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Bottlefeeding Multiples

Feeding two (or more) babies at once presents some special challenges. Members of the Twins List offer their advice on topics ranging from the logistics of feeding two at once to favorite supplies for supplemental feedings to convincing toddlers to fall asleep without their bottles. Expectant parents, check out the breastfeeding FAQ, as well.

Please keep in mind that this is not medical advice. When in doubt, consult your pediatrician!


Getting Started


Getting Started

Choosing Formula

Your pediatrician will recommend a formula, and you should check with him/her before switching formulas. He/she will also advise you on how often your babies should be fed. Be sure to mention any problems which could be related to the formula, such as fussiness, excessive spitting-up or bloody stools.

If you are using expressed milk, the breastfeeding FAQ has many suggestions for pumping effectively.

If you are concerned about diaper rash/allergies, beware of stuff like soy and other alternate formulas - they may be loaded with corn solids. What appears to be a milk sensitivity may really be an allergy to corn. We experimented with formula and found that Nursoy (with corn solids) caused an instant bleeding diaper rash! (Enfamil is the only formula I saw without corn - luckily, it's what we've been using.)

One of our twin boys, now 6 weeks old, has been spitting up some of his bottle (Enfamil with Iron) at most feedings. Several times spitting up (why they don't call it 'puking' I don't know) around 1/2 of the amount taken. We were told to try Prosoybee that is made with Soy and contains no milk. After one try, no spit up. Does anyone know if this means our child is "lactose intolerant"? Will he be able to have milk in the future? Should this be a concern? Any recommendations? Thanks!!!!

Both my ID twins are lactose intolerant. This manifested itself in loose, bloody bowel movements. It is my understanding lactose intolerant children lack the enzyme necessary to digest milk. I believe this enzyme is located farther down the intestinal tract than the stomach, so spitting up is generally not the problem.

My guess is your doctor is trying to find something a little less upsetting to your baby's stomach.

First off, check with your Pediatrician to rule out Reflux. Yes, there is yet another name other than "Spitting up and Puking". Reflux is characterized by "Puking" after every feed. It's usually not a serious thing and the baby will eventually outgrow it. The main concern, is that the baby is getting enough of the nutrients to continue growing. Check to see if the puke contains any curds (looks like cottage cheese, probably from the previous feed). This is something that your Ped would need to know.

Next, is the soy thing. My daughter had severe constipation and reflux while drinking either Enfamil or Similac. We switched her to the low iron versions, which somewhat helped the with the constipation, but not the reflux. Our almost last resort was to switch her to Isomil (soy based formula by the makers of Similac). This worked for the reflux, but not the constipation. Soy formulas are often referred to as Liquid Cement. I guess I do not need to explain that one. Our last resort would have been Nutrimigen (sp?), a very expensive (twice the price of reg. formula) alternative. Luckily for us, our doctor does believe in some holistic care and had us stay on the Isomil, but add a 1/2 teaspoon of a wheat concentrate, sorry, forgot the name. VOILA! No Reflux + No Constipation = HAPPY BABY & rested parents. At 14 months, we slowly switched both girls over to 2% fat milk. Before anyone asks, we waited for 14 months because of their prematurity (8 1/2 weeks early) and switched to 2% fat milk because the Pediatrician had them on a higher fats diet and the loss of fat obtained in 2% milk vs. whole milk would not be so great that it made a difference. She never had a problem making the transition.

For more information on reflux, see http://rainforest.parentsplace.com/dialog/get/reflux2.html

I supplemented with my girls. At first, one of them had a very difficult time with Similac. She seemed very uncomfortable, spat up more often, and cried even more than usual (serious colic!). I ended up nursing her more, since her sister had no trouble with formula.

At 4 months a remarkable transformation occurred: the colic disappeared, she smiled all the time, and she could drink the formula with no problem. In our case, I think she just had a sensitive digestive system (she was low birth weight, even though they were overdue) which made milk-based formula difficult to digest at first. Once she had matured a bit, she had no trouble. I was careful when introducing dairy products, but so far, so good....

-- As to the puking part - My son did this constantly from the time he was born until he learned to walk at 10 1/2 months. He never had a problem with gaining weight though so my doctor said not to get worried. She said it is more common with boys to have a weak muscle at the top of their stomachs - not that they are being upset by their diet. I was breastfeeding - so there wasn't a problem with that and I had tried eliminating all the nasties from my diet but it didn't make any difference. It was definitely worse when he was learning to sit - because he would lean forward a bit - squishing his tummy - and out would come lunch. He just ate more to compensate for all he was losing. The problem went away completely when he learned to walk. I guess this helps strengthen those tummy muscles. In fact he lived with the nickname POOKEY for even a while after he quit.

I know that the One Step Ahead catalog has a cushion - which is sort of like a donut - with a space cut out which is for support all around to help babies sit. I think I also saw them at Toys-R-Us. I didn't use them - but maybe if your's need some assistance - you could try them out.

Happy sitting - before you know it they'll be crawling into everything in sight!

The spitting up when in a different position may have to do with hypotonia, this is what kept B. from sitting solo...she's the worst of the trio. J. also has hypotonia. Sleeping problems can relate to this too as the low muscle tone makes it very easy for stomach contents (acids if stomach is empty) to slide back into the esophagus while sleeping, thus disturbing sleep. Both girls have what's called Chronic Static Encephalopathy...and it's possible they will be diagnosed with CP (obviously a mild form).

Don't want to worry you about this... but I'd look into the possibility. Be warned, some peds don't know much about it... especially the milder forms of such problems. Can you check into your county's 0-3 program and request an eval based on their prematurity and their slight delay in sitting? You should be able to find one at no cost. The physical therapists can tell you if your children have low tone or not...an MD can then diagnose that low tone as hypotonia.



Does anyone have any strong preferences on bottles and nipples? Now that my fraternal twin boys are drinking more from bottles, I am trying to decide which ones to stick with. I like the concept of the Playtex disposable ones, but when we tried them, the boys had difficulty getting anything out of them. Next we tried Healthflow bottles and nipples (mainly because they came with a cap) but I find that they still leak somewhat if not standing upright. Also, the nipple looks awfully long. Lastly, any opinions on rubber vs. silicone nipples. I'd like to find one favorite brand and stick with it until they are off the bottle. Thanks.

I vote for the silicone nipples - they're easier to clean and don't seem to age as fast as the rubber ones do. I have some made by a company called "Munchkins" and they have nipples with three different sized holes for different flow rates (they're color coded, too).

I also tried the disposable bottles, but don't like them as much as the plastic ones. I found a bunch of Barney and Baby Bop bottles on clearance for 50 cents each (with nice silicone nipples, too!) and love them. It's easy to tell who gets which bottle. I also have the Gerber clear plastic bottles.

To wash, I just make sure there aren't any globs of undissolved formula, then throw them in the dishwasher.

We tried the latex nipples and found that the holes would shrink in the dishwasher, this was *very* frustrating for the babies and for us, trying to figure out why they were still crying. We switched to silicone and they held their hole.

I found that with rubber nipples the milk flowed slower. With silicone it flowed faster. I always preferred the clear silicone nipples. My guys were such slow eaters and they kind of forced them to drink a little faster! I needed something CHEAP so I used Gerber bottles and/or Evenflo bottles and nipples. Couldn't afford to be buying those disposable bags all the time. My guys didn't like those flat nipples either, so when I did use the disposable bottles I had to use one of those nipple adapters so a regular nipple could be used.

All four of my kids had different preferences. My daughter liked the silicone bottles best. This was discovered only after trying Playtex and Gerber types.

With my son I think I tried every type on the market until I could get him to drink from a bottle period. Finally settled on the Playtex.

The Twins prefer Gerber rubber nipples. One won't drink his bottle if I use something else. Go figure!

I had a big enough collection of nipples and bottles for an army. Of course, my wonderful day care provider decided this summer that I didn't need all those bottle/nipples etc. She gave most of them away (with my permission), since the boys were down to one bottle in the A.M. She left me six nipples and bottle caps. Of course since that time, two have gone down the garbage disposal, two nipples had to be thrown out because they were getting "sticky" and I HAD TO GO OUT AND BUY MORE!!! You just can't win. :)

I vote for the Evenflo bottles because the type of plastic is more durable than the Health Flow or Cherub. They are usually sold in 3 packs and are solidly colored red, pink, blue, purple, etc.. You can also assign colors to each boy, so you know one always gets the blue, green, etc . (Otherwise, we used nail polish to mark the initial on them.) When my twins were born, I bought all Health Flow bottles. About a month ago, every one of these began leaking from cracks at the bottom. It was really strange how they all fell apart at the same time. But I'm actually surprised they lasted this long given the abuse these bottles have taken over the months from being thrown, dragged around in the walker, dropped from the changing table, etc. The Evenflos seem to be holding up fine, though.

The babies themselves seem to prefer the ones that are easier to hold b/c of the hollow middle. I think Cherub makes them.

I've always bought Evenflo nipples, too. I never breast fed, so I didn't have a preference for real nipple-shaped ones.

I would also get a pretty good supply of the small sized bottles. In the beginning, I used them all the time and then didn't use them much at all until the last few months when I began again b/c they drink so much less milk now.

We started with Gerber and Avent bottles. My smaller girl, with her weak suck, needed the fast-flowing Avent at first. The other ate so fast, she'd forget to breathe! We switched her to the Playtex disposables, which slowed her down just enough. By 6 weeks, both of them were on Playtex. I also nursed, so I liked the fact that the sucking action was closer to nursing. And the fact that you remove the air from the bottle had two advantages-- first, it cut down on gas in the tummy, and second, the girls could hold the bottles on their own at an earlier age. The (light!) bottle didn't have to be tipped-- they held it upright and drank as if through a straw.

I used Playtex nursers with the disposable liners. I bought the liners in bulk at a warehouse to keep down the expense (liners are also interchangeable--Gerber was less than Playtex but not available in bulk). Liners don't need to be sterilized and do help keep air out of tummies but are expensive, awkward to fill when you are sleepy, and can be messy when not installed properly. I also found that with disposable liners measurements for amounts consumed can be inaccurate usually by about 1 oz. Still I felt disposable were a definite time saver! By the way don't use liner bottles with car bottle warmers, they can melt!

I used Playtex orthodontic nipples at the suggestion of the Lactation Department at Georgetown University Hospital in Washington, D.C. where I delivered. I tried the Playtex nipple that came with the starter nursing kit, but my babies had a very hard time sucking the milk out of them. When I switched to the orthodontic nipples, they had no problem.

[Babyshoe] Follow-up from Andrea: We are very happy with the J&J Healthflow bottles with the bend in them. The small bottles are marked as if they go up to 5 ozs, but if you fill them to the top, they actually hold 6 1/2 ozs. As a result, we have been using the small bottles for quite a while (the boys are 5 1/2 months).

While some people think the "bend" is a gimmick, I've found it to be helpful - you don't need to tip the bottle so much when you're finishing the last ounce or so. Also, I like the caps that come with the bottles.

I've got a method for bottle-feeding twins simultaneously that really works-- the Podee Hands-Free Bottle. (don't work for the company, just love the product) It's a bottle with clear tubing that goes from the bottom of the bottle to about 12 inches past the screw-on lid at the top of the bottle to a nipple. (Looks sort of like a pacifier attached to a bottle by 12 or so inches of flexible "straw"). These things are lifesavers! My boys (now 4 1/2 months) have always wanted to eat at the same time (esp. when it was just me there with them). This way I just put them in their car seats or swings, "plug" them in, and was free to burp whoever needed it, whenever he needed it. The boys really liked them; in fact, for a time, one refused any other bottle. I think it's because he got so little air. We now have 6 in circulation at our house, so there's always some in the diaper bag (for hungry babes in the car), some at daycare (couldn't stand the thought of my boys screaming for food while they dealt with other kids), and some ready for when it's just me with the two of them.

I used these many a night to avoid waking my husband before I went back to work, too. They sell them at Toys r Us, Winn Dixie, and Target stores. Also, here is the company info:

Podee INC
12225 World Trade Dr.
San Diego, CA 92128
(619) 485-0560
If you think just twins gets stares and comments from people, wait till they see twins in a stroller with these bottles!!!

Another option:

"Shake it Up Bottle" #02200113 $6.95('97)
Dishwasher safe, holds 8 oz.
in The Right Start catalog
# 1-800-LITTLE-1
They have separate chambers... the powder goes in the top and the water in the bottom... and you just click the top part up and shake when ready to serve. The nice thing about them is that we keep them filled and ready to shake up in the diaper bag, and then wherever you are you've got a bottle right ready... no refrigeration, no messy pouring, no expensive ready to feed cans... they're great!

I received a message from the makers of a product similar to the Podee bottle. I'm including their information, since I don't want to play favorites... It's called Pacifeeder, and you can find them at http://www.pacifeeder.com/.


Stocking up on Nipples

I wanted to suggest to expecting parents to take and use the nipples they give you in the hospital if your babies take formula there. A nurse suggested this to us right after the babies were born and we have collected quite a number with their initial 4-day stay, and one son's subsequent hospitalizations (22 days to date). They always want to measure the amount of formula the babies take, so I would just save the original cap to the formula and when the babies were done, put it back on the bottle and rinse off the nipple and throw it in my bag. I always have enough nipples to last from one dishwasher load to the next. Now if I only had that many bottles!

No one suggested this to us and it certainly didn't occur to us. They gave us a total of 14 nipples in our small bags when we were discharged and we didn't realize that we couldn't just buy them at the store. We were in the hospital for 4 days so we could have had a nice supply of them. My hospital uses the newborn orthodontic from Ross. I did find out we can order them direct from Ross @ .75 each.

Another useful tip for us has been the use of formula can covers. We use the ready to feed kind and we found that no matter how careful we poured from a new can, some always "leaked" out down the side. The stuff's expensive enough without having to waste an ounce from every can.



Let me preface this by noting that my twins are 4 months old/1.5 months corrected for prematurity.

I used to feed both infants at once when they were a little bit smaller (4-6 lbs. or so) if they were hungry at the same time and neither could be stalled. Neither had great head control so I had to be creative. Some positions I have tried are:

  1. Get bottles, pillows, and burp cloths ready on table next to glider rocker with ottoman (any chair with good back support and a foot stool to put your feet on). Prepare two regular bed size pillows -- one pillow for my lap (sitting on ottoman), one ready to place under my arm (sitting in chair). Place both babies on the pillow and lift them onto my lap. Sitting in the glider rocker, feet up on the ottoman, knees bent so that babies' heads are elevated instead of flat, turn infant with least head control into cradle position. Angle other baby so that head is on knee nearest the other baby's head. With free arm, get the cloth diapers in position, and bottles. In this position I was able to manipulate both bottles with either hand (not always the most comfortable, but it worked) and I always used the cloth diaper to help prop the bottle for extra support if I needed to let go quickly to help the other baby.

    For burping, position cloth diapers first, move babies to shoulders and burp simultaneously. I couldn't really cross my arms effectively for burping (right arm burping baby on left shoulder and vice versa), so I usually used my thumb at the babies side for support and so I could burp with the palm of my hand. I never tried one at the shoulder and one on my lap tummy down, but I suppose it would have worked.

  2. Baby with most head control at side in car seat (tilted slightly upright). I have the Snuggli seat inserts in the car seats. I unsnapped the head rest and used it as a bar across the seat. I would prop the bottle on the head rest and feed the other baby cradled in my arm or sitting in my lap (Indian style) with head on my knee. Burping was same as above. I always needed lots of pillows for back support if I sat cross legged on my bed or floor when it came time for burping.

  3. Currently, I try to stall one of them when both are hungry. I've been dealing with a lot more spitting up than before and it gets difficult to manage when feeding them both. I suppose I've been "burned" too much that I'm afraid to try it. However, I recently was loaned a Boppy pillow (c-shape pillow) from the physical therapist, and I've considered trying to use it to help when both are hungry at the same time. They're getting too big for me to try the rocking chair position, and they still don't have quite good enough head control for me to move to the high chairs yet... I could also try both car seats... I'm hoping that eventually I'll be able to hold both in my lap, heads resting on my chest facing out.

We bought a nursemate pillow (the kind that straps around you) for breastfeeding but my husband figured out that you could prop both babies up on it and give them both bottles and have both faces looking up into yours. We continued to use the pillow to feed both of them long after they quit breastfeeding. Now that bottles are long past for my kids I still have fond memories of watching him feed both of them this way.

We also used the cloth chairs or the car seats to sit the babies in and then you can sit in between them and hold both bottles, but it's not as easy to burp them as using the nursemate pillow. Actually feeding both of them was easier than we thought because my son figured out how to hold his own bottle by about 4 months so you could let him solo for a few seconds while you reached for something or moved someone around.

I bottlefed the girls at the same time exclusively and found it much faster and easier than doing it separately. I sat on the couch and put each baby parallel to my legs with their head at the edge. I rarely used pillows under their heads, but couch pillows were the perfect size. When they were very small, they slept in our bed and I would prop myself up with pillows against the headboard and lay one on either side of me. This was *much* easier on my back than trying to lean over them in infant seats. My girls have never had an ear infection and I never had a problem with them eating relatively flat, but if yours are prone to them, their heads should always be propped up.

When I was out I put one lengthwise on my lap and the other in the stroller beside me and held both of the bottles. If there was any chance of making it to the car I could feed them very easily by sitting between them in the back seat. I often ended up there when DH was driving too. I did not turn the car seats around until after one year, and consequently they were able to hold their own cups by then.

I sometimes bottle fed both girls at the same time. I really had no choice -- it was either that or listen to the one not being feed scream bloody murder for her food:) -- plus it saved me some time to get other things done around the house, etc.

I would sit on the couch and lay each baby's head on one of my legs (comfortably), and feed them that way, or put both of them on my lap and use a pillow for their heads - this way is a lot easier as you can look in their faces and talk/play with them as you're feeding them.

It really is not as hard as I had of course imagined. [I remember thinking - HOW will I do this with two babies, HOW will I manage to do that with two babies - I sure we can all relate to that :) ]

If one baby was calm and could wait to be fed after the other, I would feed one at a time just to spend one-on-one time and bond with each baby first, but if they couldn't wait...I did the above.

I bottle fed my twins together and found the bouncinettes to be the best thing. I would lay them both in bouncinettes, and sit between them on the floor with my back up against the couch, nappy over shoulder ready for burping later. I would then hold a bottle in each hand and when my arms got tired I would rest them on my knees. When they had both finished, I would then burp one at a time. Sitting on the floor I could talk to them while they were feeding and sit on a cushion and be comfortable at the same time. Only problem I had was if I got an itchy nose with no hand free to scratch. The bouncinettes were the best equipment we had as I could also leave them in them for a nap and later when starting to feed solids before they could sit in highchairs. I don't know if you can still buy them, they were the old fashioned types with mesh over a bouncy metal frame. which I made more comfortable with a padded cover and rolled up nappy under the backs of their knees so they didn't slide off.

For the first three months I found it very difficult to feed the babies simultaneously (breast or bottle). They were so tiny (4 and 5 lbs. at birth) and I was a first-time mom and not very comfortable with a newborn (I was sure I would cause a neck injury). Anyway, although it was more time-consuming I feed each baby separately, but always one right after the other even if it required waking a baby. When they were about four months, I found I could bottlefeed each baby simultaneously by sitting cross-legged with a baby resting on each leg. I also would put the babies in their infant carriers on the sofa and sit between them and feed. When one had to burp, I would prop the other baby's bottle with a rolled-up receiving blanket.

Many mothers I talked to about propping said they felt guilty about using bottles, and especially about propping them, but I found it was convenient and frequently necessary. If you stay with the babies, there is noting wrong with propping bottles. Don't waste your energy feeling guilty! Consider instead the extra time you will have to cuddle and play with your babies when they are not feeding. After all, you don't want them to associate your love exclusively with food!

I didn't bottlefeed both boys until they were about 6-7 months old, so they were sitting in the car seat for meals, so they just got the bottle there. I would sit in front of the table, both car seats on the table, and hold the bottles for them. Not too long after that, they were able to hold the bottles on their own. At about 10.5 months, I switched them to Playtex sippy cups (after some trial & error -- to get them to suck hard enough to get anything out, I dipped the spout in apple juice).

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