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.


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

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

Kangaroo Care For Infants


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.


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



Memorial Ideas

‘How can I remember my child(ren) in a meaningful way?’ is a common question from bereaved parents.

Here are some memorial ideas for your consideration

Immediately following the death:

  • It may be possible to take hand and/or foot prints of your baby(ies). These can be framed in a shadow box with an engraved nameplate. The hospital staff will be able to guide you at/after delivery if this is at all possible. Depending upon how long the infant has been deceased while in utero, it may not be possible to make casts.
  • Have photos taken of both/all of your babies together as well as apart. This will be the only time they will be together and later in life these photos can become extremely important, not only for the parents but also for the surviving co-multiple(s) in actually seeing his/her sibling(s). One family noted that these photos were important in confirming to them that they did, indeed, have another baby. In some areas professional photographers donate their time and take the photos for free. Now I Lay Me Down to Sleep is one such organization. Alternatively, you can take the photos yourself, or ask a friend or hospital staff person to take the pictures for you.
  • Consider taking photos of hands, feet, ears as well. Baby(ies) can be carefully wrapped to facilitate such photos.
 For the funeral or memorial service:
  • Consider releasing homing pigeons either at the baby(ies)’s funeral or memorial. Try the yellow pages or internet for a local business offering this service. The birds are for rent for services and memorials. Note: Releasing mylar helium-filled balloons is not recommended as deflated balloons have been found in the stomachs and intestines of whales, turtles and birds. It is a difficult and sometimes painful death for unsuspecting animals. For the most part, regular balloons are biodegradable, but the strings, ribbons and cords are not. These parts remain a hazard for animals.
  • Consider involving the grandparents in the memorial or special services. They, too, have suffered a loss (and also grieve that they were not able to protect their own child from such a loss), and including them in a part of the service plans will help as you rely on each other’s strengths for mutual support;
  • Consider involving older children in the funeral and/or memorial service. Young children don’t always understand the concept of death, but involving them in funeral arrangements helps them better understand what is happening and why their parents are upset and sad. Left to their own devices, children can internalize negative feelings and interpret those feelings as if they, themselves, have not ‘been good’ and as a result their parents are sad, upset or angry. Including them and explaining the situation in age-appropriate language ensures they understand that the situation is not their fault, and helps them feel connected rather than left out or marginalized;
  • If the service occurs when there is still a survivor(s) either in hospital or at home with a sitter, allow yourself to be mentally, emotionally and physically present at the service. You are in the right place at the right time, so try not to be hard on yourself with thoughts of your surviving co-multiple(s) and that you should be with him/her/them.

Support at home

One idea, as a bereaved grandmother explains, occurred when her daughter and son-in-law returned home after losing triplet babies.

My daughter is home from the hospital and I will be going to take care of her this coming week so her husband can go back to work. I thought I would pass on what a loving thing their friends did. When my daughter and her husband arrived home, they were greeted by friends who [had arranged] a “shower” of love and comfort. They brought presents like plants for the house, gift certificates to the video store, cooked meals for the freezer, etc. One woman’s gift was to clean my daughter’s windows in a couple of weeks. Since we live in a desert environment, this is a very loving thing to do. They also brought covered dishes and spent time with the couple and just let them guide the conversation. My daughter said she felt so loved and cared for by so many people. One woman (although she was a little nervous about it) brought her newborn (2 weeks old) and let my daughter hold him. This did not upset my daughter. Instead she said it gave her a chance to hold a baby in her arms and it just felt so natural. I thought this was such a wonderful, thoughtful thing that made their homecoming less painful.

On birth or death days

  • Light a special candle on either the birth day or death day or both, whichever works for you;
  • Make a donation in your child(ren)’s name;
  • Do some volunteer work in your child(ren)’s name;
  • Some families spend the birth or death day at the cemetery with a picnic;
  • Some families do not want to take away from their surviving co-multiple(s)’s joy, and so if the death day is the same as the birth day, the family will set aside a different day in which to remember their deceased baby(ies);
  • One couple donates a baby layette each year in their son’s name to a male child born in the same hospital on the day their son died.
  • Consider planting a tree or flowers. One couple planted daffodil bulbs in a forest spot they liked, and went to visit them every spring and just sat in the quiet to think.

Helping a surviving co-multiple learn about their beginnings

Having photos around the house or perhaps making a memorial book can not only help with the grief process but also provide an opportunity for questions at a later point in time. Photos (even just one) around the house will encourage a surviving co-multiple(s) to ask questions, and provide an opportunity to explain and answer questions in age-appropriate language.

Down the road

  • Make a difference in the life of a child and ask the school board if you can help a child learn to improve his/her reading skills;
  • Donate a book to a local school or public library each year in your child’s name;
  • Plant a tree in a private space, or get permission to donate one to a public space;
  • Buy a bracelet and include a charm that might symbolize your child.  This is discreet and it would not be necessary to explain anything you did not wish to share.

Following is an idea from a triplet family who lost one of their young sons at 21 months due to complications from his prematurity.

Our fifth family member…

A friend of mine from Oslo, Norway, who also lost her young son, shared this poem with me. Loosely translated from Norwegian and paraphrased, it reads:

We are four in our family.

We are five in our family.

We have an invisible one in our family.

If you don’t know our fifth family member, you don’t know us.

This poem sums up for me the importance to us of always including our Angel Joey as a member of our family. This is especially so as he is one of our triplets. People will insist on calling our boys ‘twins’… but they are not. We have many pictures of Joey from his brief time with us but every year at portrait time, we want to make sure he is with us. Another friend suggested including some memento of his or even a framed picture in our family portrait. I found a small, stuffed bear with a blue ribbon and holding a wooden block with the letter ‘J’ on it. This is our ‘Joey Bear’. For the past two years, Joey Bear has joined us in our Family portraits. He is a small reminder that we are not as complete a family as we once were. One is absent from us physically but always present in our hearts.

If there has been a baby shower, ideas for what to do with the gifts

Gifts given belong to the receiver. This might not hold true if the gift is a family heirloom, e.g. silver cup or spoon. You may wish to return any special items. However, all other shower gifts or gift certificates can be kept by the receiver or returned, as you see fit. An option might be to donate some, or all, of it to a needy cause such as your community home for unwed mothers or other charity. If this latter option is chosen, think about writing a note to the giver of the gift and letting them know that their generous gift has been forwarded to a worthy cause. Reasons that gifts/certificates might be passed along include: the parents feel unable to keep them as they are a reminder of their loss, fear of more “bad luck” or parents want their next pregnancy to have a more positive outcome.


Multiple Births Canada – Loss Support Network
Telephone: (705) 429-0901 Toll Free in Canada: 1-866-228-8824

Center for Loss in Multiple Birth (CLIMB)
Jean Kollantai, PO Box 91377 Anchorage, Alaska 99509 USA Telephone: (907) 222-5321 WS:

The Compassionate Friends of Canada
Tel: 1-866-823-0141 WS:

Bereaved Families of Ontario (BFO)
Canada Telephone: (416) 440-0290 WS:


  • Forever Our Angels, Hannah Stone, Lulu Publishing (2006).
  • Empty Cradle, Broken Heart: Surviving the Death of Your Baby, by Deborah L. Davis, Fulcrum Publishing (revised edition 1996).
  • The Worst Loss: How Families Heal from the Death of a Child, by Barbara D. Rosof, Henry Hold and Co., N.Y. (1995).