Twins & Multiples

by Dr Louise Santhanam, General Practitioner

At my six week check my GP asked me how I was feeding my twins. I told her I was breastfeeding as well as topping up with expressed breast milk. She told me she thought I was a ‘supermum’ I left feeling encouraged and proud!

L, Mother

At the six week checkup for my twins, I tried to explain what we were trying to do to troubleshoot some feeding problems. My GP just said “sounds grim.” I felt like some fringe element for trying so hard. We got through it, but I wouldn’t go back to my GP to discuss further issues.

E, Mother

Feeding twins and multiples is more complex than feeding singletons, and can be complicated by issues including prematurity, low birth-weight and medical management. The Multiple Births Foundation in their ‘Guidelines for Health Professionals on Feeding Twins, Triplets and Higher-Order Multiples‘ advises that mothers of multiples should be supported and encouraged to breastfeed or provide breastmilk for their infants.

Key issues highlighted by the guidance include:

twins
Credit: Steph Oliver-Beech Photography
  • Babies should be treated as individuals when making decisions on appropriate feeding and growth patterns. This will be influenced by sex, gestational age and size at birth
  • Co-siblings should not be compared
  • Mothers should be supported to breastfeed and be made aware that use of formula milk may decrease breastmilk supply

Many multiple birth infants are born slightly preterm (between 34 and 36 weeks) and and may not require treatment on SCBU/NICU. However, they are a vulnerable group in terms of feeding. The GP can be mindful of this group, who are quickly discharged into the community:

  • Babies are often discharged early without the care plan which would accompany a more preterm infant
  • Babies are often small and may require additional support to establish effective direct breastfeeding
  • Each infant must be managed individually in terms of whether he/she is woken for feeds or has responsive/baby-led feeding
  • Babies should be monitored carefully to ensure that they are receiving enough breast milk

Further Information

The following are resources that may be useful to the GP supporting the parents of twins or multiple pregnancies with infant feeding issues. See also our page on ‘Preterm and Unwell Infants‘.

NHS Choices: Feeding Multiples Includes links to information on breastfeeding, expressed breastmilk feeding, formula feeding and starting solids.

Tamba: How do I feed my Twins, Triplets or More?  Information from the Twins and Multiple Births Association.

Multiple Births Foundation: Guidelines for Health Professionals on Feeding Twins, Triplets and Higher Order Multiples Online booklet endorsed by the RCPCH and the RCN.

Multiple Births Foundation: Feeding Twins, Triplets and More Online booklet including practical advice and images for parents of multiples.

Tamba NCT Breastfeeding Peer Supporters Scheme Tamba can connect parents of multiples to accredited NCT Peer Supporters.


Published April 2017