Caring for Newborn Twins

Start out with a schedule

In the first few weeks at home, your babies will mainly sleep and eat. Newborns need about 16 to 17 hours of sleep over a 24-hour period. They also need to eat about every 2 to 3 hours. Breastfeeding babies may sometimes need to eat every 1 to 2 hours in cluster feedings.

The key to getting through those tiring early weeks with twins is to try to get both babies on the same feeding and sleeping schedule as soon as you can. Doing so can help give you some downtime when both babies are sleeping. This will make you a happier, more rested parent. Otherwise, you’ll find yourself constantly feeding your babies one after the other, all day and all night.

If one baby comes home first ...

Newborn twins don’t always come home from the hospital together. Sometimes one baby needs a little more care and has to stay there longer. It’s very hard for parents to leave one baby behind. And it’s hard to have babies in two different places. But bringing one baby home first can give you a chance to get used to life with a newborn. If this happens with your twins, get the baby who is home first onto a schedule. And once your other baby is home, follow the tips here to get them both in sync.

Feed, burp, sleep, repeat

To help get your babies on the same feeding schedule, follow this tip: When one baby wakes up to eat, wake up the other one. You may find that one baby always wakes up before the other. This is OK. You are not harming your other baby by waking them up. Over time, your babies will start to move closer to the same schedule on their own.

If your babies were in the neonatal intensive care unit (NICU), they were likely already on a 3-hour schedule. Stick to that same schedule at home.

Newborn babies can only stay awake for about 1½ to 2 hours at a time. Many twins are premature and are awake for even less time. You’ll find that goes by very quickly when you are feeding, burping, and changing diapers for twins. Here’s what a typical daytime feeding may look like:

• Wake up and eat. When one baby wakes up, wait a few minutes and then wake up the other baby. Then feed them. (For feeding details, see below.) Feeding comes before playtime.

• Burp your babies. After they eat, it’s time to burp each baby.

• Upright time and play time. Sitting upright after eating helps your babies to digest. You can strap one baby into a bouncy seat while you burp and hold the other. Remember that babies should sleep on their back, not in an upright position. During the day, "awake time" after feeding is also the time to play with, cuddle, and talk with your babies.

• Change diapers. Babies will often poop after a feeding.

• Back to sleep. After all of this activity, it’s time for your babies to sleep again. Don’t wait for them to start crying. Crying is one of the last signs that a baby is tired. Instead, swaddle them and put them down for a nap at the same time. If one baby is more restless, help soothe them until they drift off to sleep.

Making nighttime feedings quiet time

From the start, treat day and night feedings differently. Make daytime feedings the more active time for your babies. This is when you cuddle, talk and sing to, and interact with your twins.

Nighttime feedings should be calm and quiet. This gives your babies the message early on that nighttime is about sleeping. Starting at about 8 p.m. and continuing throughout the night until the morning, keep the lights down low during feedings. Don’t sing to your babies, and don’t have any music on. A white noise machine may be helpful.

Breastfeeding, bottle-feeding, or both

Try not to think of this question as "either/or" or "all-or-nothing"! How you feed your babies is a personal decision. Breastfeeding will help you stay healthy, and breastmilk is best for newborns. Here are some things to consider with feeding twins.

In general, the more you nurse, the more milk your body makes. So your milk supply will increase as needed if both babies are vigorously nursing from the start. This is not usually the case for twins, so you may not be able to start out by feeding only at the breast, especially if the twins are born early. "Early" means less than 38 weeks gestation.

Expect that you will need to help establish your supply by expressing milk at first. Your babies may also need some formula during this time. Once your supply is well-established, it will be helpful to store extra milk. That way, your partner or other caregivers can help with feedings.

Talk with your babies’ healthcare provider if you have any questions about getting started with breastfeeding twins. It’s also a good idea to work with a lactation consultant. They can show you different breastfeeding positions for twins. They can also help with expressing milk, monitoring your supply, and addressing any other problems or concerns.

If you’re sure you're not up for trying breastfeeding or even expressing milk, formula-feeding is an option. But it does cost more, especially for twins. Or you may find that a mix of breastfeeding and formula-feeding works best. Again, this is not an all-or-nothing decision.

Here are a few general feeding tips for twins:

• Take turns with nighttime feedings. It’s helpful if you and your partner can each handle one overnight feeding. That way, you’ll both get a longer stretch of sleep. For example, you can do the midnight feeding alone. Then your partner can get the 3 a.m. feeding, using expressed milk or formula.

• Use a twin nursing pillow. This is a larger pillow made for 2 babies. It works well for both breast- and bottle-feeding, so your partner can also use it. At first, you may need some help placing the babies on the pillow correctly. But with some practice you’ll be able to do this yourself.

• Switch sides each time you nurse. Your babies may have different feeding styles. One may nurse more quickly or aggressively than the other. Or one of your breasts may make more milk, or have a stronger letdown. Switching sides may keep your breasts from getting lopsided. It can also help your babies develop their eye muscles and coordination.

Let others help you

All new parents need some help. But with newborn twins, extra help is vital! You may have family, friends, or neighbors who are available. A local support group for parents of multiples may also volunteer some time. Or you may decide to hire someone, if you are able to.

People can help you in many ways. They can bring you meals, go food shopping, clean, fold laundry, run errands, hold or bottle-feed a baby, or watch both babies while you rest. Or you may want to have someone handle a night feeding so both you and your partner can get some solid sleep.

Just make sure that people who are helping are washing their hands often to prevent infection. This is even more important if your babies were born prematurely.

Take care of yourself

Having 2 babies is an amazing experience. But it’s also stressful and overwhelming. It’s important to take care of yourself. Make sure you’re eating well and drinking enough fluids. Try to split up the work with your partner as much as possible. Accept any and all offers of help from family and friends. And reach out to other parents through local groups or clubs.

Parents of multiples have a higher risk of postpartum blues and postpartum depression. Having mood swings and feeling weepy is normal in these first weeks. This is called the “baby blues” (postpartum blues). But if your feelings last longer than 2 weeks, or if you start to feel worse, call your healthcare provider right away. You could have a more serious condition called postpartum depression. Help is available, and it’s important to start treatment as soon as possible.

To learn more

Find more information and local twin support groups at:

• Multiples of America www.multiplesofamerica.org/

• International Lactation Consultant Association www.ilca.org