When first visiting your Pediatrician, or often before the babies are born, parents have so many twin specific questions that Twin Love Concierge wanted to address these for you. We also wanted to clear up some common misconceptions we get asked by many of our workshop attendees.  TLC interviewed the renowned Dr Rachel Menaged from Westchester Health Pediatrics, fellow mom to Twins herself, and asked what the top 10 Questions Pediatricians hear most often from twin parents?

What developmental delays are most common with Twins?

In large part because of prematurity, twins have higher than average rates of developmental delays. As a pediatrician, I look at an infant’s “adjusted age.” If a baby is 4 months old, but was born 2 months early, then I would expect the infant to meet the developmental milestones of a 2 month old. Even by correcting for prematurity, many premature twins do not meet early milestones on time.

Motor delays are possible because of hypotonia, or low tone. Infants may have trouble lifting their heads during tummy time and supporting their heads while being carried. It is common for twins to have delays in speech development. Whenever a delay is noted, professionals from Early Intervention, a program for children under the age of 3 with developmental delays, become involved to evaluate the infant and provide services.

What is Twin Talk and is there anything I can do to prevent it or stop 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. Twins 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. Twins benefit from frequently hearing words pronounced correctly by adults or older siblings in the home.

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).

What should I be looking for that my newborn Twins are thriving?

I generally like to take some of the pressure off of twin parents by reassuring them that 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. Pediatricians check to make sure that babies are gaining weight appropriately. Generally healthy infants can self-regulate feeds. If an infant is satisfied with each feed and is stooling and urinating frequently, the baby is probably going to gain an appropriate amount of weight. Pediatricians will also check development at each of the frequent check-ups in the first year. During the first year, babies gradually become stronger, more alert, and interactive. Each visit is a great time to discuss what to expect by the next check-up.

One Twin was born considerably smaller than the other.  Should I be concerned despite there being no immediate health concerns?

Discordant growth (or one twin growing much larger than the other twin) is a concern during pregnancy. It 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.

Will the Twins’ vaccine schedule be different if they were born early and/or will they require any additional shots

Vaccinations are given based upon the amount of time that has passed since birth (not the amount of time since the due date). A 2 month old who was born 6 weeks early will still receive the normal 2 month vaccines.

There is one vaccine, called Synagis, which may be given to your babies if they are born prematurely. Synagis shots are antibodies to a virus called Respiratory Syncytial Virus (RSV). RSV is a virus that is especially dangerous for premature infants. Synagis shots are given monthly during RSV season to help protect high risk infants.

How do I know I am providing enough milk for BOTH babies?

While in the hospital, each baby will be weighed daily. If a baby is losing too much weight or failing to stool or urinate enough, the pediatrician caring for your infant will let you know. When you leave the hospital, make sure that you are aware of how often your baby should be stooling and urinating at home. In general, there is a gradual increase in the frequency of stooling and urinating in the first week. If you are not seeing the expected number of stools or urinations, you should call your pediatrician.

Healthy babies will generally let you know if they are hungry. If a baby is not getting enough milk, he or she will seem constantly hungry; feeds will take longer than expected and babies 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.

Is flat-head more common with Twins?

Yes, flat-head, or plagiocephaly, is much more common in twins. Some of this is due to in-utero positioning. Many twins have flattening at birth. Some if this is due to poor tone early on, which leades to consistent pressure to a particular part of the head. Some plagiocephaly will improve as the head grows with frequent tummy time and repositioning. Other infants may require helmets for correction.

Can I sleep Twins in the same crib?

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

Why are Twins more prone to reflux/colic

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


Are you expecting Twins or know someone that is? Come join our Expecting Twins Classes around the country – New York, Connecticut, Texas, Florida, New Jersey, Pennsylvania and California, see the classes tab on Twin Love Concierge. Not in these states? Book your skype consultation through our contact us tab for all USA and Canada.

Dr. Rachel Menaged is a board-certified pediatrician with Westchester Health Pediatrics in Mount Kisco, New York. Dr. Rachel graduated from Albert Einstein College of Medicine and completed her residency at the Children’s Hospital at Montefiore in New York. She was previously in private practice in Manhattan and aims to provide the highest-quality, compassionate care. Dr. Rachel is particularly skilled at building strong, trusting relationships with her patients and their families. As the mother of young twins, she knows the challenges and joys of parenthood, and enjoys answering parents’ questions.