Common health issues and illnesses in twins-including colic and reflux

Understanding common health issues in twins

Twins and triplets are more likely to arrive early and at a lower birth weight than single babies. Prematurity can bring short-term challenges such as keeping warm, feeding and breathing, but these usually improve with time, care and support from your medical team.

Feeding is one of the most common early hurdles. Smaller babies can tire quickly or find it hard to coordinate sucking and swallowing. You might notice feeds take longer or need to be more frequent. Midwives, health visitors and infant feeding specialists can help you find a feeding pattern that works for your family. If your babies were premature, you may also have a neonatal or community team supporting you.

As your babies grow, you may see differences between them. One child may gain weight more quickly, sleep for longer stretches or reach milestones at a different time. This is usually linked to birth weight and individual health rather than anything you’ve done wrong.

If you’re worried about weight gain, breathing, feeding or anything that doesn’t feel right, always speak to your GP, health visitor, neonatal team or NHS 111. Bliss and the NHS website have reliable information about premature baby complications and recovery, which can reassure you between appointments.

Colic and reflux in twins, triplets or more

Colic is very common in young babies. No one knows exactly what causes it, but many parents describe it as feeling like a tummy ache that leads to long, intense crying. With twins, triplets or more, you might have one baby who’s badly affected while the others aren’t, or all of them may go through a difficult phase at once.

Doctors sometimes use the ‘rule of three’ when thinking about colic. This looks at whether a baby cries for around three hours at a time, on at least three days a week, for three weeks or more. Other signs can include clenched fists, a red face, knees pulled up to the tummy and being hard to soothe. Colic doesn’t cause long-term harm and most babies grow out of it by around twelve weeks, but it can be exhausting.

You can try breaking feeds up with short pauses, winding during and after each feed and keeping your babies more upright when feeding and for a short time afterwards. Warm baths, baby massage, gentle movement in a sling, pushchair or car seat, or soft music or white noise can also help some babies to settle. If you’re breastfeeding, you might find that changing what you eat helps, but always talk to a health professional before making big changes or using over-the-counter colic remedies.

Reflux happens when milk comes back up after a feed because the muscles between the food pipe and stomach are still immature. It’s particularly common in premature babies. Some babies bring up small amounts of milk many times a day. Others have ‘silent reflux’, where the milk comes back up but is swallowed again, causing discomfort without obvious sick.

Signs can include frequent posseting, coughing or hiccups, refusing feeds, gagging, crying during or after feeds and sometimes more ear infections. You can try feeding in a more upright position, keeping nappy changes before feeds, offering smaller feeds more often and rubbing rather than patting when winding. If more than one baby has reflux, a staggered feeding schedule can help you give each child individual attention.

If reflux symptoms are very distressing, or your babies are struggling to gain weight, speak to your GP. They may suggest medication or milk thickeners and, if needed, refer you for further tests. Always use medicines exactly as advised by your medical team. More information on reflux in babies can be found on the NHS website.

Managing infections such as norovirus, RSV and bronchiolitis

With more than one young child in the house, infections can spread quickly. Norovirus, sometimes called the winter vomiting bug, causes sudden vomiting and diarrhoea. Your child may also have a high temperature or headache. Most children recover at home with rest and plenty of fluids, but dehydration can happen quickly in babies, so trust your instincts and get medical advice if you’re worried.

Respiratory Syncytial Virus (RSV) is a very common virus that infects the nose, throat and lungs. By the age of two, almost all children have had it at least once. It often starts like a simple cold, with a runny or blocked nose, sneezing, cough, mild fever and reduced feeding. In some babies, especially those under six months, premature babies or children with heart, lung or immune problems, RSV can lead to bronchiolitis.

Bronchiolitis is an inflammation of the small airways in the lungs. Your baby may develop a wheeze, faster breathing, more coughing and poorer feeding. You might notice fewer wet nappies and that your baby seems more tired than usual. Many cases can be managed at home with close monitoring and keeping your baby hydrated, but some babies become more unwell and need hospital care, including treatment with oxygen to help their breathing. (LINK INF-82 managing when one twin is unwell)

Keeping basic medicines suitable for babies and young children at home can help you feel more prepared. If you’re unsure whether your baby needs to be seen, the Lullaby Trust’s Baby Check app can help you assess symptoms and decide how quickly to seek medical advice. You can also call your GP or NHS 111 for tailored guidance. Always seek help if you feel your baby’s breathing, colour or responsiveness has changed, or if you simply feel something isn’t right.

Looking after yourself while your babies are unwell

When all your babies are poorly, life can feel very intense. It’s common to let go of housework and other tasks and just focus on caring for your children. This isn’t a step backwards. Once everyone’s feeling better, you can gently bring routines and habits back in. Nothing is permanently undone.

Many parents feel guilty if one baby needs more attention because of colic, reflux or illness, especially when there are twins, triplets or more. Remember that each child will have times when they need you more. Try to meet the basic needs of the less fussy baby or babies first if they’re likely to settle more quickly, then focus on the one who’s struggling.

You don’t have to manage all of this alone. As well as your health professionals and the NHS, you can contact Twins Trust’s Twinline support helpline to talk to a trained volunteer who understands life with twins, triplets or more. Reaching out for help is a sign of strength and a way to protect your own wellbeing as well as your babies’.