

When preparing for breastfeeding, here are some helpful hints:

  • Properly prepare for breastfeeding by reading a general information book on breastfeeding.
  • Discuss your wishes with your partner before birth. It is important that you both have a commitment to breastfeeding and your partner be fully supportive.
  • Get together with other women who have successfully breastfed twins and triplets. Compare notes, pick up hints, ideas and shortcuts. Your local community may offer a breastfeeding class geared towards multiples. Check with your local Health Unit. You may also connect with your local La Leche League Group for support both before and after the babies’ birth.
  • If possible, put your babies to the breast immediately after birth. If you are unable to do so, make sure you have made prior arrangements with your doctor and hospital nurse staff and that they are fully aware of your commitment to breastfeeding. Make your intentions to breastfeed clear and make arrangements to pump and collect milk until such time as you will have the babies with you and can feed them yourself. A double pump is a great investment and can save you a lot of time. Remember: Both you and the babies are learning about breastfeeding. Babies are not born knowing how to suckle. You will need to work together (perhaps with the assistance of a Lactation Consultant while in the hospital) to learn how to breastfeed successfully.
  • It is very common to have one baby who latches on quicker or more easily than the other. Put that baby to the breast first and then you will have ample time to work with settling the other baby who may need a little more coaxing and attention with latching. Another excellent investment is a horse-shoe shaped nursing pillow. Make sure the pillow you purchase is large enough to hold the two babies together. Some of the pillows available in stores are smaller and made for nursing only one baby at a time.
  • Your milk supply will be influenced by several factors: 1) how often you feed the babies (and/or pump); 2) how often you rest; and 3) the stress levels you are experiencing. You will produce an appropriate volume of milk to meet the babies’ demand (the supply meets the demand) and it is equally important to be sure and get enough rest and to limit the stress levels in your day in order to assist you in producing milk (if the beds don’t get made today, so be it!).
  • If you arrive home and have difficulties latching a baby or you or your babies are having difficulties, don’t be shy. Call your local Health Unit and find out where Breastfeeding Support Clinics are held, call your local Twin/Triplet support Chapter, Lactation Consultant or La Leche League Group. Get the help you need to assist you and your babies.
  • It may be that you will experience some nipple soreness when nursing two babies. If you stop nursing, the soreness will only return after the babies begin nursing again. Try nursing for shorter periods of time, but more often. If you are experiencing some pain, it is usually associated with poor positioning. Remove your baby, reposition him and try again. If you continue to experience nipple soreness, seek out some guidance from one of the groups mentioned above.
  • Babies hit a growth spurt any where from 3 to 6 weeks of age (and not necessarily each at the same time) and then at regular intervals of about 6 weeks each after that, depending upon each individual baby. Don’t worry if it appears that you are ‘running out of milk’ as it is more likely the babies are feeding more often due to a growth spurt. Soon the increased demand will meet up with the supply and regular feeding intervals will again develop. Their growth rate slows down at about 3 or 4 months.
  • Do not assign one baby exclusively to a breast because: 1) they may be uneven suckers and very shortly you will have a lopsided shape due to their uneven sucking patterns. Alternating the babies on each breast will even out any different sucking patterns; and very importantly 2) when a baby is assigned to only one breast, the baby’s upper eye gets over worked, while the one below can become lazy and not react properly to stimulous.
  • If you find that one or both of your babies is having difficulties with one feeding position, try a different one. One Mom of twins reported that her son would not breastfeed if he was ‘under’ his sister. The weight of his sister, while using the cradlehold position, was something that he would not tolerate. When she switched to the football hold, which allowed each baby to be free of touching one another, he settled right down and breastfeeding went extremely well.
  • Your babies should eat initially every 2-1/2 to 3 hours and you will need to nurse at least 8 times a day for several weeks. Some babies need to nurse more often.
  • Triplets – For Moms wishing to breastfeed triplets, a suggestion to assist in building up your milk supply is to put two babies each to a breast for 10 minutes and the third baby on each breast for five minutes, at each feed. At the next feed, rotate the turn of the third baby so that each baby has a turn being on the breast within the first 10 minutes. Some Moms have reported a reasonable amount of success in building up their milk supply by using this rotating system. It is agreed that it is difficult to exclusively breastfeed three babies and I know of only one family who successfully did so exclusively for nearly two years. However, I am aware of several triplet families who have very happily partially breast-fed their babies for different durations of time.

Breastfeeding Multiples – Positions

You can be assured that your babies are feeding well if:

  • there are 6 to 8 soaking wet cloth diapers or 5 to 6 wet disposable diapers per baby in 24 hours during the first six weeks;
  • each baby is having 2 to 5 bowel movements in 24 hours during the first six weeks;
  • they are feeding at least 8 to 12 times a day for a duration of 10 to 40 minutes. Duration and number of feeding times per day will vary with each baby.

Breastmilk can be stored at room temperature for about 10 hours; in a refrigerator for about 8 days; freezer compartment with a separate door for 3-4 months and in a separate deep freeze for 6 months.*

Other Resources for Breastfeeding Your Multiples

I love the drawings in some of these books. It is very helpful to actually ‘see’ the positions so they can be interpretted correctly and find the ones that will work best for you and your babies.

*Source: Mothering Multiples: Breastfeeding & Caring for Twins or More!! by Karen Kerkhoff Gromada, La Leche League International (a great book, easily understood and takes you through the steps of breastfeeding, what ‘problems’ to look for and how to correct them, the important role of partner and lots more!)

The Joy of Twins and other multiple births by Pamela Patrick Novotny, Crown Trade Paperback Inc. (includes excellent diagrams of possible positions for simultaneous feeding)

Double Duty by Christina Baglivi Tinglof, Contemporary Books (also has some great illustrations for feeding positions. Walks you clearly through the steps of breastfeeding and has a list of ‘5 Top Breastfeeding Boo Boos’.)

Multiple Blessings by Betty Rothbart, M.S.W., Hearst Books (Has a Chapter devoted to breastfeeding, including feeding the babies simultaneously or back to back, creating a peaceful environment for breastfeeding and more! Also has excellent drawings showing different breastfeeding positions.)

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Blender Baby Food

For parents wishing to make their own baby foods or wishing to have some fun choices to offer toddlers, this book on blender baby food is a must have! The sections of this book are broken down into chronological sections, from when babies need to begin solid foods through 12 months and older, and includes suggested meal plans for each age. There are 125 delicious baby food recipes included for beginning solids, with hints and tips in the margins on how to “upgrade” each recipe for older children.

Blender Baby Food, Nicole Young and Nadine Day, 2005, Robert Rose Inc., 189 Pages

baby foodThe authors begin with steps on how to recognize when your babies are ready to begin solids, address food consistency at each age and stage, answer safety with food issues (such as with eggs), choking hazards, storing, freezing and thawing prepared foods and offer a list of the equipment you can expect to use when preparing your own baby food. There is even a section covering salt, sugars and The Picky Eater. It couldn’t be easier.

Blender Baby Food guides readers through the process of making their own baby food. The blender is an easy, no fuss way to offer new flavours in a baby-friendly texture. Even after a child begins to eat table food, there is always an occasion for a fruit smoothie or a nutritious blended dip.

Young and Day include three reasons for parents to make their own baby food:

    • 1) The ingredients are all hand selected, assuring healthy and wholesome meals
    • 2) Parents can easily tailor the texture to their baby’s preferences
    • 3) It will help shape a baby’s tastes so he or she can appreciate fresh foods

The book also includes meal plans, helpful tips and techniques and even advice on storing and freezing baby food. Using this comprehensive cookbook, parents will quickly discover that giving their baby the best nutritional advantage is its own reward.

Another great point – it’s a Canadian book!

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Guidelines for Storage and Sterilization at Home

Storage and Sterilization

  1. Purchase some bottles and labels to store the milk. The bottles need to be boiled and sterilized before each use
  2. Clearly label each bottle, including date and time that the breast milk was collected so that you know the age of the bottle of milk.
  3. Do not overfill the bottles as breast milk expands when it is frozen.
  4. 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 at back of fridge, not in door)4C or 39F a) Refrigerator (fresh milk)b) Refrigerator (thawed milk) a) 48 hoursb) 24 hours
Frozen Milk (Store at back of freezer, not in door. DO NOT REFREEZE) a) Freezer compartment inside refrigeratorb) Freezer compartment with separate doorc) Deep freezer, not attached to refrigerator a) NOT RECOMMENDED
b) 3 Monthsc) 6 months
Transporting Milk (Fresh, refrigerated or frozen)15C or 60F Packed in insulated cooler with ice or “blue ice” 24 hours

Do not microwave breast milk. Microwaving changes the nutrient content of breast milk. To defrost frozen breast milk, run it for a few minutes under hot water, or stand the bottle in a pot of hot water where it will quickly defrost. If you have any questions regarding pumping or storing breast milk, do not hesitate to discuss them with a lactation consultant, doula or midwife.

Your breast milk is important to your babies.

*Reference

  1. www.kellymom.com/bf/pumping/milkstorage-preemie.shtml
  2. www.preemie-l.org/bfaq.shtml
  3. 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
  4. www.cpqcc.org/
  5. Lauwers J, Shinskie D., Counseling the Nursing Mother: A Lactation Consultant’s Guide, 3rd edition p.351
  6. Riordan Jan, Breastfeeding and Human Lactation, 3rd edition. p.378-382

Multiple Births Canada Resources

  • Breastfeeding Multiples Fact Sheet Series (includes Pumping Tips Fact Sheet)
  • Breastfeeding Twins Pamphlet
  • Breastfeeding Triplets & Quadruplets Pamphlet
  • Nursing Your Infant Twins Booklet
  • Special Delivery: The Handbook for Parents of Triplets, Quadruplets & Quintuplets Booklet
  • Twin Care: Prenatal to Six Months Booklet
  • Expectant & New Parent Support Kit

Additional Resources

Finding Our Way: Life with Triplets, Quadruplets and Quintuplets , Triplets, Quads & Quints Assoc., 2001
Mothering Multiples: Breastfeeding & Caring for Twins or More , Karen Kerkhoff Gromada, La Leche League Int’l, 1999, ISBN 0912500514
When You’re Expecting Twins, Triplets or Quads: Proven Guidelines for a Healthy Multiple Pregnancy , Barbara Luke and Tamara Eberlein, Harper Collins, June 2004, ISBN 0060542683
The Joy of Twins and Other Multiple Births , Pamela Patrick Novotny, Crown Trade Paperbacks, Inc., 1994, ISBN 0517880717
Double Duty , Christina Baglivi Tinglof, Contemporary Books, 1998, ISBN 0809230194

Video: Side By Side: Breast Feeding Multiples – a 16 minute video by Calgary POMBA and the Foothills Hospital; available from Foothills Hospital, Public Affairs Office AGW5, 1403-29 th Street, NW, Calgary, AB T2N 2T9 Telephone: (403) 670-4853

Web Sites

La Leche League of Canada
Tel: 1-800-665-4324 www.lalecheleague.org

From Valerie Lavigne – Mom of three breastfed babies, including twins. Adapted by Lynda P. Haddon – Multiple Birth Educator – www.jumelle.ca

 

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Breastfeeding Fathers/Partners

On the surface, it doesn’t appear that Dad’s or Partner’s role could be very important in the breastfeeding department. But the truth is a Father/Partner’s role is essential to successfully breastfeeding multiples. Detailed communication between the parents before the babies’ arrival and a commitment to give them the best start in life, sets the stage for a successful breastfeeding experience for the whole family.

Here are some hints and tips to guide you in your breastfeeding support role:

  1. You and your partner have discussed in detail that you want to give your babies this important start to their lives. Reinforce this decision whenever it is necessary, to other family members, friends, to each other.
  2. Consider asking for extended parental leave from your job so that you can be available in the first few weeks after your babies are home. Even if your workplace doesn’t offer extended leave, ask anyway. Explain why this extended would be an asset. Each time an employee asks for this type of extended leave, a seed is planted. Companies are often rethinking employee benefits and extended leave for the parents with multiples might become automatic.
  3. Bring your partner a nutritious snack and a glass of water each time she breastfeeds. Help to get her comfortable by putting pillows under her elbows, behind her back and a stool under her feet.
  4. Actively involve yourself in the care of the babies. Don’t wait to be asked. You may change diapers before breastfeeding and burp, cuddle and talk the baby who finishes first so that Mom can focus on the other (next) baby.
  5. Take breastfeeding classes, ask questions and check out the vast array of books on breastfeeding. Learn how to put babies to the breast, and about proper latching on so that you can assist your partner at those important first feedings. You will be a big support during those initial attempts at simultaneous breastfeeding.
  6. With the birth of multiples, it isn’t unusual for there to be a shift in the family roles, especially if the babies were delivered by c-section. A c-section is major surgery and it takes at least six weeks for recovery. Dad/Partner needs to be prepared for a variety of duties: grocery shopping, laundry, childcare for other children and food preparation, for some examples.
  7. As breastfeeding progresses and the milk supply established, Mom can express breast milk so that you can feed one of your babies with a bottle, if this works for the both of you.
  8. Breastfeeding is a learned art for both a mother and baby. Don’t stay on the sidelines. Get involved, offer encouragement and problem solving techniques to your partner as they are needed.
  9. It is important to remember to look after your relationship with your partner. Try and do something together at least once a week: Go for a walk or for a coffee and conversation. Arranging time together as a loving couple will help reinforce your togetherness and decision to breastfeed.
  10. You may need to reevaluate your feelings about your partner’s breasts. While initially you may have thought of them sexually, after a birth, things turn can around as those same breasts become a source of nutrition for your babies. Be aware of your feelings and keep the lines of communication open with your spouse. These conflicatual feelings are normal.
  11. It isn’t unusual for a father/partner to feel jealous of the mother and babies’ physical connection. Try not to feel rejected or displaced. You continue to be an important person and a leading role player both with your babies and with your partner.
  12. If you feel that Mom is having difficulty with breastfeeding, encourage her to attend a La Leche League meeting or arrange for a consultation with a Lactation Consultant. Some of the latter make house calls and with a quick consultation, matters can quickly be rectified.
  13. It isn’t unusual for multiples to arrive early, i.e. before their due date. One of the amazing miracles of breastmilk is that each mother’s milk is specifically suited for her child’s gestational needs. During the early days after your babies’ births, you may need to provide encouragement and support as Mom pumps for your babies, if they are unable to breast feed independently.
  14. Have faith in yourself and your capabilities. These are your children too and looking after yourself as well as your partner and babies, will help you all have a satisfying breastfeeding experience.

For more information about fathering, parenting, breastfeeding:

www.dadscan.ca
www.fathers.com
www.fathersforum.com
www.lalecheleague.org

Reviewed and with very helpful input provided by Erin Shaheen, Child Birth Educator and Social Service Worker, Ottawa, Ontario.

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Breastfeeding: How will I recognize if my babies are drinking enough milk?

The following breastfeeding information is provided for healthy, average term babies.  If you feel that your babies are not eating well, drinking enough milk, or taking in enough nourishment, contact your doctor for feedback on your personal situation.

There are several ways to determine whether or not your babies are eating well and the most obvious is by what comes out the bottom end.

  • In the first two days after birth, on average each baby should have 2 wet diapers and 1-2 soiled diapers.  Right after birth, the first stools will be a thick black consistency.  This is called maconium.
  • On days 3 to 5, each baby needs to have at least 2 wet diapers a day and 2-3 soiled diapers.  Stool colour will be green, yellow or brown in colour.
  • From 6 days to 5 weeks, look for each baby to have 6 heavy, wet diapers per day and 1 or more soilings of a yellow colour per day.

Some signs to let you know that the babies are getting enough milk:

  • are sucking strongly, slowly and steadily
  • has a strong cry and moves actively
  • your breasts feel softer and less full after each feed

When baby is full:

  • will break the latch and let go of the breast of his own accord
  • hand lies gently and open against your body, showing contentment

In the initial days after birth, sleep overtakes a full tummy, especially for preterm or low birth weight babies.  They just don’t have the stamina to keep on feeding.  If your baby falls asleep at the breast after a few sucks, you will need to try and wake him up.  This can be done by stretching him by holding him up under the arms, try to get a good burp out of him, move him around your body, don’t let him snuggle, and some parents will undress the baby to stimulate him to continue eating to fill his tummy.  If babies do not take in enough milk, you will be back to feeding them again in a very short time frame.

Babies’ approximate tummy sizes:

  • Up to 2 days after birth, is about the size of a chickpea
  • 2-10 days about the size of a hazelnut
  • 10 days to 1 month about the size of a walnut.

This is what you are trying to fill at each feed so it is helpful to make sure the tummy is as full as possible each feed.

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Bottle Feeding

As with many parenting issues, the pendulum of public opinion swings from one extreme to the other over time. In the breast versus bottle debate, breastfeeding is enjoying a renaissance, and ads in magazines, bus shelters and on television can be seen encouraging breastfeeding as the optimum (the only?) method for feeding your baby. So much emphasis has been placed on promoting breastfeeding in recent years that it has become virtually impossible to find information on how to effectively bottle-feed your infant.

My own feeding story began with a strong motivation to breastfeed our twins exclusively for at least six months, more likely a full year. Thanks to the availability of material through a comprehensive public health campaign and my friend Carole, a committed breastfeeder, I had stocked up on all the pro-breast propaganda, and was convinced that anything other than exclusive breastfeeding would constitute my complete failure as a parent. So persuaded was I that I was rather rude to a woman in my office who gave me a “starter kit” of bottles as a shower gift a month before the arrival of our twin boys. How dare she jeopardise my plans to give my little babies the best start in life! Didn’t she know that studies show breastfed babies are healthier, happier and smarter? Obviously, we wouldn’t be needing any bottles in our home.

It wasn’t long after the birth of our little ones that I realized this was a more complex issue than my pre-purchased nursing bras and perfectly sub-sectioned breastfeeding information binder could address…

As per our carefully constructed birth plan (of which we had distributed multiple copies to any and all health-care providers we came into contact with throughout the pregnancy), Alex and Simon were placed on my body within an hour of their birth by Caesarean-section, where they quickly snuggled into my chest (skin-to-skin, just as the literature had suggested), and began rooting, as predicted. Simon even found a breast and immediately got to work. Great, I thought, he’s a ‘boob man’! This is going to be a cinch!

By the end of the first 24-hour period, however, both boys were still losing weight, and things were getting pretty sore at the feeding trough. Furthermore, Alex and Simon were doing lots of screaming and crying. And by now the novelty of the birth had worn off for me, and the early effects of sleep deprivation combined with major surgery had definitely kicked in. Yes, I was feeding often, yes, I had several people “check the latch”, yes, I continued to breastfeed and hope for the best.

When my physical pain became so unbearable that I tensed up all over at the mere thought of feeding, I began applying various ointments and magical creams which my breast-militant friend had procured from Dr. Jack Newman, guru on the womanly art. But I didn’t quit. Yet. I did all the “right” things—I learned how to feed from a little cup so that the boys wouldn’t suffer “nipple confusion” by using a bottle. When another nurse arrived at shift change, she suggested we try finger feeding with a tube, since that would help the babies developed the suck reflex for when I was ready to let them back on the real thing. In the meantime, I was advised to pump, since it would be gentler, less painful, and would encourage my milk to come in. I did so every two to three hours.

The tube/finger-feeding business was a complicated affair, and required many skilled hands and about 35 minutes per baby. Then there was the pumping to keep up between finger-feeds. We proceeded for another 24 hours. Sleep deprivation consequently grew worse. Post-partum depression set in and was joined by tremendous guilt when we finally gave Twin A the first bottle of formula (oh how he sucked it back, the poor starving child!)

Finally, on Day Four, we elected to move entirely to bottles, despite the damage this would inevitably incur on our psyches and our wallets. While my dear husband fed the boys each a bottle of formula and then wheeled them in their bassinet down the hospital hall for a little “walk”, I slept for a glorious three hours. Delightful! The road to recovery could begin. When hubby returned, I was awake enough to count my babies’ fingers and toes for the first time since their birth several days earlier. They each had twenty in total. Now I knew.

The following weeks were difficult ones, as readers who have recently gone through the birth and early parenting of multiples can surely relate to. In addition to the chaos of bringing home more than one baby and acclimatizing to the accompanying lack of sleep for the next six months, there was the unexpected twist of having to learn about bottle feeding: Buying formula (thank goodness for those crack-open, ready-to-feed cans—they are worth every extra cent on the line of credit), washing and preparing bottles (wisely, we had kept the unwelcome shower gift from a month ago and now my husband scrambled to find where we had stashed the box we never thought we’d use) and calculating how much formula to feed….

But another, more disturbing aspect complicated our early months as parents, and that was the barrage of uninvited comments from strangers with regards to our feeding methods.

Once a judgemental non-parent myself, prone to give dirty looks to bottle-feeding mothers on the bus or subway, I now found myself the object of scorn for precisely the same reason: I remember attending a baby shower for a friend of ours with a singleton when our boys were about three months old. While we were there, it was feeding time, and out came the bibs, burp cloths and bottles. As my husband was warming the formula in the kitchen, I wandered out to the garden with one of the babies. Immediately I was surrounded by aunties and grandmothers who wanted to meet “the mother of the twins”. I patiently answered the usual battery of stupid twins questions, and was mid-sentence when one old battle-axe called out in a rather loud and matter-of-fact voice, “you’re breastfeeding of course”.

I should have ignored her or told her as politely as I could that it was none of her business. But that pressure-induced guilt inside of me welled up, and I felt compelled to explain myself.

“Actually, we’re not,” I responded tentatively.

“Oh?” was her open-ended reply.

“Yes, well, we had a lot of trouble at the beginning.” I continued, “having twins posed different challenges than I had anticipated.”

“My niece had twins, and she breastfed for months and months”, responded the battle axe.

“I had a C-section, so there were come complications”, I meekly offered.

Wouldn’t you know it, the battle axe’s niece had also had a C-section, but of course she had had no trouble at all with breastfeeding. I burst into tears and rushed back into the house, where my husband took one look at me and was ready to kill someone. Instead, we fed the babies (bottles), packed up, and went home.

This emotionally draining experience and many others prompted me to do some research around bottle/formula-feeding so that I could do it “right”, and also so that I could be armed with data, should I need to defend myself in the future. When we had first come home from the hospital, I had called our public health nurse, who naturally knew nothing about bottle-feeding, though she did encourage me again with the breastfeeding, reminding me that it really was best for the babies. I then looked up bottle-feeding in one of our baby books, and found a chapter on how to sterilize bottles and prepare formula. (Already figured that one out from the instructions on the package.)

Finally, I stumbled across a glorious little book called “When Breastfeeding is Not an Option; A Reassuring Guide for Loving Parents” by Peggy Robin.

The more research I did on breast and formula/bottle feeding, the more I began to wonder: “Is breast really best?”

At issue are the claims that breastfeeding increases intelligence, lowers incidence of childhood illness and increases the mother-infant bond. I can assure you that our rocky but determined beginning did little to increase any type of bonding as I was so exhausted and freaked out, I barely knew which end was up on my babies! As for the other two claims, I began to have my doubts on their simplistic validity. After all, the baby formulas of today are scientifically formulated to emulate breast milk as closely as possible. All include essential nutrients, vitamins and minerals, and many now boast DHA and other ingredients hitherto only found in breast milk. In fact, the more I looked into the studies on breastfeeding and its positive effects on babies, the more I questioned whether it was the breast milk itself, or the act of cuddling and holding a baby close (which could easily be done with bottles) that caused the benefits in question.

In particular, I was intrigued to learn that infant massage, which has been studied in the West since the 1970s*, claims to produce similar benefits to breastfeeding: Weight gain (especially in preemies), neurological development, decreased hospitalization and improved digestion are all qualities noted in children who have experienced habitual infant massage. Perhaps most exciting for parents of multiples is that unlike breastfeeding, infant massage (and bottle-feeding) can be done by both parents and other care providers, a real advantage with more than one baby in the mix. (Why wouldn’t you want to sharethe joys and burdens of feeding more than one at a time with willing helpers?!) Indeed, other than the antibodies found naturally in breast milk, I really couldn’t find hard data that proved the superiority of breastfeeding as an act in itself for the babies.

My research aided me in charting a course that would best meet the needs of my family, and my husband and I made a pact when we moved to bottles: As often as possible, the babies would be held and cuddled when being bottle-fed. We wanted to emulate the physical closeness of breastfeeding as much as we could, and so we wanted to learn to bottle-feed well, to become “bottle-feeding experts”, if you will. (We also began incorporating a daily regime of infant massage into the bath time/bedtime routine, and I am convinced that it was this daily opportunity for bonding through physical touch that helped Alex and Simon grow healthy and strong, and assisted us in growing more attached to our new babies, despite various other challenges.)

Having lived through this new parent experience, I am concerned now with the multitudes of mothers who—for whatever reason—do not end up breastfeeding, but have little support in alternative feeding care. Sure, the formula packages include instructions on how to prepare the formula, but there is little guidance on how to lovingly administer the bottle to your baby. Did you know, for example, that you are actually supposed to hold the infant slightly upright when feeding, in order to prevent ear infections? And knowing what we know about the benefits of skin-to-skin contact in newborns with their parents, why not bottle-feed naked? (In a warm room with a blanket, of course, and perhaps not publicly!) The emotional high that comes from snuggling with your little ones while you feed not only transfers to the babies, but also builds confidence in the parent who knows she has fed her babies competently.

One of the many reasons I decided to become a prenatal instructor was so that I could present objective, comprehensive, research-based information on feeding options to parents expecting multiples. Don’t get me wrong—I’m all for breastfeeding, when it’s a good fit for a particular family. But the first few weeks and months of life with new twins, triplets and more are so wrought with anxiety, I feel it is important for parents to be knowledgeable about some different feeding scenarios, so that whichever option or combination of options they choose for feeding their little ones, they will be confident in the knowledge that they are “doing it right” and that it is good for their babies.

Breast- or bottle-feeding shouldn’t be a decision based on pressure from those around us. Every parent is an expert on his or her own family, and has the responsibility and the right to make an informed decision about how best to meet the feeding needs of their newest family member(s). And now that we have more comprehensive data on different factors that can impact newborns’ physical and emotional health, I hope that future public health campaigns and also individuals who mean to help will focus on supporting all appropriately-researched feeding methods to the best of their abilities in order to provide the best start for our youngest members of society and their emotionally vulnerable and sleep-deprived parents.

* for more information on infant massage, see the work of Vimala McClure and others

Websites:

Article is by Vera Teschow. Vera is a full time teacher, and the mother of Alex and Simon. Visit her online at www.verateschow.com.