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Higher-order multiples

The rate of triplets and even higher order multiples has gone from 1 in 1000 to 1 in 200. While we hear much about the "explosion" of higher multiples, we hear less about the high rates of disability in these children and the extra demands placed on the family, the school and health and support services. The rates of triplets and higher order multiples really began in the early 1980's with the wider use of fertility drugs and the gradual growth of the more invasive reproductive technology. This led in the UK to the comprehensive survey published in 1990 with the title "Three, Four or More".

Most of this book concerns health issues before or at birth and in the first year or two after the birth and there are only short sections on Preschool and School. However the main themes of these do give us some idea of the questions that do arise and how different these are from the issues that face parents of singletons and even twins. The main problems at Preschool are:

• Getting all the children there
• Cost and whether there could be any reduction for "quantity"
• Finding places for all.

The main dilemma about higher multiples in school is the placement across or within classes. There are so many potential permutations complicated by the fact that one or more of the multiples may have special needs.