Laura, and others working with mothers of twins for the first time,

A good resource for breastfeeding twins is "Mothering Multiples:
Breastfeeding and Caring for Twins" by Karen Gomada.  It is available
through La Leche League, P.O. Box 4079, Schaumberg, IL 60168-4079
(708)519-7730.  FAX 708-519-0035.

It is very possible to breastfeed twins and have them grow well.  In the
case mentioned, all the usual points about the breastfeeding should be
evaluated, just as with a single baby who is lagging in weight gain.  If
this mother is very slender, it may be that the babies genetically will be
slender body types as well, but I would not expect them to plateau with no
weight gain at this age. What has been their pattern of weight gain since
birth?  Did they initially gain and then stop? A thorough history and
observation of the breastfeeding should be done to assess exactly why the
babies have not been gaining..

I have some mothers of twins in my LLL Multiples Group who are quite
slender but have babies who are very good size on breastmilk alone. These
mothers joke about how hungry they get.  One told of eating 8 muffins at
one sitting - with jam!  This is not a good time to initiate a strict diet,
if nursing 4 month old twins and chasing after an older child as well.  Why
does the mother want to do this?  Does she have an eating disorder, or some
other concern that led her to adopt a strict lowfat diet right now?

You may want to take a look at the book "Having Twins" by Elizabeth Noble
(1991), which has a detailed chapter on nutrition during a multiple
pregnancy, based on the recommendations of Gail and Tom Brewer.  Not all
dieticians agree with the advice given, but it would be good for you to
read and be familiar with the chapter.  The book is widely read by women
who are pregnant with multiples, and is in book stores and libraries. There
is no discussion on a mother's diet for breastfeeding twins, however.
Another popular and widely available book which has a chapter on
breastfeeding is "The Joy of Twins" by Pamela Novotny.  There are also the
usual breastfeeding resources (LLL's "Womanly Art of Breastfeeding,"
Huggins' "The Nursing Mother's Companion" which recommends eating 3,000
calories per day, Pryor's "Nursing Your Baby," Renfrew et al's
"Bestfeeding," Gotsch's "Breastfeeding Pure & Simple," etc.), many of which
have a brief chapter or paragraph on nursing twins.  "The Baby Book" by
William and Martha Sears is another example that is widely available,
pro-breastfeeding, and has a section on  twins.

Anne Altshuler, RN, MS, IBCLC and LLL Leader in Madison, WI