A Challenging Change

Every book on parenting will tell you that life forever changes after the birth of a child. So parents of twins or higher-order multiples (triplets or more) can feel as if they've left the hospital and arrived home on a different planet.

Yet multiple births are more common than ever, as more couples have babies later in life or turn to fertility treatments, both of which increase the chances of having multiples. The incidence of twin and higher-order multiple births has climbed rapidly over the last two decades. Between 1980 and 2000, the number of twin births in the United States increased 74%, and the number of higher order multiples increased fivefold. Today, about 3% of babies in the U.S. are born in sets of two, three, or more. Most of these multiple births (about 95%) are twins.

The arrival of multiple newborns presents certain medical, logistical, financial, and emotional challenges for a family. But the upswing in twins, triplets, quadruplets, and more also means an increase in resources to help those families. Often, parents who are expecting multiples find that other families who've been through the experience are a great help.

Changes Accompanying the Birth of Multiples

Some of the differences in lifestyle that multiple births will require are easy to anticipate. Standards for household neatness will likely have to relax for a few years, unless you can afford to hire a house-cleaning service. You'll get a lot less sleep, as multiple babies require frequent feeding and care at night.

The financial impact also can be significant. Any costs associated with newborns — for diapers, clothing, food and medication, high chair, toys, car seats, etc. — are exponentially higher. Even the cost of health care for the delivery of twins is four times higher than with a single birth. Add to this the cost of expanded living space, a larger vehicle, and possibly part-time help in the home. One partner may even need to give up an income to stay home and take care of the babies.

Also, because of the high rate of disability in kids born as part of higher-order births, particularly those born prematurely, there's the possibility of having to manage the costs associated with caring for a child with a lifelong disability.

Though some stores give discounts for families who have twins or higher-order multiples, larger-scale donations of formula and diapers from major manufacturers are more rare than they once were. At the same time, family and friends with babies, social service agencies, nonprofit groups, and support groups can be good sources of hand-me-downs and can help you meet the needs of your babies.

Some changes may come as more of a surprise. Having less time for each individual baby can make you feel guilty or sad. These emotions can become even more complex if you already have other children. Any stress and fatigue associated with caring for your kids can sometimes have an impact on your relationship with your partner.

Yet despite all of the challenges, multiples also bring great rewards. You'll get the unique chance to love several babies at once and marvel at the relationship between them, which is a very special one. And there's a fascination surrounding multiples that is hard to deny.

Help From Others

When caring for multiple babies, it's important to recognize the need to recruit extra help. Some families hire help, some rely on volunteered time from extended family members, neighbors, fellow parishoners, or support groups for parents of multiples. Before your babies are born, think about the levels, sources, and types of help that would feel the most comfortable for you and your family.

Volunteers could bring food, bathe babies, shop, clean, or babysit while you nap or get out of the house. They can even run errands for you. But also consider how comfortable you'll feel having other caretakers in the house, which can compromise your feeling of intimacy and privacy with your family.

Even though there's no one right way to raise your multiples, it might help to see what other parents have done. Look for a support group for parents of multiples in your town.

When you're setting up your network of volunteers, it's also important to keep in mind the health of your newborns. Infants born prematurely can be particularly vulnerable to respiratory syncytial virus (RSV), a flu-like illness that can be highly contagious and cause serious health problems. Establish hand-washing procedures and other safety precautions around the house for your helpers. It's also important that those caregivers be familiar with any medical problems the infants have.

Multiple Baby Basics

Feeding will consume a large chunk of each day. Multiples can be either breast- or bottle-fed successfully and each approach has passionate advocates. Breastfeeding offers nutritional and immunological benefits and is easier on the pocketbook. It works because the lactating breast functions according to the laws of supply and demand. The more a baby nurses, the more milk the mother's body produces.

It's possible to nurse two babies simultaneously, but it may take some time to master. So if you choose to breastfeed, consider talking with a lactation consultant, who can show you basic positions to help you nurse your babies either two at a time or singly. It may also be helpful to pump and store breast milk so that your partner or other caregivers can help with the feedings.

Bottle-feeding may take some of the pressure off exhausted mothers, especially if you have more than two infants to feed. Some mothers use a combination of breast- and bottle-feeding to keep some of the benefits of nursing while still getting help with feedings. Whatever way you choose to feed your babies, you may want to track the feeding schedule on a bulletin board to make sure every baby gets enough.

• Bathing multiple babies can be quite a challenge. Some parents bathe their children separately in the interests of both safety and one-on-one time. For higher-order multiples, though, this may be impractical. Your best bet is to recruit some help during bathtime. When the infants are older, it will become easier to bathe more than one at a time.
• Dressing your babies in the first few months doesn't have to be a big production. Some parents color-code wardrobes to see at a glance whose clothes belong to whom. It may make sense to have multiples share some basic items of clothing, such as sleepers. As the babies get older, it becomes more important to give them their own clothes and establish their unique identities.
• Sleeping is necessary for your sanity! Call on your helpers so you can get an occasional nap. Even if you get your babies on a synchronized sleep schedule, you'll only get a few hours of sleep at a time. This will not give you the resources you need to care for your babies.

Many parents alternate "night shift" feedings and take turns napping. You might also consider waking and feeding all the babies when one wakes up in the night. This helps you coordinate your babies' schedule and minimize your wake-ups.

Try to sleep when your babies do. Though it can be difficult to let go of the thousand other things you need to do, remember that your well-being is crucial to your ability to take care of your babies.

Parenting Issues With Multiples

It can be impossible to tell multiple babies apart when they first come home, so don't feel guilty if you mix yours up at first. Many parents leave the hospital bracelets on or get new ones. Others paint each child's big toenail a different color or color-code their clothes. As your babies mature and their personalities develop, it will be easier to tell the difference between them.

Parents often worry about making sure their multiples develop as individuals. Here are some ways to support each child's individuality:

• give them distinctly different names
• refer to them by name, rather than as "the twins" or "the triplets"
• avoid dressing them alike as they get older
• keep their clothes in different drawers
• give them their own toys
• give them separate gifts and cakes on their birthday
• encourage them to pursue different interests and abilities as they get older
• give them time apart

It may be difficult to avoid comparisons, especially when it comes to important milestones such as walking, first words, or potty training. If one child lags in a developmental area, consult your doctor to determine the standard age range for that skill. But if the delay isn't outside the typical limits, try not to pressure the slower sibling. It's likely that your child is very aware of the difference already.

As kids get older it's important that parents look at every child's strengths and help them develop a sense of mastery. Also, remember that some of these infants will have legitimate developmental delays, which should not be overlooked.

If you have older kids in addition to the multiples, it's important to attend to their needs and any difficulty they may experiencing related to having such special siblings. It's not uncommon for older siblings to feel envious of the attention that the new babies receive and to act out as a result. If possible, try to regularly set aside time to spend individually with older siblings.

Don't forget that you need to be taken care of, too. Feeling stressed and overwhelmed is completely normal. Be sure to find time for sleep, to be alone, and to pursue your own interests.

Mothers of multiples are more likely than other mothers to suffer from "baby blues" and postpartum depression. Baby blues may leave you feeling weepy, easily upset, or excessively worried. These feelings may last for a couple of days, but for some new mothers can go on for several weeks.

In postpartum depression, these symptoms are more severe and longer lasting. A mother may feel despair, lose her ability to eat or sleep, or have thoughts of harming herself or the babies. If you experience any of these symptoms, seek a doctor's help immediately.

Maintaining Your Relationship

Not surprisingly, the demands placed on parents of multiples strain the best of relationships. With all your energy directed toward your children, there's often little left over for each other — yet this is just when you need each other most. Try to give each other breaks when you can and to ask what your partner needs each day. It can be very helpful to have an outlet for expressing your feelings. Support groups for parents of multiples can help, as can marriage counselors or clergy.

It's important that you do what you can to keep some couple time. Because it's often hard to leave multiples with one sitter, you might need to get creative. Some parents pack dinner, then strap their babies in their car seats and drive around until they sleep. Then they have a chance to dine al fresco in peace.

Other parents go out half as often as they normally would in order to be able to afford two sitters when they do go out. Still others choose to start their evening later, after the babies fall asleep, so that one sitter is able to stay with the sleeping babies. Do whatever you're most comfortable with, but remember that spending time alone together is more a necessity than a luxury.

Special Multiples Behavior

Multiples may develop language more slowly than singletons. This is may be due to prematurity, birth weight, or other factors. In addition, twins and multiples may receive less individually directed speech from parents. It's important for caretakers to spend time speaking directly to each child, as well as reading to them and encouraging language.

Social skills can come earlier for multiples, simply because they've always been with siblings, but they may do less well in other groups. Parents may encounter problems separating multiples, so it's a good idea to occasionally separate them even at an early age. Also try to introduce other people into the mix, including other kids and adults. Still, multiples are built-in playmates for one another, and from early on it's apparent that their relationship is special.

Parenting multiples has its challenges, but the rewards are twice (or more!) as great.

Reviewed by: D'Arcy Lyness, PhD
Date reviewed: November 2010