A Unique Child: Twins - At the double

Caring for twins requires a thoughtful approach, to ensure each child gets the best start in life. Meredith Jones Russell takes a look at what settings might need to consider.

With the number of families with twins steadily increasing across the UK, more early years practitioners are having to learn how to tailor their practice to care for multiples.

In 1976, 9.6 women in every 1,000 gave birth to more than one baby, while by 2012, the most recent year for which figures have been released, this rate had risen to 15.6, according to the Office for National Statistics. The number of twins born in the UK has increased by 50 per cent since the 1980s, and in 2012 more than 12,400 sets of twins were born.

Even with this increase, however, few practitioners deal with quite as many twins as those at Child First Nursery in Banbury, which currently has seven sets on roll.

'Twins have just been coming through the door thick and fast,' says nursery manager Amy Ames. 'Two actually left to go to school this year or we'd have even more.'

Ms Ames has received an invitation to the celebration of National Twin Day in Northamptonshire on 13 September, although not in her capacity as nursery manager but as the mother of her own nine-month-old twin sons, who also attend the nursery.

Research by Curtin University of Technology in Perth, Australia has suggested that parents should ascertain whether practitioners have any experience of managing twins before choosing a pre-school environment for their multiples, and Ms Ames agrees that being a mother to twins herself might account for the unusual number of twins at her nursery.

'I have teething twins who don't sleep through the night, so I understand what parents are going through,' she says. 'Maybe that helps them to send their children here.'



Curtin University researchers also advise that even if a setting has previous experience with twins, parents should be able to use their understanding of multiples to guide the care provided. 'A couple of bottom-line requests could be made,' they note. 'For instance, that the children always be addressed by staff and other parents by their own names.'

Ms Ames says this is something her nursery has always tried to do, in addition to encouraging parents to choose separate key people for their twins. 'The most important thing is educating our staff that all our twins are individuals,' she says. 'They aren't going to mirror each other in everything, so we are careful not to categorise them. They are never "the twins" but "Harry and George" or "Jenson and Jarvis".

'When you give feedback at the end of the day you make sure you never say "they" or "them"; you always need to personalise the feedback.'

However, helping twins to fit in at nursery while treating each one as an individual can be a difficult balance to strike.

'Of course all children are unique and special, but at the same time we try not to treat them differently from any of the other children,' Ms Ames adds. 'They're children before they're twins. I know from personal experience that twins can sometimes feel like a freakshow - when I'm out walking around with my kids, people will stop us and point or chat or even ask for photos. We don't want that for them. We want them to feel like all the others.'



With this in mind, the nursery focuses on helping children to feel part of the social environment from the outset. Recognising the personal, social and emotional impact of being a twin can be an important part of a practitioner's approach, and with only 33 per cent of parents with twins able to give their children regular periods away from their sibling prior to starting school, professionals can often help by gradually separating them, either into different groups or across separate activities, to allow them to establish their own set of friends.

Ms Ames says this is something encouraged at Child First. 'We like to get them used to playing apart so that when they get out to the big wide world after nursery it isn't such a shock to their system.' The setting has a free-flow design so children of the same age are not kept together at all times.

Pat Preedy, adjunct professor at Curtin University, has designed a model defining the relationship between multiples as 'closely coupled', 'extreme individuals' or 'mature dependents'.

Ms Ames says that her experience suggests that when twins start at nursery they usually tend towards the former category, and can be very reliant on one another, but her staff will try to encourage them to develop towards the latter.

'They start off playing together and if they're upset they will always seek their twin out for reassurance,' she says. 'But we encourage them to play with other children and gradually they will start to just look out for the reassuring face and then carry on, and as they get used to the nursery and the other faces they don't even need that as much any more.'

She says that other children in the nursery tend not to relate to twins differently at all. 'The children themselves don't actually categorise them as twins usually. They just don't make that association.'

In fact, Ms Ames believes staff have a lot to learn from the children themselves, especially when it comes to identical twins.

'It's amazing how observant the other children are. They know exactly who is who while staff have to guess or make a note of what colour jumper they have on or how they've done their hair.

'And they almost never refer to children as "the twins" either; they just call them by their names. We try to learn from them in that way and do the same.'


About 50 per cent of twins are born prematurely, and disabilities are more common in multiples - often, although not exclusively, due to low birthweight or complications during delivery.

Where twins have not suffered such complications, their general development is similar to singletons, although some twins may have a slight delay in their physical, social and behavioural development during their early years.

Most commonly, multiples may encounter speech and language delays, with boys more affected than girls. Delays are sometimes attributed to twins' closeness - with about 40 per cent of twins estimated to develop their own language (or cryptophasia), attention-seeking behaviour using simple and loud talk only - or busy parents who have less time to help develop their children's language.

Providing a listening ear and reassurance to parents is therefore also a key element of the service a nursery can provide.

'Things can be very different when you've got two,' Ms Ames acknowledges. 'We are a workplace nursery and when parents have twins you do notice they can be particularly stressed. You have to be able to pick up on that and our staff have to be very confident in noticing the signs and being able to go and have a chat and support them when it is needed.

'Sometimes it's the little things. We are in a town centre and the car park isn't attached to the building, so we need to be on hand to help parents in and out with buggies or car seats. It's just things like that you can do to help them, because it's not easy.'

Caring for multiples can be demanding, and establishing routines both at home and in the pre-school setting is recommended by researchers at Curtin University, to help multiples organise themselves and feel secure.

Ms Ames says this is backed up by her nursery's approach. 'It's like a little family. We try to create very much a home from home environment, and with so many twins coming in it means people talk, so we get other family members and friends and neighbours joining too.

'That means we don't have to put so much into marketing because the word of mouth really does it for us, but it also makes it easier for the children to settle in because they often know other people here already.'

For the staff at Child First, however, making the children feel at home can have unexpected consequences. 'When they get to a certain age and they've been here for a while, they start to get a bit mischievous,' Ms Ames says.

'The identical twins quite often take advantage of the fact you can't always tell them apart and start to play tricks on the staff!'

But she admits the problems could be worse. 'To be honest if the biggest challenge we have with our twins is just telling them apart, we can't be doing badly,' she said.


There were 812,970 multiple births in the UK in 2012. This included 12,400 sets of twins.

About one in every 65 UK pregnancies results in a multiple birth.

Multiple births are more likely in England and Wales, where the incidence in 2012 was 15.7 in every 1,000 maternities, than in Northern Ireland (14.9) or Scotland (14.8).

The likelihood of having identical twins is about one in 250 (0.5 per cent).

About one-third of all twins are identical and two thirds are non-identical.

On average, 25 per cent of in vitro fertilisation (IVF) pregnancies result in either twins or triplets, compared with 1 per cent of natural conceptions.

The infant mortality rate is about five times higher for multiple births than for singleton births, due partly to multiple births tending to have lower birth weights than singletons.


  • Twins and Multiple Birth Association (TAMBA), www.tamba.org.uk, is a registered charity set up by parents to help families and professionals dealing with multiples via campaigns, research and support services.
  • The Multiple Birth Foundation, www.multiplebirths.org.uk, is an international charity employing healthcare professionals dedicated to supporting multiple birth families and educating and advising professionals about their special needs.
  • International Council of Multiple Birth Organisations (ICOMBO), www.icombo.org, raises awareness of the needs of multiple birth infants, children, adults and their families and promotes their health, education and welfare.

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