Twins
Aasma A. Khandekar
I. Description of the issue.
A. Epidemiology.
1. The twin birth rate is approximately 32 in 1000 births.
2. Monozygotic twins occur with uniform frequency (3.5/1000 births) and are not appreciably influenced by race, maternal age, or other known factors.
II. Advice to parents of twins.
A. Infant twins. Parents of infant twins need support and advice regarding organization, feeding, individualization and separation issues, and stress management. Ideally, discussion of the more relevant issues should begin before the birth of the twins. It is an excellent idea to refer expectant parents to a local Mother of Twins Club for advice and support both before and after delivery.
1. Organization. Efficient organization of the household and anticipatory preparation for caregiving tasks are essential for twin families. Parents should try to recruit outside help in the first weeks after the birth.
Parents can buy either a twin stroller or two less expensive umbrella folding-type strollers, which can be clamped together. Two infant car seats will be necessary. Infant twins can sleep in bassinets or even in a bed with bolsters rather than in two expensive cribs. Many baby retailers offer twin discounts on items such as clothing and other gear.
Organizing daily activities is very important to reduce stress. It may be helpful to make charts for feeding and other essential daily activities (a daily bath for the babies is not essential).
Parental time, both alone and spent with other family members, should be planned. It is also important to set aside separate time for parents to spend with the twins’ other siblings.
2. Feeding. Feeding infant twins can be very stressful. This may be due to specific feeding problems with premature or small-for-gestational-age twins or simply because it takes so long to feed two babies.
Oversized feeding pillows designed for twins can be helpful with formula- or breast-feeding both infants at the same time.
Twins may be breast-fed simultaneously (“tandem nursing”), which will cut down on feeding time. This may not be practical until the infants/mother have mastered latching and effective nursing.
Modified demand feeding, in which the baby who wakes to feed is fed first and the second one is awakened to feed after that, is another preferred option.
Breast-feeding mothers may also choose to pump in the immediate postpartum period to stimulate milk supply. A lactation specialist may be able to advise and/or assist the mother in alternative feeding methods including cup feeding and supplemental nursing systems. Breast-feeding mothers can be reassured that with adequate stimulation, it is possible to supply enough milk for both babies.
Babies should be alternated on both breasts to ensure even milk production and vary visual stimulation.
Many mothers will elect to bottle-feed their twins at least some of the time. Whenever possible, two adults should be enlisted so that both twins are held for feedings. When this is not possible, the mother or other caregiver could prop one twin up against a leg or across the lap while holding the second infant so that both may be fed simultaneously.
When babies advance to solid foods, freezing large quantities of food at one time will cut down on the work of meal preparation. Parents should be counseled to avoid comparing how much one twin eats with the other.
3. Sleep. Promoting good sleep habits is as important in twins as singletons. Twins who sleep better also allow for more well-rested parents.
Table 106-1. Parental behavior promoting individualization of twins
Choose different-sounding names.
Do not dress twins alike all of the time.
Use individual names when referring to twins.
While twin pictures are appealing, take several pictures of each child individually.
Take twins on separate excursions.
Spend quality time alone with each twin.
Refer to other twin as “your brother/sister” or by his or her name.
Praise individually.
Discipline individually.
Encourage frequent opportunities for individualized contact with other adults, siblings, and peers.
Provide toys according to individual preferences, needs, and interests.
Expect that twins’ behavior and thinking will differ most of the time, and approve of differences.
Encourage relatives and friends to treat twins as two individuals (e.g., individualize gifts and social activities).
Parents may find that setting a schedule (around the timing of naps and nighttime sleep) for both twins to sleep at the same time may be challenging initially but helpful in the long term.
Encourage parents to establish a sleep routine from an early age. Bathing, cuddling, and singing can be performed together, as can be storytelling. One parent can read to each twin, or both can be propped up on the lap and read to by one parent.
During or after transitions, illnesses, or vacations, temporary disruptions are expected, but it is important to maintain and reestablish, when necessary, elements of the bedtime routine as soon as feasible.
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