.

While vaccines are one of our great success stories in modern medicine, saving millions of lives over the past several decades, they remain a topic of uncertainty for many parents. You are not alone if you have questions about vaccinations for your growing family. This article will guide you through the most up-to-date newborn-vaccination recommendations to help keep you and your newborn twins safe.

Highlights:

Newborns have a high risk for severe complications from vaccine-preventable illnesses.

All babies should receive the first hepatitis B vaccine within 24 hours of birth.

The CDC recommends COVID-19 vaccines for everyone ages six months and older, including people who are pregnant and breastfeeding.

Pregnant women should also receive a Tdap (whooping cough) and flu vaccine.

.

Family members and caregivers should be up-to-date with immunizations and boosters, including whooping cough and influenza vaccines.

Why are vaccines so important?

The simple answer – getting vaccinated is better than getting the disease. Those quick little pokes have saved many children from dying from diseases like meningitis, diarrheal infections, and many more. Since a newborn’s immune system is not fully developed, they are at an even higher risk for severe complications from vaccine-preventable illnesses.

.

Are vaccines effective?

Yes! Vaccines do an outstanding job. Many diseases affecting children have been reduced or eliminated thanks to vaccines. Most childhood vaccines are 90% to 99% effective in preventing disease, and if a vaccinated child gets the disease, the symptoms are less severe than the illness of a child who did not get the vaccine.

.

Are vaccines safe?

Millions of children safely receive vaccines each year. The most common side effects are pain or swelling at the injection site. Serious side effects from vaccines are rare. For every 1 million vaccine doses, 1 to 2 people may have a severe allergic reaction. Your doctor’s office is well-trained to treat any severe allergic reactions that may occur.

Why do vaccinations start at such a young age? Do I have to stick to the recommended vaccination schedule?

Changing the recommended vaccination schedule is not a good idea. The CDC’s recommended scheduling for each vaccine is based on age and factors like immune response and likelihood of exposure to the disease. There is no research to show if a child would be equally protected with a very different schedule.

.

Tips for vaccinating twins

Most new parents cringe at the idea of their newborn receiving their first shot, and this can be double as tough for parents of twins. Here are a few tips to help make the injection go as smoothly as possible:

.

Enlist some help: Having an extra pair of hands to help undress, dress, and comfort the babies after the injection can be incredibly helpful. If no one is available to help, ask if a staff member, such as a medical assistant, is available to help during the vaccinations.

Ask for something sweet. A sweet solution of sucrose or glucose (often called sweet-ease) a minute before the shot can help reduce your little one’s discomfort with the injection.

If you are breastfeeding, this can help soothe them after the vaccination. Have your helper hold them during the vaccination and get them dressed, so you can take them afterwards.

For triplets or more: Consider having them vaccinated at different times, especially if you do not have a helping hand.

Vaccines for newborns

Hepatitis B Vaccine

Brand Names: Engerix-B and Recombivax HB (3-dose vaccine series); Pediarix, Vaxelis (4-dose vaccine combination series)

.

Hepatitis B is a contagious liver disease caused by the hepatitis B virus. The vaccine is vital in your newborns because approximately 90% of infants who become infected with hepatitis B will become chronically infected (compared to only 2%–6% of adults). Chronic hepatitis B can lead to chronic hepatitis, liver cancer, and death.

All babies should get the first hepatitis B vaccine within 24 hours of birth. The hepatitis B vaccine may be given as a 3-dose vaccine series or as part of a 4-dose vaccine combination series (a vaccine that combines more than one vaccine into one shot). Both series start at birth and are completed by 6-18 months.

Some newborns will have a mild reaction, such as pain at the injection site or a rash. If you are concerned about symptoms, call your pediatrician for guidance. Here are a few tips for comforting your twins after the injection:

.

A cool, damp cloth can help reduce any redness and swelling at the injection site.

Some newborns will want to eat slightly less the 24 hours after getting a vaccine and may prefer smaller and more frequent feedings.

.

If a pregnant mother tests positive for hepatitis B, the babies will get their first shot of the hepatitis vaccine within 12 hours of birth and receive a hepatitis B immune globulin (HBIG) along with the vaccine to help prevent the disease.

What is the recommendation for the hepatitis B vaccine in premature babies? If your twins were premature and weighed less than 2000g at birth (about 4lbs., 6oz.), the American Academy of Pediatrics (AAP) recommends the hepatitis B vaccine be given at one month of age or when discharged home from the hospital (whichever comes first).

___________

.

Vaccines for family members and caregivers

Family members and other caregivers can protect newborns by staying up-to-date on all their vaccinations.

.

Whooping Cough Vaccine (DTaP for children and Tdap for preteens, teens, and adults)

Whooping cough can cause severe and life-threatening complications in babies, especially those under six months. About half of babies who get whooping cough will end up in the hospital, about 1 out of 4 will get pneumonia, and 1 out of 100 will die. Whooping cough is very contagious and is transmitted through respiratory droplets. The best way to protect newborns from whooping cough is to ensure pregnant women get a whooping cough shot (called Tdap vaccine) during each pregnancy between 27 and 36 weeks. It’s also crucial that siblings and anyone around the babies are up-to-date.

Influenza Vaccine

Influenza (commonly called the flu) can also cause severe complications like dehydration, pneumonia, and even death in babies less than six months. Because flu vaccines are not approved for use in children younger than six months old, protecting newborns from the flu is especially important. The CDC recommends that all pregnant women get the inactivated flu vaccine (the injection, not the live nasal flu vaccine). All caregivers and household members six months and older should also get the influenza vaccine.

COVID-19 Vaccine

We still have a lot to learn about the risks of COVID-19 in newborns; however, it appears most newborns who test positive for COVID-19 are asymptomatic or have only mild symptoms. The CDC recommends COVID-19 vaccines for everyone ages six months and older, including people who are pregnant and breastfeeding. Booster shots are approved for everyone five years of age and older.

.

Helpful resources for parents

To learn more about vaccine ingredients: What’s in Vaccines?

Centers for Disease Control and Prevention (CDC): Vaccines & Immunizations

American Academy of Pediatrics: Conversations About Vaccines

Adverse reactions should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your health care provider will usually file this report, or you can do it yourself. Visit the VAERS website or call 1-800-822-7967. VAERS is only for reporting reactions, and VAERS staff do not give medical advice.

.

References

Kempe A, Saville AW, Albertin C, et al. Parental Hesitancy About Routine Childhood and Influenza Vaccinations: A National Survey. Pediatrics. 2020;146(1):e20193852. doi:10.1542/peds.2019-3852

Child and Adolescent Immunization Schedule. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Published 2022. Accessed September 3, 2022.

Hepatitis B Foundation: Hepatitis B Vaccine Schedules. Hepb.org. Published 2022. Accessed September 5, 2022.

The post Newborn Vaccinations: a pediatrician’s guide to keeping your newborns safe appeared first on TWINS Magazine.

FASDs are a group of conditions that can occur in a person exposed to alcohol before birth. The severity of symptoms varies from child to child, but can include:

• Vision or hearing problems
• Problems with the heart, kidneys, or bones
• Sleep and sucking problems as a baby
• Hyperactive behavior and difficulty with attention
• Learning disabilities (especially with math) and intellectual disability
• Speech and language delays
• Shorter-than-average height
• Abnormal facial features, such as a smooth ridge between the nose and upper lip

What do we know about twin pregnancies and exposure to alcohol?

A study of twins exposed to alcohol in utero shows that similar amounts of alcohol can lead to drastically different levels of neurological damage.¹ While twins with identical DNA had similar fetal alcohol outcomes, non-identical twins could show strikingly different outcomes: one could be born with severe symptoms while the other was only mildly affected.

What does this mean? The risk of damage does not only depend on how much alcohol is consumed during pregnancy, the baby’s genetics also play an important role. The biggest takeaway, to protect all babies, including those most genetically vulnerable, the only safe amount of alcohol is none at all. There is also no safe time during pregnancy to drink alcohol, and all types of alcohol are equally harmful, including all wines and beer.

How are FASDs Treated?

FASDs last a lifetime, and while there is no cure for FASDs, early intervention treatment services can improve a child’s development. Treatment typically includes special education services, behavior therapy, counseling, and medication. In some cases, children with FAD may need to be placed in a special education classroom or receive other types of educational support.

Fetal alcohol disorder is a serious condition. If you’re pregnant or thinking about becoming pregnant, it’s important to avoid drinking any alcoholic beverages so that you can reduce your child’s risk for this disorder. If it is hard to stop drinking, talk with your doctor about getting help. You also can visit the Alcoholics Anonymous website at www.aa.org or call the Substance Abuse and Mental Health Services Administration’s treatment referral line at 800-662-HELP (4357).

References

1. Genetic risks play part in fetal alcohol syndrome. Newsroom.uw.edu. https://newsroom.uw.edu/news/genetic-risks-play-part-fetal-alcohol-syndrome. Published 2022. Accessed September 9, 2022.
2. Alcohol and Pregnancy. Acog.org. https://www.acog.org/womens-health/infographics/alcohol-and-pregnancy. Published 2022. Accessed September 9, 2022.

The post Fetal Alcohol Spectrum Disorders in Twin Pregnancies appeared first on TWINS Magazine.

But today, as a parent, I turn my attention towards my children and find great joy in watching them revel in anticipation of Santa and the presents under the tree. 

As a psychologist, one of my goals is to help clients bring their life back into balance.

However, this Christmas, my children are reminding me of a strategy that not only allows people to feel more balanced but helps them to get in touch with their true, authentic selves.  

The strategy that my fantastic five-year-old twins are reminding me of is the value of play, and the role that fun has in reducing stress and bringing me back to my true self. 

Winnicott and the Power of Play

Donald Winnicott (1896-1971) was a child psychiatrist who talked about the concept of True self versus False self. He says that everybody is born with a True Self – the happy, innocent, problem-free, creative, curious, and playful human qualities that are most evident in childhood. 

Over time, though, as the child gets older and becomes an adult, the child loses connection with their True Self. What then emerges is a False Self. The False Self is the part that’s often associated with being orderly, mannerly, proper, and behaving in ways that will help the person fit into society. 

What’s important to remember is that the role of the False Self is to protect the True Self. The False Self emerges to help the child (or adult) cope with their environment. 

A person’s True Self never goes away. It only remains hidden and covered up by the False Self. 

Play Exposes the True Self   

Winnicott strongly believed that when an adult engages in any activity that resembles play, it helps the adult reconnect with their true, authentic self. In other words, the True Self emerges when we find activities that allow us to have fun.

Whether it’s engaging in physical activity (such as playing a sport, participating in fitness classes), being creative (painting, drawing, writing, listening to music, singing backup vocals to your favourite tune), hanging out with friends, or playing board games. Any different activities that remove you from your day-to-day world can help you to connect with your authentic self. 

When you spend time connecting and having fun with your children (whether they are two years old or 30-years old), you bring yourself back down to a younger level, which helps you reconnect with your True Self.

And when you spend time playing and doing activities that bring a sense of enjoyment and pleasure to your life, you are reducing stress and bringing yourself back into a more balanced state. 

I hope your Christmas and the holiday season allow you to laugh and play and provide you with an opportunity to reconnect with your True Self. 

The post De-stress through the power of play appeared first on TWINS Magazine.

When Kim brought her twin-toddlers to the pediatrician’s office, one child cried the whole time and the other kept asking for cookies.  By the time Dr. Carter entered the room, Kim was frazzled.  Her children’s distractions caused her to forget to ask a couple of important questions of the doctor.

This happens frequently.  Many parents are distracted during office visits and forget to mention important details of health or behavior to their doctors.  Perhaps this has happened to you.  Here are some ideas to help you office visits go more smoothly:

Bring your twins’ medical histories with you

For your first visit, bring a copy of your children’s medical records from your previous physician.  Your new doctor is interested in their medical histories, previous surgeries, diagnoses, and treatments.  Remember to bring immunization records.  Have all your records in a file folder for safekeeping, and let the office make copies, but keep the originals for your home records.

Bring your list of symptoms 

Before the appointment, make a written list of each child’s symptoms and any questions you may have for the doctor.  This helps you remember important information you may otherwise forget.  Symptoms are like pieces of a puzzle.  When you tell your doctor all of the details—even seemingly unimportant ones—it gives your physician a clearer picture of your situation.  It helps make an accurate diagnosis and treatment plan.

Talk to your doctor about medications

If your twins take any medications, vitamins or herbs, bring the bottles with you in separate zip-lock plastic bags, labeled with each child’s name.  Your doctor will easily see what they take, dosage and frequency.  By looking at your bags of medications, your doctor can prevent misunderstandings and mistakes.  It’s an important safeguard.

Your doctor may want to change a medication.  If the physician doesn’t explain why, ask about the reason(s).  Sometimes doctors are busy thinking and forget to clarify why they are making changes.  Ask about side effects or anything you should be watchful of with new medications.  Usually children won’t experience side effects, but if they do, you’ll know how to respond.

Everyone’s body responds a little differently to each medication.  If one of your twins is taking a new prescription and having a problem with it, call your doctor if you are concerned.  Some meds need close monitoring to make sure they are working properly.  If a med isn’t working well, your doctor may want to switch to another one, which your child may tolerate better.

Schedule appointments based on priority items

If you child has several medical problems, select the most important one or two that need addressing.  As mothers, we tend to try to solve everything in one visit.  But this can result in inadequate time for the most important health issues.  If there isn’t enough time to address your child’s problem thoroughly, a follow-up visit can be a good solution.  Your doctor can make sure your child is progressing well with the new treatment and you can talk about your other concerns.

Most pediatricians and family doctors schedule or allot 10-minutes per appointment, per child.  It’s important to respect their time constraints.  Doctors appreciate patients who focus on health issues and don’t draw them into conversations about unrelated topics. Most pediatric offices will allow you to schedule your twins’ appointments together.

Out of respect for your doctor, don’t ask for a medical opinion related to another child’s health if you don’t have an appointment for that child.  If your other child also is sick, it’s best to schedule a separate appointment.  This enables the staff to prepare each child’s medical chart for the office visit and avoids confusion for the doctor.

Appointments are easy to forget, especially well-child check-ups.  The children are feeling fine and moms forget the visit because doctor appointments aren’t part of the normal routine.  If you think you may forget, post a reminder note on the refrigerator the day before the appointment.

Doctors not only appreciate when parents remember appointments, but also when they arrive a few minutes early.  Latecomers set the doctor’s schedule back, sometimes for the entire day.  If every person arrives early and uses the proper time allotment, everyone’s waiting-room time is relatively short.

Develop a treatment plan with your doctor

Your doctor wants you to understand the treatment plan set up for your child(ren).  If you don’t understand something, ask your physician to go over it again and explain in detail what each step is for and how to carry out.  No question should be overlooked if it is important to you.  During your visit, if possible, write down important details that could easily be confused or forgotten.

Share your concerns

Don’t be afraid to talk to your doctor about personal issues or uncomfortable topics pertaining to your twins.  Your doctor treats all types of problems regularly and can help you.  But your physician is not a mind-reader and can visually recognize only some aspects of your children’s health, so you have to introduce the topics your physician needs to know about.

Tests, procedures and specialists

Your doctor may want to order medical tests or send your child to a specialist for problems that need great attention. Certain screenings and lab work help your doctor thoroughly understand the roots or manifestations of certain conditions.  Provide the nurse with the dates you are available for appointments or tests.  This saves time and enables your nurse to schedule things more quickly for you.

A quality physician only orders test when they are necessary tests.  Today things are different.  Insurance companies oversee testing payments and won’t allow unnecessary tests to be done.  You can rest assured that your doctor will only order tests that are important.

Payment plans

Bring your co-pay, insurance cards, credit card or cash.  Your driver’s license or identification is required for the first appointment, in order for your children to be seen.  If you are having financial problems, many offices will allow you to use a payment plan.  Like any other service providers, doctors expect and appreciate timely payment.

Know your doctor and the staff

Even as your doctor finds it important to know certain things about your family, there are things you may want to know about your doctor.  It’s time to ask how long your pediatrician or family practice doctor has been in practice and where he or she attended medical school.  The physician and the office staff should be friendly and polite.  They should return your phone calls in a timely fashion.  It’s important that their office be clean and well-organized.

Work together for good health

It takes extra preparation to make smooth office visits.  Be especially alert when procedures or immunizations are being given to your twins—you’re an important element of safeguarding them from medical mistakes.  If the room is noisy or chaotic, it’s possible the nurse could become distracted and administer a shot to the wrong child.  With your watchful eye, mistakes can be prevented.

Your doctor and the office staff care about your family’s health and will give you wise counsel, to the very best of their ability.  Have reasonable expectations for relief of symptoms and cures.  Not everything can be “fixed” instantly and medicine is as much art as science.

Judy Gyde lives in Toledo, Ohio and is a former pediatric nurse who has twin nieces and a son-in-law with a twin sister. The pediatrician she worked for had about five sets of twins per month who visited the practice for routine checkups.

The post Make the Most of Your Twins’ Pediatric Appointments appeared first on TWINS Magazine.

Her husband, Scott, managed through sheer force of will to get her to Bethesda Oak Hospital in Cincinnati, on time. Unfortunately, her obstetrician was snowed in. Hours drifted by. Leah was no longer on Terbutaline, the drug preventing her from going into labor. She hadn’t expected to need it. So while Leah waited for her obstetrician, labor contractions started.

At first, she ignored them. She had experienced contractions on and off for months. But the contractions grew stronger until it was apparent she was in full-blown labor. Anxiously, she talked the situation over with her nurse, since there were still no obstetricians in the hospital. She made the decision to go through a “trial of labor” to see if she could deliver her twins vaginally.

Now, in labor, Leah had to make a choice she had not been prepared for: What form of pain relief should she use during delivery? Should she ask for an epidural? If she had had the C-section as scheduled, she would have an epidural or spinal without question. But she really hadn’t explored other helpful techniques like meditation or breathing methods. What about other drugs? Leah regretted not thinking about this earlier.

Pregnant mothers of twins usually decide in advance whether they will be having a C-section or vaginal delivery. Those planning a vaginal delivery have a big decision to make about pain relief during labor. Those planning a C-section may have enough information about epidurals before the big day. Getting an epidural (or a spinal) can be a scary event, and unnecessary fears may be avoided if women are informed.

What is an epidural?

Dr. Phillip Bridenbaugh, president of the American Society of Anesthesiologists in 2015 and editor of the book “Neural Blockade” the definitive book about pain management, described an epidural as a tiny tube placed into the spinal fluid. A small amount of medicine is injected and runs through the tube in a continuous, slow drip.

The medicine is usually similar to Novocain but sometimes is an opiate, like morphine. It temporarily numbs the roots coming from the spinal cord, stopping pain and other sensations. Higher doses can numb the nerve roots more, preventing leg movements.

How is a spinal different?

A spinal is a similar method of pain control. It involves a single injection of the same medicine into (instead of outside) the sac containing the spinal fluid. It causes complete numbness and is safe. It works well for scheduled C-sections or pain during delivery, but not as well for labor pain with vaginal deliveries. This is because it is given as a single dose that only lasts for a set amount of time, typically two to three hours. Labor often lasts much longer.

An informed decision

So, what does one really need to know to make an informed decision about epidurals? Mothers expecting twins have special reasons to consider epidurals for vaginal deliveries. For one, they are more likely to end up having a C-section as there is a greater likelihood of complications delivering multiples. Dr. Bridenbaugh says that once an epidural is in place, no further steps need to be taken if a C-section is required. If a pregnant mother of twins tries natural labor with no epidural, and she ends up needing a C-section, an epidural or spinal has to be put in fast, or she may end up “knocked out” with a general anesthetic.

Women delivering twins may likely end up needing a forceps delivery. Epidurals are especially good for forceps deliveries because they cause the muscles around the vagina to relax more completely, as well as eliminate the pain caused by the forceps.

Mothers of twins also may need “manual” help delivering the placenta. This is when an obstetrician removes the placenta by hand. Difficulties can occur because the placenta is usually bigger with twins, and sometimes there are two placentas. Epidurals protect against pain in this often unexpected procedure. Prolonged labor is another issue. Many women delivering twins choose epidurals when in prolonged labor rather than relying on natural techniques, such as breathing methods, which are hard to sustain for long periods of time.

Should you worry about injury from an epidural? Dr. Bridenbaugh stated that serious or permanent injury to the nerve roots is extremely rare: one in around 40,000 to 60,000 patients. An infrequent complication is a dural puncture, which is a temporary tiny hole in the dura mater surrounding the spinal cord. This may cause a headache after the procedure. However, headaches are much less common after epidurals than they are after spinals.

Epidurals are the best method of pain relief available for labor. While her obstetrician was stuck in the snow, Leah decided to use an epidural while she tried delivering vaginally. She had felt moderately painful contractions for months while she was on bed rest.

When she received the epidural, the pain relief was so complete and immediate she described her feeling as euphoric. She said she finally realized how much pain she had been in all along, and, at that moment, she felt total relief.

Pregnant mothers of twins often get epidurals, as do mothers who already have had twins and are pregnant with another child. Learning the basic facts about epidurals may ease some fears and help with decision making. Those who use epidurals should do so without guilt, disappointment or fear that they are harming their babies.

About the Author:
Karen Jobalia, M.D., of Cincinnati, Ohio, works with many parents expecting multiples.

The post Pain Management – Should you worry about epidurals? appeared first on TWINS Magazine.

So how do children fare in this online environment? What sort of things should we consider as parents and educators to support our youth in this new set of challenges? Will these new circumstances create extra anxiety? What about our students with learning differences who may already be experiencing some anxiety in their schooling experiences?

When you consider some of the cognitive load that comes with online learning, there are many new potential stresses being introduced to the learning environment:

• Wifi or internet issues: freezing screens, downed internet, internet hiccups that might kick you out of your call temporarily (and missing content or instructions due to any of the above).
• New technology: trying to figure out how to open and use new software, how to save items, how to submit or “turn in” items, how to flip between seeing the live class and programs that you are supposed to be working on.
• Discomfort being on screen: it takes time to get used to having your face on the screen for all to see! There definitely could be some self-consciousness around this.
• Background noises: many students who are working from home may be contending with siblings who are also doing distance learning, parents working from home, pets running around, household chores being done, etc.
• Increased screen time in one place: especially in elementary school, kids are not used to sitting in one spot for long periods of time. They move from desk to small groups, to the library, to the gym, to the carpet, etc. They are not used to staring at a computer screen or being in one spot for such long periods.

When you look at all of these new potential items that children are contending with, within this context, it helps to understand how an online learning environment can produce extra anxiety and stress.

“Living with anxiety is like being followed by a voice. It knows all your insecurities and uses them against you. It gets to the point when it’s the loudest voice in the room. The only one you can hear.” – Unknown

Let’s chat about some of the things to keep in mind while assessing how our kids are TRULY doing from an emotional and mental health perspective during online learning:

Thought #1: Many of the things that cause school-related stress (keeping up with classmates and the pace of the class, not understanding content, time pressures on tests, having a hard time staying on task, etc.) will still trigger anxiety when learning at home. Those same stresses exist whether in a physical classroom or a virtual one.

Thought #2: Consider what the intended outcome is for attending school (to love learning, to develop and grow, to prepare us for the future, etc). Those are still the same goals but they have just become more complicated. We don’t know how the future will look and it is easy for all of us (kids included!) to feel hopeless and nervous about the possibilities.

Thought #3: There is still social pressure with online/remote learning. People are allowing access into their personal spaces and environment in a different way. This could create the possibility for ridicule, shame, and bullying. Kids also do not have their regular friends with them to chat with or feel supported by. This can be isolating and leave students feeling even more alone.

Thought #4: When we’re overwhelmed by the pressure we shut down, browse the web, and put off the tasks that are draining our energy. Our kids will do the same thing and when they get behind, procrastination, worry, and guilt might become a cyclical issue.

Thought #5: New York Times teachers found that about half of their students didn’t log into their remote learning courses. We have to consider the why behind this. It is easy to jump to the conclusion that those students don’t want to learn or are unmotivated (which is why they didn’t log on). However, we must look at students as individual people, each with their own set of circumstances. They may not be logging on due to many different reasons: anxiety, uncertainty, fear, family issues, tech issues, etc., and not just due to motivation issues.

Thought #6: Those with anxiety often feel uncomfortable with unpredictability and change. Right now online learning may seem to be the safest option for education, but there are also a lot of changes that come along with this mode of learning.

There have been so many changes this year. We need to keep checking in with our kids. Some of the struggles and anxieties they may be feeling are ones we can predict, others may take a little more digging, and need to be looked at from different angles and perspectives. With the unpredictability and uncertainty of life and learning right now, it is easy for anxiety to creep in.

So as a reminder to all of us, here are some common ways anxiety might manifest:

• Inability to focus
• Fear of school
• Tantrums over school/homework
• Headaches
• Stomach aches
• Restlessness
• Rapid breathing

Online learning can provide some great benefits to kids with learning differences such as ADHD, dyslexia, or LD over in-person classes. Let’s not look at either option as “the ideal” since none of our current options are perfect for our kids right now.

Instead, let’s support, nurture, guide, and watch out for them, and each other as we all ride this rollercoaster full of anxieties, uncertainties, and hopefully some moments of gratitude together.

“If we could look into each other’s hearts and understand the unique challenges each of us faces, I think we would treat each other much more gently, with more love, patience, tolerance, and care.” – Marvin J. Ashton

For more online learning tips and resources for children with learning differences, visit www.shiftyourthinkingld.com.

The post Assessing Your Child’s Mental Health While Learning Online appeared first on TWINS Magazine.

Most people realize that there is a percentage of women who experience feelings of sadness after they deliver their baby or babies. The reality is that many people have no idea of the severity and complexity of life with PPD. 

In fact, there are a number of discouraging myths that keep many women from seeking help when they experience the signs of depression after delivery.  

In this article, we will look at what postpartum depression is, why it occurs, debunk some popular myths, and talk about how to get help for you or someone you love.

Postpartum depression does not have to derail your experience as a new mom of multiples. 

What is postpartum depression?

There is not one single underlying cause of PPD. Instead, experts believe that there is a myriad of contributing factors that lead to developing this form of clinical depression. 

Postpartum or perinatal depression affects as many as 1 in 7 women. It is so common that it is the most common complication of childbirth. 

Who is most likely to develop postpartum depression?

PPD can affect any woman. It strikes women who experience easy pregnancies, as well as, those with difficult pregnancies. First-time mothers and mothers who have one or more children can also experience PPD. It doesn’t matter if a new mom is married or single, and things like income, age, ethnicity, culture, and education make little difference in your risk of experiencing depression after birth.

One group of women who are at a higher risk of suffering from postpartum depression are moms of multiples (or MoMs). MoMs are much more likely to develop PPD than moms of singletons. While not all twin moms will experience symptoms, they are at an increased risk. 

What are the risk factors for postpartum depression?

• A change in hormone levels after childbirth 
• Previous experience of depression or anxiety 
• Loneliness, not having close friends and family around
• Family history of depression or mental illness 
• The stress involved in caring for a newborn and managing new life changes
• Having a challenging baby who cries more than usual, is hard to comfort, or whose sleep and hunger needs are irregular and hard to predict
• Having a baby with special needs (premature birth, medical complications, illness) 
• Lack of family support
• The health consequences of childbirth, including urinary incontinence, anemia, blood pressure changes, and alterations in metabolism
• The physical changes during and after pregnancy
• Other emotional stressors, such as the death of a loved one or family problems
• Financial or employment problems 
• Caring for twins, triplets, or higher-order multiples 
• Isolation and lack of social support
• Changes in the sleep cycle 

Difficulties with breastfeeding might also be linked to PPD. New moms who have difficulty breastfeeding in the first 2 weeks after delivering their babies have a higher risk of PPD 2 months later, according to a study at the University of North Carolina in Chapel Hill. 

What is the difference between baby blues and depression?

Many new moms confuse their own postpartum depression with the less serious “baby blues.” Baby blues happen when moms feel more melancholic than is typical for them after delivering their infant. As hormone levels drop, moms can feel moody, sad, tired, and generally “blue.” This is very different from PPD. 

Unlike the baby blues, PPD doesn’t go away on its own. It can impact a mother’s ability to care for her newborn. The symptoms are much more debilitating and longer-lasting. Any mom who is concerned about how she is feeling should talk to their doctor in order to stay aware of what is going on. 

How prevalent is postpartum depression?

Rates of PPD in singleton pregnancies

According to a report and statement issued by the U.S. Preventive Services Task Force, 8.9 percent of all pregnant women and 37 percent of new mothers experience clinical depression in the months before or after giving birth. Less research has been done on new fathers, but some studies suggest that about 10 percent of dads may also experience postpartum depression. For half of the women diagnosed with PPD, this is their first episode of depression. 

Rates of PPD in twin pregnancy

Moms of multiples experience PPD at a higher rate than singleton moms. Researchers have not yet isolated whether these higher rates are due to physical etiology (such as higher levels of hormones) or the additional stress of caring for two newborns. 

A 2009 study, published in the journal Pediatrics found that new MoMs were 43 percent more likely to have postpartum depression than were mothers of singletons. While not all moms of multiples will develop PPD, it is important for these MoM’s and their families to be on the lookout for potential symptoms.  

Recognizing the signs of postpartum depression

In theory, it sounds like it would be fairly simple to identify and treat PPD, right? 

The reality is that after delivering newborn twins, in the sleep-deprived newness of parenting, things can get muddy. MoM’s often think their sadness or anxiety will go away. They often blame their feelings on exhaustion. Understanding the signs of PPD can help to tease apart normal postpartum blues with true depression. 

What are the symptoms of postpartum depression?

The warning signs are different for everyone but may include: 

• A loss of pleasure or interest in things you used to enjoy
• Fear of not being a good mother 
• Eating much more, or much less, than usual
• Anxiety — all or most of the time 
• Fear of being left alone with the baby 
• Racing thoughts 
• Feeling guilty or worthless, including blaming yourself 
• Excessive irritability, anger, or agitation 
• Sadness, crying uncontrollably for very long periods of time 
• Difficulty sleeping, beyond the typical new parent lack of sleep
• Disinterest in the baby, family, and friends 
• Difficulty concentrating, remembering details, or making decisions 
• Thoughts of hurting yourself or the baby (seek help immediately if you experience this symptom).

What to do when you suspect postpartum depression?

If you suspect someone you love may be suffering from any form of postpartum depression, anxiety, or even blues – the first thing to do is talk about it. Many moms don’t even realize what is going on. In many cases, it is the loved ones that first recognize the symptoms. 

However, if you are feeling any of the earlier noted signs of PPD, talk to your doctor right away. There is no need to suffer in silence. PPD is treatable!

Fighting the stigma of postpartum depression

Despite the mountains of research surrounding postpartum depression and dialogue that is opening up, many women still feel a stigma when it comes to PPD. There are a number of myths that keep many people in the dark about the realities surrounding postpartum depression. 

Debunking the myths

Myth #1: Moms who have PPD don’t bond with their babies

Truth: Moms with PPD love their babies just as much as moms who do not have PPD. Depression is in no way a sign that a mom will not bond with her baby and love her twins the same as any other mother.  

Myth #2: You can only get PPD if you had a previous mental illness

Truth: While women with a history of mental illness (specifically a mood disorder) are slightly more likely to develop postpartum depression, any new mom can experience it regardless of health history. What’s more is that MoM’s who have experienced a mental illness in the past, are not necessarily going to develop PPD.  

Myth #3: Symptoms show up right after birth

Truth: In many cases, moms will not experience the symptoms of PPD for weeks (or even months) after giving birth. In some cases, women can display signs during the last stage of pregnancy and some won’t develop until as much as a year after delivery. Typically, the condition develops within 4 to 6 weeks after giving birth, but it can sometimes take several months to appear.

Myth #4: PPD will go away on its own

Truth: PPD is a serious condition that requires treatment. It often will not subside on its own and may require a combination of therapy and medication to alleviate the symptoms. Many new moms wait in hopes that the symptoms will retreat on their own, but inevitably prolong their negative feelings. 

Myth #5: Moms with PPD cry nonstop

Truth: Postpartum depression can take many forms. While some moms of multiples will be tearful, others will experience PPD as isolation, anxiety, or withdrawal. A woman does not have to cry around the clock to be experiencing PPD.  

Seeking help for postpartum depression

If you experience these symptoms during pregnancy or after delivering your babies you should talk to your doctor. Also, if you recognize any of these signs in someone you love, encourage them to talk to a medical professional. Many women delay seeking treatment for PPD and suffer in silence for much longer than is necessary. 

Too few women seek help for postpartum depression

In a survey published in the Journal of Psychiatric Practice, parents of twins or other multiples reported experiencing the most difficulty during the first three months of their babies’ lives. The study included 244 parents of twins and other multiples (including 197 mothers and 44 spouses or partners), asking about parents’ mental health during the postpartum period. 

They found that, although 48 percent of the study participants had struggled emotionally after their babies were born, very few got help. Many parents reported that with caring for multiple babies at once, finding childcare, and the financial stress of finding a therapist, often felt like another burden.

Coping strategies

In addition to psychological interventions and medication, there are a number of things new moms can do to help cope with the stress of parenting two babies. Using some or all of these coping skills in the face of PPD can help improve outcomes and manage symptoms. 

1. Get some exercise. Okay, maybe you aren’t ready to hit the gym but simply taking a walk, going for a bike ride, or even a few minutes of dancing with cranky babies can go a long way. 
2. Make time for yourself. While finding a few quiet moments for yourself may seem impossible, they are so important. Make sure to take a break and focus on yourself. Take a shower, talk to a friend on the phone, meditate, or do anything that makes you feel like yourself again. 
3. Stay on top of your diet. This point covers two important aspects. First, if you are breastfeeding make sure you are getting enough calories. Second, be sure you are making good food choices that will fuel your tired mind and body. 
4. Get your rest. This is probably the most laughable on our list. Once you are done chuckling at our suggestion, read on. We realize that adding an extra hour of sleep to your day is highly unlikely, remember that rest is more than sleep. A 20-minute power nap, meditation, or mindfulness and just a micro-break a few times each day can help keep you going. 
5. Connect with people. One of the biggest sources of melancholy new moms report is feeling isolated. Long hours spent just you and your babies can be an isolating experience. Connect with friends or family or join a Moms of Multiples group near you. 

Despite the growing body of information about postpartum depression and its impact on moms of multiples, there is still a gap that needs to be bridged. Too many women are left untreated and suffering in silence. The more information moms-to-be and new moms have, the more they can understand what is going on. 

Postpartum depression is a real diagnosis and is very treatable. Be on the lookout for the signs and symptoms. If you or someone you love are experiencing any, be sure to talk to a medical professional right away. There is no need to suffer in silence.  

Resources:

American Psychological Association – What is postpartum depression & anxiety?

Journal of Psychiatric Practice – Perinatal Mental Health Treatment Needs, Preferences, and Barriers in Parents of Multiples

Journal of the American Medical Association – Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression

Medical News Today – What to know about postpartum depression

National Public Radio – Mommy Mentors Help Fight The Stigma Of Postpartum Mood Disorder

National Public Radio – Pssst: Parenting Twins Can Be Depressing

Obstetrics and Gynecology – Early breastfeeding experiences and postpartum depression

Pediatrics – Multiple Births Are a Risk Factor for Postpartum Maternal Depressive Symptoms

Postpartum Support International – Depression During Pregnancy & Postpartum

US Preventative Services Task Force – Perinatal Depression: Preventive Interventions

The post The Truth About Postpartum Depression appeared first on TWINS Magazine.

In the early days of feeding two newborns, it might be necessary to pump every two hours in order to build your milk supply. This might sound cumbersome, but pumping may be a critical part in maintaining a substantial milk supply for two babies.

There’s a fair amount of trial and error in pumping for twins. You will eventually see what works best for your body and your family’s schedule. But, there are plenty of tips that can help you get started with a solid foundation. Then you can make adjustments as you need to.

How to successfully pump for two 

If you’re pregnant with twins or know someone who is pregnant with twins, or currently trying to juggle pumping for twins on your own, keep reading. I’ve got a few tricks to share that will help take the guesswork out of pumping and help you get started on the right foot.

Pumping is hard work, and it is going to take up a good portion of your day. There are no shortcuts. But you just gave birth to twins, so you’ve got this. Note that committing to pumping is half the battle. 

The more often you do it, the more efficient you’ll become. Getting in and out of all that equipment will become second nature, and your body will start to produce milk as it reacts to the pumping. 

Again, you’ll have to adapt a schedule to your lifestyle, depending on other children, work, etc. Experts suggest starting to pump as soon as you’re able to, even though your babies might not develop an appetite for three days after being born. 

Here’s a basic schedule that you can start with, then tweak as necessary:

• 7:00 am Pumping Session #1
• 9:00 am Pumping Session #2
• 11:00 am Pumping Session #3
• 1:00 pm Pumping Session #4
• 3:00 pm Pumping Session #5
• 5:00 pm Pumping Session #6
• 7:00 pm Pumping Session #7
• 9:00 pm Pumping Session #8

Most mothers that are pumping for twins also do one or two late-night pumping sessions. At least one of these sessions should be done between midnight and 6 am, when a spike in the breastfeeding hormone prolactin occurs. 

As you get into the pumping routine and establish your milk supply, you’ll be able to pump more quickly and efficiently. This means less pumping throughout the day. 

Things to keep in mind

As you adjust your schedule and make it work for you, these are a few things that you’ll want to ask yourself to help find the perfect balance:

• What are the times during the day that you have help?
• How much are your babies eating?
• Are you able to breastfeed at all?
• When are you sleeping and eating?

Helpful tips

Pumping requires a few supplies, a considerable of time, and most importantly patience. Many new moms find it particularly difficult to spend so much time sitting. This can lead to overthinking and second-guessing every single aspect of pumping. 

Worry can make things extra hard, so here are a few pointers that can help you pump successfully:

Pump frequently

Creating enough breast milk for your babies is all about supply and demand. The more you pump, the more your body will make. If you’re concerned about when you will find the time, you have options. 

1. Power pumping is when you pump for 10 minutes at a time two to three times over the course of an hour (or even longer). 
2. Pumping after your little people nurse is another option to up the ante. The more milk you express, the more breastfeeding hormones (prolactin) you will create, and the more breastmilk you will make.

Research the best types of breast pumps

Most health insurance companies will give you a pump. If not, social media is an excellent resource for learning about breast pumps. This is a good time to rely on what other twin moms recommend. 

Do not share breast pumps (or buy used devices) unless they are safe for multiple users. Most breast pumps are meant for use by only one person, meaning you should not share them with family or friends. If the breast pump is contaminated and only intended for a single user, it can cause you or your baby to develop an infection. 

Pump at the hospital or birthing center

Make sure you do your first pumping session at the hospital. You don’t need to bring your pump with you as most hospitals provide a pump for you to use while you’re there. 

They will both have lactation experts on hand to show you how to do it correctly, which is imperative for pumping success.

Extra parts

When you pump at the hospital or birthing center right after having your baby, they will give you your own set of parts to use. Take these home and rotate them in with your parts so that you don’t have to wash them as frequently throughout the day. 

If you don’t have extra parts, you can keep yours in the fridge after each pump break and then do one wash at the end of the day. Properly cleaning your parts is essential, so you’ll want to allow enough time to do it right. 

Ask for help

Don’t be shy about asking for help. All of those people offering up their help mean it. Your spouse, family, friends, and neighbors are all ready and willing to watch your babies for a little bit while you pump. Make sure to rest and eat while you have extra eyes and hands around, too!

Set up shop

Identify an area of your home or workspace that you’ll use for pumping. Stock up with snacks and activities or things you can work on while you’re pumping. Sitting still for so much time may be the hardest part. 

Pumping breaks are also a great time to eat or nap, so keep snacks around and make sure your pumping area is comfy. Bonus if you keep some foods on hand that can help boost your milk supply. Also, keep a bottle or two of water nearby just in case you forget to bring some with you. 

Use a tracking app

There are many mobile apps available to help you track both your pumping sessions and how much milk you’re producing. It can also help keep a record of any supplements you’re taking. In those early, exhausting days you might even find yourself asking if you missed a pumping session. A breastfeeding tracker app can be helpful when this happens. 

Caitlyn’s pumping experience

For my pumping adventure, I found the hardest part to be the mental challenge of it all. If I were more prepared for the time-consuming experience of sitting, then I would have been much more efficient. 

I was able to pump for a little over a year successfully. However, it would have been a more positive experience had I known any of these little tricks beforehand. I hope that some of these will help you make your pumping days a little less stressful and a lot more enjoyable. 

Breastfeeding twins is an incredible commitment. Any amount of milk that you’re able to provide your babies is a gift. While breastmilk is ideal for babies, your mental health matters. Please reach out to a healthcare professional if the breastfeeding journey becomes overwhelming.

The post Taking the guesswork out of pumping for twins appeared first on TWINS Magazine.