I have answered Jay's query about thrush and her friend with twins privately, as she requested, but it brings up an issue for me. Over several years, practically every mother of twins and triplets that I see has struggled with thrush at some time. I suspect that because so many have had c-sections, preemies, and/or antibiotics, they are more susceptible. Add to that the fact that they are exhausted, and also sharing the same breasts (and too frequently a pacifier/nipple shield or whatever as well.) But still, thrush adds such an additional burden of misery to an already difficult situation with multiples. Have others experienced this as well? There is a really comprehensive article in Leaven, Vol 34, no 5, October/November 1998, pp 91-96, "Yeast Infections and the Breastfeeding Family" by Karen Zeretzke, IBCLC. But all the things we know to do to combat yeast can absolutely overwhelm these stressed families with multiples. What do you all see as the real essentials if we had to make a list of things to do in order of importance? And can we offer a preventive strategy, knowing that these families seem more vulnerable to thrush? Another interesting note: a local physician told me this week that babies she sees on nystatin seem to have major problems with gassiness and constipation. I have had a lot of mothers complain of gassy babies, but I had thought it was from the thrush. And I did recently have a baby of a triplet mom go over 8 days without a stool at age 4 weeks, (born at 34 weeks' gestation), which seemed unusually long at that age. (Baby was gaining well, good amount of wet diapers, abdomen was soft when checked by pediatrician, and did eventually poop a large amount. So was this related to the use of nystatin? After nystatin was stopped, he has a stool generally every 2 days. He is now 8 weeks old. And good news: This mom called me tonight just to share her joy! All 3 babies slept the same 4 hours in a row 2 nights ago, and the same 5 1/2 hours in a row last night! The thrush is diminished, her sore nipples are feeling a lot better, off nystatin all 3 babies are less gassy and happier, and she thinks this breastfeeding is really going to work. She is totally nursing all 3 and has finally gotten all of them off the nipple shield introduced in the hospital (tackling one at a time). This mom has overcome so many hurdles. I'm so proud of her. She really wanted to breastfeed, and got so many negative messages from so many people (of the "Don't set yourself up for failure" type, but without any support or help for even trying it). Weight gains for all 3 babies are excellent, and she has plenty of milk, despite a severe postpartum hemorrhage 8 days after delivery. Support has come from a wonderful mother-in-law; frequent home visits from a county public health nurse who is IBCLC; help dealing with nipple problems, thrush and bacterial infection from an Family Practice MD who is IBCLC; a support system from the LLL group of other mothers nursing multiples, and its leaders; and a pediatrician who is willing to learn. It's very much a team effort. Most of all, she is one of those mothers who will work to overcome all sorts of obstacles to get what they really want. She grieved over the fact that she only nursed her 13 year old for 2 weeks, and nothing was going to stop her this time around! Anne Altshuler, RN, MS, IBCLC and LLL leader in Madison, Wisconsin mailto:[log in to unmask]