WHP Pediatrician Rachel Menaged, MD’s Comments Featured On Twin Love Concierge Website

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Rachel Menaged, MD, FAAP of Westchester Health Pediatrics Answers Top 10 Questions From Parents Of Twins

Katonah, NY, October 10, 2015 — On the first visit to their pediatrician, or even before their babies are born, parents of twins have a number of twin-specific questions, reports Dr. Rachel E. Menaged, a pediatrician with Westchester Health Pediatrics.

To assuage fears, clear up common misconceptions, and offer overall information about twins, Dr. Menaged, herself a mother of twins, was interviewed recently by Twin Love Concierge, a maternity consulting service exclusively for twins. Asked to name the top 10 questions pediatricians hear most often from parents of twins, here are excerpts from Dr. Menaged’s answers:

1. What developmental delays are most common with twins?

In large part because of prematurity, twins have higher than average rates of developmental delays. Motor delays are possible because of hypotonia, or low tone. Twins may have trouble lifting their heads during tummy time and supporting their heads while being carried. It is also common for twins to have delays in speech development.

2. What is “twin talk” and is there anything I can do to prevent it?

Twin talk generally refers to a language shared by only a twin pair. A true “secret language” is rare. Twins will often imitate each other’s speech and may mispronounce words the same way as a result. This may contribute to overall speech delay that is common in twins. In general, the more that parents speak to and read to their twins, the better.

3. Is there a weight gain guideline for preemie twins?

Yes, after a premature baby is discharged from a NICU, the baby’s pediatrician will use a premature growth curve (a Fenton preterm infant growth curve) until babies are at least 1 month post due date. At that point, World Health Organization (WHO) growth curves may be utilized to monitor weight gain for the first 2 years (based on their adjusted age).

4. What are the signs that my newborn twins are thriving?

Regular visits to a trusted pediatrician are all that is needed to evaluate infant twins. Twin parents often find the first few months overwhelming, and their pediatrician will do a full evaluation of each twin at each visit. He/she will check to make sure the babies are gaining weight appropriately and developing normally during the first year. NOTE: Each visit is a great time to discuss what to expect by the next check-up.

5. One twin was born considerably smaller than the other. Should I be concerned?

Discordant growth (one twin growing much larger than the other) is a concern during pregnancy and can be a sign of intrauterine crowding or placental insufficiency. The greater the difference between the weights of two twins, the higher the rate of neonatal death for the smaller twin. That said, if your infants are beyond the neonatal period and seem healthy, there is no need to worry about the size difference.

6. Will the twins’ vaccine schedule vary if they were born early?

Vaccinations are given based on the amount of time that has passed since birth (not the amount of time since the due date). There is one vaccine (Synagis, antibodies to Respiratory Syncytial Virus) which may be given to your babies if they are born prematurely.

7. How do I know if I am providing enough milk for both babies?

While in the hospital, each baby will be weighed daily. If one (or both) is losing too much weight or failing to stool or urinate enough, the pediatrician caring for your infants will let you know. When you leave the hospital, make sure you are aware of how often your twins should be stooling and urinating at home. If you are not seeing the expected number, call your pediatrician. If a baby is not getting enough milk, he/she will seem constantly hungry, feeds will take longer than expected and he/she will cry for milk soon after finishing each feed. When in doubt, a visit to your pediatrician for a weight check is always an option.

8. Is “flat head” more common with twins?

Yes, flat-head (or plagiocephaly) is much more common in twins, partially due to in-utero positioning and/or poor tone early on, which leads to consistent pressure to a particular part of the head. Some plagiocephaly will improve as the head grows with frequent tummy time and repositioning but some infants may require helmets for correction.

9. Can my twins sleep in the same crib?

Early on, twins may sleep in the same crib. As they become more mobile, however, it is safer to move them to separate cribs so they do not roll on top of each other or otherwise accidentally harm each other.

10. Why are twins more prone to reflux/colic?

Twins are much more likely to be born premature and reflux is quite common in premature infants. The lower esophageal sphincter, which keeps food in the stomach, is often relaxed and consequently, the contents of the stomach often flow back up into the esophagus. Fortunately, this problem usually resolves itself with time.

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