"Being a mother is learning about strengths you didn’t know you had, and dealing with fears you didn’t know existed." – Linda Wooten
Parenting newborn twins alongside a toddler is no small task, but for Nena Spence (OTD, OTR/L), a pediatric occupational therapist, it was a chance to apply her professional skills at home. In this article, she shares her journey from feeling overwhelmed to confident as she learned to balance the demands of her young children. With insights drawn from her dual roles as a mother and child development expert, Nena offers practical strategies and tools to help families thrive amidst the chaos of raising multiples.
How has the transition been for your family with the arrival of your twins, especially balancing the needs of an older toddler and two newborns?
The hardest part of our transition was meeting the needs of our toddler when we brought our identical twin girls home. Even at just 18 months old, he knew his life had been turned upside down. We tried to keep things as consistent as possible for him, still sending him to daycare two days a week, but it felt like he was so mad at me for those first few weeks. All he wanted to do was hang out with his dad, which broke my mama heart! Of course, I had my hands full trying to learn how to tandem nurse the twins and manage the 40 diaper changes a day we had in those early weeks, but I was still heartbroken that my one-on-one time with my little guy had come to an end.
Someone once told me that when situations arise where you have to choose between the twins and your toddler, as long as everyone is safe, choose the toddler because they’re the one who will notice.
We tried hard to stick to that, and I think it really helped him learn to love his new sisters while minimizing any resentment and jealousy he may have felt.
As a pediatric occupational therapist, how has your professional knowledge influenced the way you approach parenting, especially with your twins?
The biggest OT technique I’ve incorporated into my parenting style is the concept of co-regulation. As an occupational therapist, I work with children to develop self-regulation skills, and much of that involves teaching them strategies to help regulate their bodies. Brand new babies, of course, do not have the capacity to use their own strategies, so we must model appropriate emotional regulation for them. Life with infant twins and a toddler is often super chaotic, but I’ve found that the more regulated I can keep myself, the calmer all the children are. It also helps me connect with them on a deeper level, knowing that my calm is contagious.
My OT background also gives me a unique perspective on their sensory and motor development. I try hard to create sensory environments for my children that provide a “just-right” challenge. I want them to explore the world around them through their senses while also recognizing when their little bodies need a break. This has been especially important when introducing solid foods to my twins—I pay close attention to the textures of the foods we offer and adjust the presentation as needed to ensure they have positive food experiences and success. I also give my babies plenty of time on the floor—whether it’s tummy time, side-lying, or back-lying, the floor is truly the best place for them to develop new motor skills.
Bonus: the only "baby gear" you need is a blanket to lay on the floor!
What are some of the key routines or habits that have helped your family adjust to life with twins and an older child?
From day one with our twins, we worked to get them on the same eating and sleeping schedule. Once I figured out tandem nursing (which took about a week for us), I used the Twin Z tandem nursing pillow every three hours on the dot to feed both girls together. If one twin woke up for an overnight feed, we would wake the other, and eventually, they were in sync, which definitely saved our sanity. It was also beautiful to watch their twin bond while eating and sleeping together. They would reach for each other's hands while tandem nursing and snuggle their faces close to each other when napping. Twins truly are magical and special.
We also learned from our singleton to avoid forming the habit of feeding to sleep (because eventually, you have to break it). There were definitely times when the girls nursed to sleep, especially early on when they slept so much of the day, but whenever possible, we tried to establish the habit of having a wake window after each feed. This also helped with spit-up by keeping them upright after eating.
For families with premature multiples, what early interventions or developmental activities would you recommend to support their growth and well-being?
Always keep their adjusted age in mind! This makes such a difference when babies are small and learning major motor milestones. Forgetting their adjusted age can leave parents feeling stressed, thinking their babies are "behind," when in fact, they are right where they need to be. Of course, there are situations where early intervention services may be needed to address developmental delays, but if parents can focus on the age their children should be developmentally, it will help reduce stress for everyone.
That being said, premature babies often have difficulty latching due to the small size of their mouths, so I highly recommend seeing a lactation consultant if you're interested in breastfeeding premature multiples.
How do you create functional routines in your daily life to ensure all your children are getting the attention and care they need?
With our singleton, we were very “go with the flow,” which definitely had its benefits. However, with three kids under two, that just wasn’t possible if we wanted to create the best environment for all of them to thrive. So, we had to add structure to our day. Of course, there are plenty of days that don’t go anywhere near according to plan, but at least we have a plan in place.
What worked best for us was focusing on sleep first, then feedings, and filling in playtime in between. I learned about age-appropriate wake windows for the twins (which constantly change for small babies), and I work hard to stick to them. My toddler is still on a one-nap-a-day schedule, so I always prioritize that. From there, I schedule the twins' breastfeeding sessions every three hours and my toddler’s three meals a day (plus snacks). The remaining time is for playing!
I make it a priority to carve out time just for my toddler, where we can play and do toddler activities, and also time to bond with the twins and focus on baby-specific things. Here’s what an ideal daily routine looks like in our house for 6-month-old twins and a 2-year-old toddler (though it rarely goes perfectly).
The twins no longer need night feeds but still wake up overnight often (as does our 2 year old). If your babies are still waking up overnight, you’re not alone and you’re not doing anything wrong! They’re little and they will learn!
Also, this is our schedule for non-daycare days. On days they go to daycare, things naturally look a bit different.
What advice do you have for parents of multiples when it comes to promoting motor skills, especially if their babies were born prematurely?
I encourage everyone I know with babies to do everything they can to make sure their babies crawl! Some babies just won’t crawl, and that’s okay, but try your hardest to encourage it whenever possible because it is so important for motor development. Many OTs in the United States were disappointed when the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) removed crawling as an “official” motor milestone in 2021.
Crawling is a cross-lateral movement, meaning it coordinates both sides of the body, which is crucial for later motor milestones.
It also helps the two sides of the brain learn to work together and develops a child's ability to cross the midline of their body—skills that are super important! So, encourage crawling whenever possible!
How do you incorporate sensory play or other occupational therapy techniques into your daily routine with your children?
We always use mealtimes as an opportunity for sensory play. Before the twins started solids, I would often put them in their highchairs (or on the floor near our table while our toddler ate) and let them explore different textures in a sensory tray. Now that they’re starting solids, mealtimes have become sensory exploration time!
We also make an effort to get outside every day. We live in Michigan, so colder weather is coming, and we’ll see what bundling up three babies for the snow looks like, but the outdoors provides the best sensory play you can get!
Have you found any specific tools or equipment helpful for your twins' development or your family’s routines, especially when dealing with premature babies?
As an OT, I’m a strong advocate for floor time whenever possible to encourage motor development. However, as a mom of three, I also appreciate baby gear that makes life more functional! One item I’ve loved is the Twin Z pillow. It’s ergonomically designed for breastfeeding multiples and also works well as a tummy time pillow and a cushioned support when your little ones are learning to sit but are still prone to tipping over. It’s been a fantastic multipurpose tool, and I love how easy it is to move from room to room or take with us on outings.
Another piece of twin equipment we’ve loved is the double bottle warmer. Once we got the twins on the same feeding schedule, they were often hungry at the same time. The last thing you want is one baby crying hysterically from hunger while their bottle warms up, enviously watching their twin eat!
Baby carriers have also been a lifesaver! They allowed me to keep my hands free to care for my toddler or get things done around the house. Carriers also made it feasible to leave the house with all three kids by myself. We had the Weego twin baby carrier, which I used frequently once my C-section had healed enough, until the girls reached the weight limit (around five months old). It was my go-to for grocery shopping—twins in the Weego double carrier and my toddler in the shopping cart (or using grocery pickup/delivery services).
Now that they’re too big for the Weego, I’ve been using single carriers, with one twin on the front and one on the back. While using two separate carriers means more straps and buckles, it’s definitely possible to carry both girls without needing to buy another twin-specific carrier.
What tips do you have for setting up a household environment that supports the development and thriving of multiples, alongside an active toddler?
We created safe spaces for the twins in our play areas and spent time explicitly teaching our toddler how to help keep his sisters safe. This included using gentle hands when touching them and making sure he knew which toys were his and which were theirs.
While we encouraged him to be responsible, we were also mindful that he was not yet two years old and could unintentionally cause them harm. These safe spaces were thoroughly baby-proofed to help protect the twins, but we also created areas where our toddler could engage in independent play that was developmentally appropriate for him. For example, in our basement, we set up a toddler-sized table and chairs with arts and crafts supplies. Our toddler knows where his supplies are and understands that they stay at his craft table (to prevent choking hazards from ending up in the twins' play spaces).
Parent burnout is a significant issue that can impact not only the well-being of parents but also the overall health of the family. What strategies do you recommend for managing stress and self-care as a parent of multiples, especially when there are other young children in the family?
Learn to leave the house early. As daunting as it seems at first, in our experience, it only becomes more challenging as the babies get heavier, more active, and more alert. I’m so glad I figured out the logistics of leaving the house with all three babies by myself early on because now that they’re more awake and active, they’re used to being on the go with me! I also wanted to ensure that our singleton still got to enjoy all the toddler experiences he deserved, without feeling like his sisters were causing him to miss out on fun things.
Leaving the four walls of your home is so important for a parent’s mental health and so beneficial for your children’s development.
It’s also crucial to build confidence as a parent early on because this is your new reality as a parent of multiples—and you truly are a “super-mom/dad/parent.” Many people find the comments they get from strangers when out with multiples annoying, but I found it helpful to frame these comments as compliments and confidence boosters (because that’s usually how they’re intended).
Being a parent of multiples (and other children) is exhausting, and to be the best parent you can be, you need to take care of yourself. So, even if leaving the house just means walking down the driveway to get the mail, learn how to do it with those babies—your future self will thank you!
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Thank you Nena, for being so generous in sharing your experience with us.
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