Bottle Feeding Twins
"Feeding 50ml of milk in 1ml servings to a new-born, super drowsy baby at 3am in the morning having only had a couple of hours sleep is an 'interesting' experience"
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(TG = Twin Girl, TB = Twin Boy)
Note - We had issues with the babies staying latched, so didn’t breastfeed for long, although we did give lots of pumped breastmilk via the bottle. If you can successfully breastfeed then below may be a bit less relevant, however, especially for multiples, breastfeeding can be a challenge, so at some point it's possible you might need to bottle feed, even if its just to share the load with your partner!
As our twins were born during Covid, I was only allowed in for 3 hours during and after the C-section. It was long enough to get a few smiles out of them, change a couple of nappies and generally fall in love 😍 My wife then had the insane task of looking after both babies on her own for 2 nights while not being able lift them due to the operation. I am not sure how she got through those nights, but I went and picked all 3 of them up and got them home where I could take over as much of the heavy (and light!) lifting as possible.
It’s true that when you get babies that small home, there isn’t “a lot” to do, in terms of variety, but feeding, napping and nappy changing are utterly relentless. With the twins being born at 37 weeks (full term for twins, but 3 weeks early compared to a singleton), their stomachs were tiny so they needed feeding initially every 2 - 3 hours, day and night. They were also so small that they didn't have a strong enough suck to properly feed from breast or bottle…so we had to use a 1ml syringe.
Home time with a very precious cargo! (@0 months!)
Feeding 50ml in 1ml servings to a new-born, super drowsy baby at 3am in the morning having only had a couple of hours sleep is an “interesting” experience. At that point you are also desperate to make sure your most precious are getting all the food they need, so you really feel pressure. We were lucky in that we had captured some “colostrum” which is a super nutritious “first” breast milk, containing lots of antibodies, which is perfect for feeding up babies with tiny stomachs. We were told after the birth that it's actually possible that the body produces colostrum up to weeks before the birth, so it's worth checking this and manually capturing with a syringe and storing in the freezer as a backup.
This experience really set the tone for feeding - it's an absolutely critical part of parenting, that we desperately wanted to get “right”, and yet remained totally at the mercy of the twin’s appetite and development, and very frequently provided new challenges just as we thought we had it cracked. We found it helpful to approach it methodically and calmly, and also cut ourselves some slack when things don't go according to plan (a common parenting theme!). It is also worth mentioning before I get into the nitty gritty, that it was, and remains, an amazing time for us to bond with the twins and get them nice and relaxed and drowsy for a nap!
1. Feeding (along with sleep) quickly became one of the things that dictated how we and the babies felt day to day. I wish I had realised that the feeding pattern will shift and change as much as it did, as I initially got quite disheartened when we just thought we had it nailed, then everything changed. Once we got used to it though, we adjusted and got on top of it again!
2. Possibly up to several weeks before birth, colostrum (a really nutritious “super milk”) can be produced by the mother. We didn't know, but wished we had tried to manually capture it with a syringe so we had more as backup.
3. The twins were born at 37 weeks, normal for twins, but early compared to a singleton. For our twins, this meant that when we first got them home, they were so small they couldn’t even drink from a bottle - we had to syringe feed them the first few days - a seriously delicate and time consuming experience! They also dropped 10% of their body weight over the first week, also normal, but it was unwelcome, especially with some of the early challenges with feeding!
4. The twins had tiny stomachs, with feeds every 2 - 3 hours or so for the first couple of weeks, with no regard for our need for sleep!
5. We had a shit ton of bottles, seriously. It just made it easier to have them on the side ready to go, and meant we didn't have to worry if we were delayed from the washing up etc. (I would recommend at least 8 per baby).
6. We also needed a lot of milk feeding bibs - TG especially would spill a lot of milk when drinking, and they helped with possets and general mess!
7. We stored premade bottles of breastmilk in the fridge, or used sealed cartons of room temperature baby milk for the night time feeds. As the twins would drink both milk at room temperature and warmer milk, we could feed them at night without having to go anywhere, by pouring a carton into a sterile bottle. You can buy machines that will auto mix and heat a bottle, which sounds great and plenty of people said it is a life changer, but we found some evidence it doesn't sterilise the milk powder properly so gave it a miss.
8. Both the twins had silent reflux (where they bring back up their milk feeds, but don't vomit fully, very nasty for them) which impacted us up until about 9 months. We tried lots of different things to sort it. Largely we just had to wait it out with other things not making a massive difference. I wish I had been better prepared for this as it was horrible to see them suffering.
9. Wind could be a nightmare, and was one of our biggest ongoing challenges. We weren't militant enough about winding them no matter how cosy and sleepy they got feeding - taking the time to try and get some wind up would have been quicker than the time we lost because they woke up 10 minutes after we put them down with wind!
10. After about 2 months, we managed to do a decent job of not feeding the babies to sleep, It happened sometimes without us meaning it too, and sometimes out of desperation as nothing else is working, which was fine, but we wanted to put babies down awake (albeit drowsy) so they can self soothe to sleep. Lots more on this in the sleep post.
11. Breast pumping could be a pretty time consuming process, and needed to be done close to normal feeding times to keep milk supply up, which eats a lot into sleeping time. When we were maybe getting 4 hours a night in 40 - 60 minute slots, this was brutal. I was also super conscious to try and pick up as much of the slack elsewhere as I could so my wife could try and catch up on a bit of sleep!
12. Keeping track of feeds via an app was great for our mental health in terms of not worrying that the twins were underfed - if a a twin drank less for a feed, it was really reassuring to watch them self regulate to have pretty much the same amount of milk each day anyway. It also helped us to have a little extra to hand for their last feed if they are miles off for the day. For twins it could be hard to keep track of who has drunk what, so it also solved this problem! Finally we also got a feel for when they might be ready to drop a feed slot, if the volume of particular feed dropped off consistently. We used baby connect, which could track a host of other things, we also used it to track nappies.
13. Feeding the babies in bouncers was a great way for one person to feed both twins at once as we could hold both bottles at once! I have even seen some great home made bottle hangers that dangle the bottles just above the bouncers for triplets and beyond! A twin baby feeding pillow also worked nicely if placed on a bed or big sofa. When babies can hold their own bottle (6 - 9 months) these allowed us some welcome partial downtime while they fed themselves.
14. It got easier - I remember thinking there is just no way we could keep up the routine of the first few months. Over time we needed less feeds, with faster drinking and more independent babies that needed less help. Now feeding is a really special time to get some one on one relaxed time with the twins!
Once the first 2 or 3 days had passed, we managed to get them feeding from both bottle and breast (although we still had issues maintaining a latch, hence using both). With multiples, it was critical to get them both feeding at the same time, as if they get out of synch for feeds we could kiss the very limited sleep we got goodbye...
We had a few feeding issues, and I don't think, especially across 2 babies, that this was particularly uncommon. What was very tough to deal with was the fact that we could do very little about these ...
What went well/Not so well!
Honestly feeding changed so much and so quickly it’s tough to think of anything specific that went spectacularly well, although nothing went consistently badly either!
Feeding and Sleeping
You can probably gather from above that milk feeds and sleeping are closely linked. Milk makes babies drowsy/asleep, so it as natural to fit in naps around their feeds, but it's important not to link the two forever...
Once the first 2 or 3 days had passed, we managed to get them feeding from both bottle and breast (although we still had issues maintaining a latch, hence using both). We knew that with twins, it was critical to get them both feeding at the same time, as if they got out of synch for feeds we could kiss the very limited sleep we got goodbye, as both babies would wake up at different times. That said, later on when we had fewer feeds, a slight stagger worked if one of us was looking after them alone and are trying to get them down for a nap around the same time.
Initially, with tiny stomachs, the twins fed every 2 - 3 hours. If they hadn't woken when a feed was due, we had to wake them up! Waking a sleeping baby seemed crazy, and involves some really antisocial alarms being set at night, but believe me it was better than random wakeup bingo which quickly leads to zombies and chaos - we constantly found that reliance on routine and having a conscious approach to how we were doing things was critical to helping manage physical and emotional overwhelm! It took a couple of days to get them in synch, and of course, as they grew the timings changed, but it usually only took a day or so to adjust the schedule and get everyone back on the same page. It was tough emotionally for the first 6 months when the routine changed frequently (usually just when we thought we had it nailed!). Tracking feeds helped as we could start to see certain feeds dropping off and adjust the routine proactively.
In the first month or two, It was hard to tell if the twins wanted changes to the schedule, or were just having a bit of an off day. But, as time went on and we would see the twins refusing a bottle or taking a long time to finish it, it got easier to judge that a feed needed to be moved or dropped. With twins, this was complicated slightly as they wouldn't always change at the same time! This is where split feeding was handy for a short period, as we could feed one that was "ahead" and then once fed and down for a nap we could come and feed the other who by then would hopefully be hungry.
In those initial weeks we were totally sleep deprived, not entirely sure what was going on, and were still getting to know how and when the babies wanted to be fed. We knew it was critical for us to give ourselves as much of an advantage as we could so we weren't left needing to fiddle about in the wee hours, or make decisions on the fly.
Firstly, we had a ton of bottles so we only needed to wash up once a day, and could keep enough sterilised and ready to go - to begin with we were using something like 12 bottles a day per baby! We tried a few brands and types just to see if they would help with reflux, wind and general speed of drinking (we did find the reflux specific bottles helped a little). We also had a lot of bibs too, as TG especially spilt a lot up to about a year old!
We also used the cartons of baby milk that can be stored at room temperature and then just cracked these open in the bedroom and poured them into the sterilised bottles (which last for 24 hours if sealed shut after sterilising). It’s a little more expensive but was so much easier than trying to boil water, measure out formula and then cool the new bottle down at 3 am when we were in a waking dream. It wasn’t advised to pre-make bottles and leave in the fridge unless there was no choice, and you can only use formula milk for 90 mins after you make/pour it, and even less time if it's been started due to bacteria! We heard about machines that will auto mix and heat a bottle, which sounds great and plenty of people said it is a life changer, but we found some evidence it doesn't sterilise the milk powder properly so gave it a miss, especially as the cartons were an easier option.
Having tracked all our feeds up until about 14 months (using baby connect), it became clear that, even if they had to fit in an extra feed somehow, the babies would once at a preferred level for their age, consistently consume the same amount of milk +/- 10% every day, so stressing too much if early feeds don't go so well was unnecessary, although on those days having a bit extra ready to go for later feeds certainly wasn’t a bad idea!
The final thing was breast pumping - this is a way of capturing breast milk for storage later, and is especially handy with multiples so we could both feed a baby at the same time until we got the hang of breastfeeding two at once (some never do), or if like us you have complications getting breast feeding going reliably at all - we ended up principally bottle feeding. Breast milk does have a lot of additional antibodies and nutrients compared with formula, so even though we couldn’t breastfeed directly, we still wanted to pump as much breastmilk for as long as we could and bottle feed this. Breast pumping itself was time consuming, and needed to be done around feeding time so all the appropriate hormones are firing to trigger milk production. One of toughest things for my wife was tacking on pumping sessions to all of our feeds, which meant where at night she might have had a 90 minute window for sleeping, she lost anywhere from 15 - 40 minutes to pumping. It was super gruelling and tough to watch knowing you couldn't do anything. We also found that some pumps were better than others after trying a few. Our local NHS (the UKs national health service) breastfeeding support team rented us one of the top models which ended up being the best overall for us (Medela Symphony), although it seemed regardless of which one was used, my wife had to finish off with a manual pump.
We had a few feeding issues, and I don't think, especially across 2 babies, that this was uncommon. What was tough to deal with was the fact that we could do very little about these issues, as it seems that somewhere between 6 and 12 months, lots of things just are "grown out" of. Of course we went to the doctor and tried everything that we could, but medicines and changes to how we did things had moderate or even sometimes a negative impact. As things are changing all the time anyway, trying to figure out if what we had done was really helping was a job in itself! Here are the issues we came across:
Neither baby could maintain a latch properly, ultimately leading to us 100% bottle feeding. After trying lots of positions and different bottles, we eventually went to check for tounge ties. TG had one, and TB apparently had a very high pallet so was struggling to create a latch. Once TG's tounge tie was dealt with (not pleasant) it did help her a bit, but she continued to struggle to drink without spilling right up until around a year.
Wind could be (and 18 months on continues to sometimes be) a total pain in the ass (excuse the pun!). Small babies don’t have the physical ability to pass wind properly, and also don’t know how to! It was super tempting when you have a nice relaxed baby that is feeding to just let them carry on without a break for winding, then when we were done, they were super drowsy or asleep, so we put them straight down… 90% of the time they would wake up screaming at some point in the next 20 minutes, usually just as we were drifting off ourselves. We then have a very awake, rightly pissed off baby on our hands. In terms of winding, over the knee or shoulder are old classics, but we found that what works changes over time as the babies develop, so we had to keep experimenting. TB's high palate meant he took on a lot of wind as he couldn't seal properly on the bottle, which didn't help!
Both twins had silent reflux. Reflux in general means that babies bring back up some/all of their feed, silent reflux means they do this but don't actually throw it back up, instead it goes back down into the stomach. While this sounds better, it's actually worse, as the half digested, acidic milk then flows back down the gullet which is painful. It was really heart-breaking to hear the discomfort they were in, and there didn't seem to be much we could do about it - we tried lots of different medicines and milk types to sort it, along with leaving them upright for 20 minutes after each feed (another 20 minutes of sleeping time for us gone 😥). Prescription Gaviscon helped a little, with gripe water and cranial osteotherapy not doing much (although others swear by them). We also found propping the cribs up slightly(we used a small rolled up towel) at one end so that their heads were elevated helped a little. For the most part though, it improved over time. By 9 months it was largely gone, although right up to 18 months we heard TB suffering from time to time,
Sometimes we accidentally overfed! This quite often lead to a big vom explosion 🤮, which not only ruined the nice drowsy mood, but required a full clothes change, clean up of carpet, and then another attempt at feeding to try and make sure any lost milk was made up for! I found this usually happened when a baby fell asleep whilst feeding and we didn't notice, so they carried on feeding (the suck reflex doesn't require them to be awake apparently!). As tough as it was to do, we got pretty on the ball about pulling a bottle out of a "possibly" sleeping baby's mouth, they soon told us if they were still awake and wanted to carry on feeding!
One final thing that caught us out was that most bottles needed their teats to be changed to a higher flow rate as the babies grew and could feed faster - we were wondering why they were getting frustrated while feeding, and lots of hiccups, and this was it!
Things did get easier with time!
The number of bottle feeds reduces over time, and the speed and independence with which the babies drank increased, which made feeds less intense, and gave us back a lot of time when you consider bottle prep and sterilisation (from a year, you don't need to sterilise bottles, another MASSIVE deal!). That said, things like growth spurts or needing dream feed can really buck this trend and had us briefly reintroducing feeds after we thought they were dropped. As the babies get older, they also become better able to handle things like wind and conditions like reflux, so the uncertainty and discomfort around feeding also eased.
Feeding and Sleeping
You can probably gather from above that milk feeds and sleeping are closely linked. Milk makes babies drowsy/asleep, so it as natural to fit in naps around their feeds. We were careful though, as feeding babies to sleep, especially after the first 3 months, can impact their ability to sleep through the night. You can find out much more in our sleep post but essentially, babies like to wake up in the same place they went to sleep, so if they fall asleep in your arms, then when they wake up in their crib, they are likely to be confused and pissed! Whilst formal sleep training could only really start from 6 months, we tried to build up good sleep habits sooner, and got into the habit of keeping them awake (but drowsy and content) for their feed, then put them down into their crib awake. This wasn't always possible, especially when they are really small, so you just have to use common sense, but we definitely found it easier to manage the older they got. Also, as mentioned above, wind can be a silent saboteur of good sleep if it's not dealt with, which usually requires an awake baby. A good rule that we didn’t follow religiously, but I wish we had now, is to switch to feeding when they wake, then do an activity, (even just reading a book), then sleep - this breaks the link between feeding and sleep completely.
We tried to avoid dream feeds (a feed you perform just before you go to bed, say 10pm, ideally without really waking up the baby, so they are full and sleep through) as we had read that this actually prolongs the time it takes for them to naturally become able to sleep through the night. There were times however where we had consecutive nights of a someone not sleeping through and ultimately demanding a feed at night - when this happened we would introduce a dream feed for a week or so, and then gradually reduce it as long as they continued to sleep through. My hunch is this typically coincided with growth spurts, or sometimes around the time a milk feed had just been dropped and perhaps other daytime feeds hadn’t picked up the slack yet.
With more than one baby, feeding could be a little more complicated if only one of us parents were around, especially before the twins could hold their own bottles. As noted above, bottle prep in particular was key to ensuring we didn't end up running around trying to prep 2 bottles while both twins are hungry and crying for milk, as we couldn't comfort or carry both at once!
We did stagger feeds from time to time, usually when we found a bit of a difference in when both were hungry (typically TB would begin to drop a bottle feed a little before TG, so would start to last longer between feeds). This worked well when there was only one of us on hand as we could put one down for a nap immediately after their feed, and then focus on the next baby.
Most of the time though, feeding both at the same time was preferable as once one started to feed, the other got bigtime FOMO! When solo parenting, a double feeding pillow, or using two bouncers next to each other meant one person could hodl two bottles and the twins were supported, we also rigged a setup using pillows and a rolled up towel on our sofa - I am sure everyone ends up with their own "bespoke" solutions!
Once the babies were old enough to hold their own bottles (a MASSIVE deal!) at about 6 months, we could just get them set up and hand them the bottle and take 10 minutes to sit and relax while they feed themselves! As the twins grew out of bouncers (~14 months), we could just leave them to feed themselves with bottles, but along with quite often ending with a game of "find the bottle" (and milk puddles 🤦♂️), I think we all missed the cuddles and time together a bit too much to make this the norm!
Bottle holding is MASSIVE deal and gave us a break while they feed! (@1 year)
What went well?
Honestly feeding changed so much and so quickly it’s tough to think of anything specific that went spectacularly well, although nothing went consistently badly either! That said, after first couple of months, we had adjusted to feeding time in general and minimised the health issues, it was a generally relaxing and pleasant experience where we got to spend some quiet time with the twins.
Being organised and staying on top of bottle prep, having milk cartons handy etc was a life saver. On the odd occasion we had to make milk from scratch in the first 6 months, it seemed super time consuming and fiddly.
What was hard and what would we do differently?
Knowing how much effort and disruption pumping took, we might have considered a different approach or doing less of it. That said, we were really happy we managed to supplement formula for so long, so this might be just one where forewarned is forearmed and we just had to suck up the extra demand this puts on us.
We probably tried to experiment/were a bit too reactive in the early days with routines and feeding, when we should have just waited for clearer signals from the babies that they wanted things to change. It’s tough to get this right, especially with two, as each has their own different needs, schedule etc.
We are still feeding the babies twice a day, and I think we probably need to do something to change the way we feed before bed - currently we feed them separately (we have only done this since they were about 13 months or so) so they don't distract each other. I think we will regret setting the precedent that they get fed separately, and will have to unpick this at some point soon when we want to do a combined bedtime routine. This is where better following the feed - activity - bed sequence would have helped us, as I suspect they wouldn't have been so excited when we went to put them down if we had fed and done an activity before hitting the bedoroom.