How to give kangaroo care to preemies

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How to give kangaroo care to preemies

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Touching and holding is an important part of caring for your baby in the NICU.

One way to hold your baby is called kangaroo care. This is when you hold your baby skin-to-skin on your chest.

Kangaroo care is good for your baby. It helps keep him warm, is good for his heart and breathing and helps him sleep better.

Kangaroo care is good for parents, too. It can help you feel close to your baby and reduce your stress.

If your baby’s not well enough for kangaroo care, you can touch her in other ways to comfort her.

What is kangaroo care?

Kangaroo care is when you lay your diapered baby on your bare chest (if you’re the father) or between your bare breasts (if you’re the mother). It’s also called skin-to-skin care because your baby’s bare skin is touching your bare skin. Put a blanket on your baby’s back to help keep him warm.

Kangaroo care is great for both you and your baby, especially if your baby’s in the newborn intensive care unit (also called NICU). Doing kangaroo care for at least 1 hour is best. But you can do it for as long as you and your baby are comfortable. Talk to your baby’s health care providers about how often you can do kangaroo care in the NICU. You also can do kangaroo care after your baby’s home.

How can kangaroo care help your baby?

Kangaroo care may help your baby:

  • Stay warm
  • Keep his heart and breathing regular
  • Gain weight
  • Spend more time in deep sleep
  • Spend more time being quiet and less time crying when he’s awake
  • Have a better chance at breastfeeding

How can kangaroo care help you?

Kangaroo care may help you:

  • Make more breast milk. Breast milk is the best food for most babies in the first year of life.
  • Reduce your stress
  • Help build your confidence to take care of your baby
  • Feel close to your baby

When can you start kangaroo care?

Some babies can start kangaroo care soon after birth and some babies may need to wait. You can do kangaroo care with your baby even if he’s connected to NICU equipment. Ask your baby’s providers when you can start kangaroo care with your baby.

How can you comfort your baby if he’s not ready to be held?

If your baby isn’t well enough for you to hold, you can be close to him in other ways. For example, you can do gentle, still touch called hand hugs (also called a containment hold or hand swaddling). To do a hand hug, with your baby laying on his back, put one hand gently on his head and the other gently on his tummy or around his feet. When you touch your baby, don’t stroke him. This can be overwhelming for babies.

Doing hand hugs can sometimes calm your baby when he’s fussy. It also can make you feel better because you can see your baby breathing and being calmed by your touch.

How to give kangaroo care to preemies

Little Elena Stojic was in a hurry to get to know the world. She was born in the maternity ward in Kragujevac at 29 weeks, two months early. She is the second child in her family, but the first to spend her first days, not at home, but in hospital. Her mother, Mirjana, recalls how she felt when she saw Elena in the incubator for the first time.

“When Elena was born, she weighed just 980 grams and we were very concerned about her development. Childbirth in itself is stressful, but it’s much more stressful when you cannot be with your baby,” says Mirjana Stojic.

For more than 30 days Mirjana was only able to look at Elena through the incubator. That first physical contact, which is so crucial, was not possible due to conditions in the hospital. However, everything changed with UNICEF’s donation to the Kragujevac Neonatology Center.

Elena experienced skin-to-skin contact with her mother thanks to a kangaroo care chair and top allowing Mirjana to hold her preterm baby on her chest for longer periods of time. A small hat and socks, together with the kangaroo care top, also aided this important process by helping Elena maintain a healthy body temperature. Skin-to-skin contact is a wonderful way to encourage parent-baby bonding, and provides health and developmental benefits.

“The moment I took my child in my arms and put her on my chest, the magic began. The greatest pleasure; the sweetest child is with me. Happiness, joy. At that moment time stopped – it was just the two of us. We relished this time together, it felt like time had stopped for us,” Mirjana describes the first time she put Elena on her chest.

She compares her daughter’s behaviour before and after their first skin-to-skin contact.“Elena was pulling the probes, pulling all those little cables. With the first skin-to-skin contact – she was calmer. While she was on my chest, the frequency of her heartbeats reduced. And her progress in terms of weight is visible. After our first skin-to-skin contact her weight increased rapidly.”

Dr Ristic, Head of the Kragujevac Neonatology Center, emphasises the importance of the donation of twelve “nests” used for positioning babies while they are in the incubator.

“Nests help babies be in a similar position to the one they would be in in the womb. This [donation] means so much to us. Before, we had to get by any way we could”, says Dr Dragana Ristic.

How to give kangaroo care to preemies

As babies gain weight, psychomotor development follows. Elena is not only gaining weight, but she has established a strong bond with her mother.

“When I see Elena smile, I feel unbelievable happiness – she is fine. If she’s smiling, she’s fine. She’s a satisfied baby, satisfied with everything that is being done for her, with everything that she’s given and provided with. When the baby is happy, the mom is also happy.”

“Skin-to-skin contact reduces stress, as babies can listen to their mom’s heartbeat and voice, and feel the warmth and smell of their mom’s body. Simultaneously, lactation is stimulated, which is so important for a child’s nutrition,” explains Dr Ristic.

The benefits of skin-to-skin contact are not lost on Mirjana and her husband.

“It was like the biggest dream come true for us. Even though she was so small, I wasn’t afraid to hold my child. I was overcome with the desire to just take her in my arms, to have her close to me. That’s my mission as a mother – to put my child on my chest and provide her with the security and safety every child deserves”.

UNCEF, within its programme of cooperation with the Ministry of Health of the Republic of Serbia, collaborates with the Clinical Centre of Kragujevac to improve the conditions for the care of preterm new-borns in the Centre for Neonatology. Apart from the procurement of medical equipment, UNICEF has also invested in the additional training of 30 neonatologists and paediatric nurses in Kragujevac.

The name ‘kangaroo care’ comes from the way kangaroos hold their babies in their pouch. It involves holding your baby against your chest. This can include skin-to-skin contact. Skin-to-skin contact with your premature baby is a wonderful way for you both to bond. It also benefits your baby’s health. Kangaroo care can include breastfeeding your baby if you’re able to or want to do so.

You can start kangaroo care as soon as you and your baby are ready and your healthcare team will help you decide when this is. You can continue with kangaroo care after you go home from hospital, with support from your healthcare team.

How can kangaroo care help me and my baby?

Many parents say that kangaroo care helped them to bond with their baby. It can also help to reduce stress and anxiety, helping parents feel more confident about looking after their premature baby. Both parents and siblings can practise kangaroo care with their baby.

Kangaroo care helps babies adapt to life outside the womb. It improves babies’ sleep and growth and helps protect them against infection and low body temperature (hypothermia). It also helps you prepare for breastfeeding (if you’re breastfeeding) and can reduce the length of time your baby spends in hospital.

“We treasured our kangaroo care time. Our son would settle in completely different ways on each of us, which was amazing and we continued kangaroo care at home for a long time. Our now 5-year-old still snuggles up to us in the same position. He’s just a lot bigger now!”


Can all babies have kangaroo care?

Kangaroo care may not be suitable for babies if their condition is not stable. Some babies may only be able to cope with occasional kangaroo care. The nurses will try to help you and your baby practise kangaroo care, whenever it is possible to do so safely. They will take into account your condition, your baby’s condition and how busy the unit is.

Some parents find it difficult to give their baby kangaroo care. For example, if you’re in discomfort after the birth you may find it difficult to hold your baby for long periods of time. Some parents can’t spend as much time at the hospital as they would like, maybe because they have other children to care for or because they have to travel a long way to the hospital.

It’s completely natural to feel disappointed or upset if you’re not able to enjoy skin-to-skin contact as soon as your baby is born. But you can start and continue doing skin-to-skin in the days, weeks and months to come. If you breastfeed, you’ll have plenty of opportunities. Both parents can do skin-to-skin when bottle-feeding too.

Talk to your medical team if you want to spend time having kangaroo care but don’t feel that you’re getting the chance. Having skin-to-skin time with your baby should be encouraged. If staff in the unit are not doing this, don’t be afraid to ask.

“I think it’s completely normal to feel anxious and nervous to hold your baby if they are born early, are very small and with a lot of equipment attached to them. This was definitely the case with my husband. He was comforted by the fact that the nurses never expected him to be able to handle and position our son on his chest by himself.”


Kangaroo care: step by step

  • Ensure you have visited the toilet, had a drink or have one to hand and make sure you have had any medications and/or pain relief you need first.
  • Avoid using strong smelling soaps or wearing perfume/aftershave as this can be overwhelming for most babies.
  • Wear a front-opening or loose top if having skin-to-skin.
  • Always wash your hands before picking up your baby.
  • Place the baby upright on your chest.
  • If you’re doing skin-to-skin, wrap your top around your baby to keep them warm. Otherwise, a blanket can be used.
  • You may feel more comfortable if you have a pillow under your elbow that is resting on the chair arm.
  • Lean back, relax and enjoy the closeness with your baby. You can use a mirror to look at your baby if you wish.

If your baby is attached to tubes or wires, your healthcare team will guide you on the safest way to care for them. You may be able to give your baby kangaroo care but you will need to stay near the machines and try not to move around too much.

Alternatives to kangaroo care

If you can’t do kangaroo care for any reason, there are other kinds of touch you can do.

Hand hugging is when you place one hand on your baby’s head and cup the other around the baby’s bottom. Just make sure you clean your hands first.

Modified kangaroo care or encircled holding is when the top of the incubator is removed, and the parent leans over the baby while the baby is still in the incubator. This is a wonderful way to connect with your baby. It doesn’t necessarily last as long as a standard kangaroo care session, but some parents say it can have positive effects. For example, some mum’s say it helped them with milk production.

How to give kangaroo care to preemies

Premature and sick babies undergo many medical procedures that can cause them some discomfort. As your baby’s parents, you are the best people to balance this with a positive, reassuring touch.

Positive touch is a way of communicating your love and reassurance to your baby and hearing your baby’s needs in return. Babies do communicate, and by watching and listening to your baby you can learn what kind of touch to use and when it is appropriate, safe and pleasurable for your baby.

It’s harder for your baby to communicate when exposed to too much noise, too much light, too much cool air, or an uncomfortable lying position. See whether the environment can be calmed down first. In time, you will get to know your baby’s individual ways and you may find your baby responding more often and for longer.

Comfort holding

Comfort holding is one of many ways for you and your baby to get to know each other. Your baby may be more comfortable lying in the incubator than being held. In this case, the staff may suggest that you try comfort holding if they think your baby is well enough. Comfort holding is ‘still touch’. Cradling your baby with still, resting hands can be more comforting than stroking or massage, which are more stimulating.

Comfort holding can:

  • soothe your baby during uncomfortable procedures.
  • settle a restless baby.
  • help your baby to get back to sleep after feeds and care.
  • encourage your baby to be quietly awake and responsive.

Comfort holding is a way to experience loving touch when your baby is not ready to be held.

Talk to your baby’s nurse about comfort holding. Together you can watch for signs from your baby that will guide you as to when and how to do it.

  • Remove watches and jewellery, pull your sleeves up to the elbows, and wash your hands and lower arms. This reduces the risk of infection inside the incubator.
  • Always make sure that your hands are warm before touching your baby.
  • If your baby has difficulty keeping warm, make sure there is a layer of fabric (a hat, vest or blanket) between you.
  • Speak to your baby before touching, so that they are aware of your presence before you start.
  • Cradle one or both hands around your baby’s feet, head or body, and keep them still. Your baby may also like to grasp one of your fingers.
  • Wait and watch for signs that tell you that your baby is relaxed.

You can continue for as long as you are both comfortable. When you finish comfort holding, move your hands away from your baby very slowly.

Kangaroo Care

Kangaroo Care is skin-to-skin contact when a baby is placed against the parent’s chest. Benefits include improvements with lactation and with establishing breastfeeding, and better weight gain for the baby. In the longer term, it helps parents to feel closer to their babies and more confident in caring for them. Kangaroo Care can be used with babies with high medical needs, but this will require careful planning and collaboration with the neonatal staff.

Talk to staff and plan a good time and comfortable place for you to try Kangaroo Care.

While Kangaroo Care is based on direct skin-to-skin contact, removing your baby’s clothes is not vital if this is upsetting for him or her. A hat and a blanket for extra warmth might be necessary for very small babies.

Hold your baby chest-to-chest tucked inside your clothes, enclosing him/her to keep his/her temperature stable. Check that the head is well supported and if you can’t see your baby easily, try using a hand mirror.

Explore what you both like to enjoy together. Some babies like to have their eyes shielded, others like to be sung to softly or while having a tube feed. Allow time for your baby to settle and get the full benefit.

If you baby is happy, you can cuddle for as long as you are both comfortable. Lie back, relax and enjoy.

Listen to parents talk about their experiences and challenges with caring for their baby on the neonatal unit, a health professional on the benefits for everyone and get tips on how to get involved.

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How to give kangaroo care to preemies

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How to give kangaroo care to preemies

After a premature birth, it’s natural for parents to feel overwhelmed. Fortunately, there are some things both moms and dads can do to feel a little more in control, and to help their baby get stronger — including practicing kangaroo care. We’ll walk you through what kangaroo care is, its benefits, and how a little (or a lot of) skin-to-skin contact each day can help your preemie grow and develop, and maybe even go home sooner.

What Is Kangaroo Care for Premature Babies?

You’ll have lots of questions following the premature birth of your baby, and you might be wondering whether you can enjoy skin-to-skin contact with your little one. In fact, not only is it helpful for full term babies, but it is also considered especially useful for preemies.

Kangaroo care is simply holding your baby, who is wearing only a diaper, against your bare chest. You can cover his back within a blanket or with one of your own pieces of clothing, giving him the feeling that he’s safely in mom’s (or dad’s) “pouch.” It’s as if the baby’s in a kangaroo pouch — hence the term.

The importance of skin-to-skin contact has been more widely known since the 1970s, when it was found that preemies had a much better chance of survival if they spent a large portion of the day between their mom’s breasts. Today, we know that babies can benefit from skin-to-skin contact with dads, as well.

Kangaroo Care Benefits for Preemies

There are many benefits of skin-to-skin contact for preemies and their parents. Here are some of the better-known advantages this practice offers for premature babies:

Helps regulate the baby’s heart rate, breathing, and body temperature. For example, the mom’s breasts change in temperature to suit her baby’s needs. If the baby is a little warm, her breasts will become cooler to help cool the baby down, and vice versa. The close contact will also intuitively teach the baby to regulate his heart rate and breathing to mom’s or dad’s.

Improves oxygen circulation. In turn, deeper, more regulated breathing will increase the rate of oxygen being delivered to the baby’s organs and tissues, which promotes growth and development of his organs, and helps him gain weight.

Helps calm the baby. Your preemie will recognize the heartbeat and voice of mom from his time in the womb. That’s why being pressed against mom’s chest helps him feel more secure.

Better sleep. Preemies who get plenty of kangaroo care have more high quality, deep sleep, allowing them to grow, develop, and gain weight faster.

Promotes brain development. More restful sleep, less stress, and better oxygen circulation to the preemie’s organs and body tissue all contribute to healthy brain development.

Boosts immune system. Contact with your skin can help expose the baby to healthy bacteria, boosting his immune system.

Helps the baby put on weight. As the preemie begins to rely on the parent for temperature regulation, he uses fewer calories for keeping warm. Skin-to-skin contact also promotes his physical development, leading to weight gain.

Less crying. As the baby rests better and stays calmer for longer, he’ll cry less and feel less distress.

Helps bonding. He’ll also hear mom or dad’s breathing, and smell his parent’s skin, helping parent-baby bonding.

Helps promote breastfeeding. Babies who are held close to mom’s breasts are more likely to show an inclination for breastfeeding. This closeness can even help improve mom’s breast milk production.

Overall, this kind of care can help reduce some of the common problems preemies face as well as help improve the chances of an earlier discharge from hospital.

For parents, it can help alleviate some of their worry by making them feel more closely bonded with their baby. It also gives mom and dad confidence that they are doing everything they can to help their little one get stronger. Research indicates that this bonding time may also help reduce the risk of postpartum depression.

How to Safely Practice Kangaroo Care

Ask the NICU staff about when to begin kangaroo care. Your medical team will be able to tell you about your hospital’s post-birth policy. Some will want you to wait until your baby’s health is stable, while others will encourage skin-to-skin contact right after birth. If possible, discuss your preferences with your doctors before labor, so you won’t feel disappointed if your baby isn’t placed on your chest right away. A hospital’s policy may vary based on whether it’s a vaginal birth or a cesarean birth, as well.

Here are the steps to follow for kangaroo care:

Once you’re given the all clear and are ready to safely practice kangaroo care, wear a shirt that can open at the front. Moms, remove your bra as well. Alternatively, there are even special kangaroo care shirts, allowing your baby to be placed down the front and held tightly against your chest.

Place your naked baby on your bare chest. He can still have his diaper and hat on. Remember, preemie diapers are specially designed to fit premature babies’ weight and size.

You can drape a blanket or one of your tops across your baby’s back to make sure he doesn’t get cold. Just make sure his face is still visible.

It’s preferable to sit in a quiet, dimly lit room, so you can both relax. Let your baby rest during this time, without play or interruptions.

Hold your baby like this for at least one hour a day, for at least four hours per week. However, if your baby enjoys it, and if your physicians also recommend it, you’re welcome to hold your baby for much longer. In most cases, the more the better.

You can even enjoy skin-on-skin contact while bottle feeding or breastfeeding your preemie. Many dads especially enjoy the benefits of skin-to-skin contact while bottle feeding, for example.

NICU staff will be able to provide moms and dads one-on-one guidance to make sure this shared time is comfortable and enjoyable.

What to Watch Out for With Skin-to-Skin Contact for Preemies

You might feel nervous about holding your baby for the first time, particularly if he’s connected to tubes and looks small and fragile. And when you begin skin-to-skin contact, you might be fearful that you’ll hurt your baby by holding him close. Don’t worry — you won’t. Hospital staff will be able to help position your baby on your chest, so that any tubes or wires are moved to a comfortable spot. It can help to place the baby on a blanket, lean gently over your baby, wriggle your hand under the blanket, and support his back and head as you lift him up onto your chest.

To help make kangaroo care even easier for premature babies, there are special clothes for preemies that are simple to open at the front so that your baby can be placed on your bare chest. Make sure you keep your baby in an upright position, with his breathing way clear.

With a little practice, you’ll be confident in practicing kangaroo care, sure in the knowledge that you’re helping your preemie get stronger every day.

A world-first study led by Monash University has demonstrated significant benefits to a premature baby’s heart and brain function when held by the parent in skin-to-skin contact.

Parent-infant skin-to-skin care (SSC) or kangaroo care, started in the late 1970s in Columbia when incubators to keep babies warm were not available. It is now widely recognised as a beneficial component of holistic care provided for pre-term infants.

Incorporating 40 pre-term babies born at around 30 weeks (normal is 40 weeks) and with an average weight of 1.3kg (normal is 3kg) the study, led by Professor Arvind Sehgal, Neonatologist & Head of Neonatal Cardiovascular Research at Monash Children’s Hospital and Professor of Paediatrics at Monash Health, found that one hour a day of kangaroo care significantly improved blood flow to the brain and cardiac function, in comparison to measurements done while in the incubator.

This study, published in the Journal of Paediatrics, provides scientific evidence and rationale as to why the infant’s heart rhythm and neurodevelopment is better with regular kangaroo care. Improving blood supply is important as it carries oxygen and nutrients to the brain and other organs, and guides neurodevelopment.

“The findings of our study are significant as this is a low cost intervention, easily applicable to infants in neonatal units across the world, and helps the most vulnerable of the populations we care for,” Professor Sehgal said.

While SSC is a common practice worldwide, barriers still remain. These include concerns that infants might get cold or small premature babies are unstable and might not tolerate this handling, leading to compromised heart function or unstable blood pressure. However in this study, infants maintained their temperature (in fact, slightly higher than baseline), when measured one hour after SSC.

Previously noted benefits of kangaroo care include reduced stress and crying, increased parent-infant bonding. It is beneficial to parents (mothers) as well as it reduces stress, and increases breast milk supply.

“SSC is perhaps the normal physiological state, while the stress response of being separated from parents is the status of the pre-term infants the vast majority of the time,” Professor Sehgal said.

“We hope this study encourages neonatal units around the world to promote kangaroo care, as well as reassure places where this is already being practised, that the effort and commitment from staff and parents is worthwhile.”

You might have heard that skin-to-skin contact—also called kangaroo care—has plenty of benefits for both a mother and her baby. Indeed, it's been associated with improved mental development, healthy weight, easier breastfeeding, and more. Read on to learn more about kangaroo care, and why you should consider the bonding method with your premature or full-term infant.

What is Kangaroo Care?

Skin-to-skin contact between mothers and newborns was first used in neonatal wards in Bogota, Colombia, which had a shortage of incubators for babies with severe hospital infections. Neonatologists Edgar Rey and Hector Martinez turned to nature—specifically kangaroos, which hold their young as soon as they are born. They sent mothers home with the instruction to hold their infants diapered but bare-chested between their breasts in an upright position as often as possible, feeding them only breast milk.

What the doctors found was that this skin-to-skin contact not only allowed mothers to leave the hospitals (which decreased overcrowding) but it also decreased their babies' dependency on incubators. And the most astounding? The doctors watched as mortality rates plunged from 70 percent to 30 percent.

Now doctors across the United States, South America, South Africa, and other countries recommend this skin-to-skin contact—called kangaroo care or kangaroo mother care—to new moms of both premature and full-term infants. The bonding should last from 60 minutes to 24 hours a day, and it can be performed by fathers as well.

Benefits of Kangaroo Care

"Physiology and research provide overwhelming evidence that kangaroo mother care is not only safe but superior to the use of technology such as incubators," says says Dr. Nils Bergman, senior medical superintendent of Mowbray Maternity Hospital in Cape Town, Africa, where doctors deliver 7,000 children a year. "Depriving babies of skin-to-skin makes alternative stress pathways in the brain, which can lead to ADD, colic, sleep disorders, among other things."

Here are some important benefits of kangaroo care.

Better Adaptability Outside the Womb

"Thermal regulation is a very common problem with infants, especially preterm babies," says Malika D. Shah, M.D., assistant professor of pediatrics and neonatology at the Northwestern University Feinberg School of Medicine. After all, when your baby was in the womb, she didn't need to regulate her own temperature. Since your skin is the same temperature as the womb, Baby will find it easier to adapt to her post-birth environment.

Boosted Mental Development

Preemies who received kangaroo care had better brain functioning at 15 years old—comparable to that of adolescents born at term—than those who had been placed in incubators, says a Canadian study. By stabilizing heart rate, oxygenation, and improving sleep, the brain is better able to develop, Ludington says.

  • RELATED: Science Proves You Can't Hold Your Baby Too Much

Promotion of Healthy Weight

One Cochrane Library review concluded that skin-to-skin contact dramatically increases newborn weight gain. "When babies are warm, they don't need to use their energy to regulate their body temperature," Ludington says. "They can use that energy to grow instead." Plus, kangarooed babies enjoy increased breastfeeding rates, which can't hurt healthy weight gain.

Easier Breastfeeding

"Newborns instinctively have a heightened sense of smell, so placing your baby skin-to-skin helps her seek out the nipple and begin breastfeeding," says Katie Dunning, R.N., clinical coordinator of labor and delivery at Mount Sinai Hospital. In fact, moms who practiced kangaroo care were more likely to breastfeed exclusively and, on average, these moms breastfed three months longer than those who didn't practice skin-to-skin care, says one study published in Neonatal Network.

Healthier Heart Rate and Respiration

Babies who suffered from respiratory distress and stayed in kangaroo care positions were relieved within 48 hours without respirators. One study concluded that heart rates for infants given kangaroo care were more regular than babies not given it.

Improved Immunity

"Premature [babies] seem to have poor immune systems—[they're] susceptible to allergies, infections, feeding problems. Early skin-to-skin contact dramatically reduces these problems," says Bergman.

  • RELATED:Preemie Complications

Increased Milk Supply

When mom and baby are together, hormones that regulate lactation balance out, helping you produce more milk, Dr. Shah says.

Reduced Fetal Stress and Pain

Just 10 minutes of skin-to-skin contact reduces babies' levels of the stress hormone cortisol, and increases levels of the "cuddle hormone" oxytocin, which stimulates the parasympathetic nervous system to make babies feel calm and safe, says Ludington. Her research, published in AACN Clinical Issues, shows that when preterm infants are held chest-to-chest, they react less to heel sticks, a minimally invasive way to draw blood, and a common source of pain among preemies.

Better Sleep for Baby

Less stress = better sleep. Preemies who were cradled skin-to-skin slept more deeply and woke up less often than those who slept in incubators, reported the journal Pediatrics.

Promotion of Bonding with Dad

"From their time in the womb, babies recognize their fathers' voice," says kangaroo care researcher Gene Cranston Anderson, Ph.D., R.N., professor emeritus of nursing at Case Western Reserve University in Cleveland. "Babies find skin-to-skin contact with dad calming, and it helps them bond."

  • RELATED:12 Ways for Dad to Bond with Baby

Prevention of Postpartum Depression

Various studies show that kangaroo care reduces postpartum depression. According to MCN: The American Journal of Maternal/Child Nursing, activity in the mother's adrenal axis is negatively influenced by childbirth, and skin-to-skin contact may reactivate the pathways to minimize the risk of depression. Plus, oxytocin released from skin-to-skin care decreases maternal anxiety and promotes attachment, further reducing the risk, says Dunning.

How to Practice Kangaroo Care

When it comes to kangaroo care, more is better, but according to Ludington, the first two hours after birth are the most important, in terms of easing Baby into the world.

After that, continued skin-to-skin contact can still be beneficial, especially for preemies that have low birth weights and are unable to regulate their own temperature. Consider it an alternative to an incubator, says Dr. Shah, who recommends preemies get frequent kangaroo care for the first 20-plus weeks of life. "Do it as long as both baby and parents enjoy it," she says. When your baby starts fussing and trying to get off of your chest, it's a good sign it's time to let her do her own thing.

This soothing technique helps premature infants bond with their mothers and go home sooner.

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Premature babies, or preemies, require special attention. Preemies in the intensive care nursery (ICN) at John Muir Health often receive kangaroo care, a simple but powerfully effective therapy that is very helpful for baby and mom.

Kangaroo care is one of several techniques in the ICN to help these delicate, sensitive babies thrive. It is a skin-to-skin experience in which a preemie is next to her mother’s chest while the mother is resting in a reclining chair.

“The rise and fall of the mother’s chest as she breathes and the sound of her heartbeat provide a soothing rhythm for the baby,” says Sue Cleaver, ICN clinical coordinator. “The mother’s body warmth keeps baby comfortable and feeling safe.”

The process gets its name from the experience of a kangaroo baby, or joey. A joey is born before it is fully developed and for its first six months lives in its mother’s pouch. When ready, it leaves the warmth and safety of the pouch to venture outside.


Janine Pearson offers a strong endorsement for kangaroo care and her overall birthing experience at John Muir Health. Her son Nicholas, a preemie, was born there.

“I just can’t say enough about the experience,” Pearson says. “All the nurses and staff were so open. Dr. Scott (medical director of the ICN) was first rate. They all listened to me and educated me. They made a big effort to get me any information or help I wanted.”

Pearson explained that she entered the hospital when she was only 24 weeks pregnant and starting to go into labor. Since 24 weeks is far short of the 38 to 40 weeks of a full term pregnancy, she chose to enter the hospital where she could stay in bed and hope to postpone the birth.

This tactic delayed the birth for about four weeks and Nicholas was born at 28 weeks and 5 days, weighing 3 lbs. He weighed 5 lbs. 12 oz. when he went home a little more than a month later.

After birth, Nicholas’ doctor put him on a continuous positive airway pressure device to facilitate breathing, Pearson explained. After the third day, Nicholas was off this machine and breathing well by himself.

Then came kangaroo care. Pearson says, “It’s as close to being in the womb as you can get. From the beginning, he settled down and seemed just to melt into me. It was so bonding and was very calming for him and me. And, Eric (his dad) liked doing it too.”


Kangaroo care is a simple practice with profound benefits, says Cleaver. Studies show these babies get off ventilators sooner, gain weight faster, do better with feeding, and go home sooner.

Parents also experience less anxiety. “It’s very empowering for them. They no longer feel like helpless bystanders,” Cleaver says.

Among the other kangaroo care benefits for preemies are:

  • Decrease in the output of stress hormones
  • Less crying
  • Lower oxygen requirements
  • Increased intimacy and attachment

Benefits for moms include:

  • Improved breast milk production
  • Increased self-confidence in caring for their preemie
  • Knowledge that they are doing something positive for their baby
  • Less anxiety

For dads, the benefits of kangaroo care include increased self-confidence in caring for preemies and the knowledge they are helping their baby in a very significant way.

A guiding principle when caring for preemies is remembering that they would, under normal circumstances, still be in the womb.

Preemies are underequipped to deal with the stimuli they receive in the ICN, Cleaver says. They have to deal with bright lights, noise, and the discomfort of medical procedures. They can quickly use up all their reserves of energy.

The main goal is to keep each baby as comfortable and free from stress as possible. For example, nurses put these little patients into a soft cocoon of buntings and blankets so that they can stay in a fetal position with their arms and legs tucked close to their body.

This technique is one of many aimed at providing comfort and reassurance to preemies.

Golden hour script

Another important element of ICN care is the golden hour script, which is a set of guidelines for doctors and nurses treating extremely premature babies.

The golden hour — the first hour of a premature baby’s life — is vital because treatment during that time can have long-term effects. The process begins in the delivery room, Cleaver says.

If a newborn is experiencing breathing problems, doctors and nurses insert a tube into the baby’s mouth and windpipe. The tube has a special device called a Neopuff, which assists the baby’s breathing by providing breaths at a constant pressure.

“We are getting babies off ventilators sooner and have observed a drop in chronic lung disease,” says Cleaver. “We believe the golden hour script will have long term effects for our premature babies and possibly help them go home sooner.”

Kangaroo Care originated in Bogota, Columbia in 1983 by Neos Edgar Rey and Hector Martinez when they developed the “Kangaroo Mother Care” program to decrease the high mortality rate among preemies. Mums carried their prems in slings all day, every day and the mortality rate fell from 70% to 30%.

How to

It is a method of skin-to-skin contact to promote parent/infant bonding especially for premature babies. It is the practice of holding a premature infant dressed only in a diaper and a hat between a mothers bare breasts or father’s chest, similar to a kangaroo carrying their young. Through contact with their parents skin, the babies are kept warm and allow a close interaction with their parents. Kangaroo Care has not been shown to have any physical risks to the preterm babies. Kangaroo Care can also benefit older prems and full-term babies.

Pic source: Thanks to mum Kimberlee

The practice of Kangaroo Care was first introduced to neonatal units to involve parents in the care of their preemies and to decrease some of the stress associated with an infant needing neonatal intensive care.

Parents who have experienced KC have expressed excitement and joy with the practice and many feel like parents for the first time since their infant’s birth. Infants have been observed in a restful sleep state while in the kangaroo position. As well, Kangaroo Care has been found to promote parent/infant bonding, breastfeeding and an early discharge for premature infants.

Policies vary from hospital to hospital but most have a policy which allows babies who are stable, including those less than 1500grams breathing on their own. Some hospitals also allow babies on oxygen or CPAP to be held in a Kangaroo Cuddle.


There are a number of benefits of kangaroo care:

  • The baby has a stable heart rate (no bradycardia)
  • More regular breathing (a 75 percent decrease in apnoeic episodes)
  • Improved oxygen saturation levels
  • Longer periods of sleep
  • More rapid weight gain
  • More rapid brain development
  • Decreased crying
  • Longer periods of alertness
  • More successful breastfeeding episodes
  • Earlier hospital discharge.

There are also benefits to the parents which include:

  • Feeling close to their baby – Kangaroo Care plays an important role in helping parents to bond with their baby despite the fact that their baby is not home
  • Having confidence that they can care for their baby
  • Gaining confidence that their baby is well cared for

Other Resources

Kangaroo Mother Care Promotions
Aims to promote the spread and implementation of Kangaroo Mother Care as the standard method of care for all newborn babies, both premature and full term. They aim to give firm scientific facts for medical and nursing professionals, and at the same time to convey these to all parents, to ensure babies get the best care.

Klokánkování / Kangaroo Care
Facebook Page dedicated to Kangaroo Care

Kangaroo Babies: A Different Way of Mothering [Paperback]


Premature babies who were breastfed exclusively and kept warm through continuous skin-to-skin contact have become young adults with larger brains, higher salaries and less stressful lives than babies who received conventional incubator care, according to a study published this week.

The research (pdf), in the journal Pediatrics, compared 18- to 20-year-olds who, as premature and low birth-weight infants, were randomised at birth in Colombia to receive either traditional incubator care or kangaroo mother care (KMC) – a technique whereby parents or caregivers become a baby’s incubator and its main source of food and stimulation – until they could maintain their own body temperature.

The kangaroo method involves the baby nestling in a “kangaroo” position on the caregiver’s chest as soon as possible after birth, accompanied by exclusive breastfeeding. Parent and child leave the hospital together as soon as possible after birth, after which there is rigorous monitoring of baby and mother for one year after the infant’s original due date (rather than the actual birth date).

Researchers investigated 264 of the KMC participants who weighed less than 1.8kg at birth, and found that the technique offered significant protection against early death. The mortality rate among incubator-treated babies was 7.7%, more than double that of those in the KMC group (3.5%). Almost every other area investigated revealed further advantages: average hourly wages of the KMC group were nearly 53% higher than their counterparts; cerebral development was significantly higher; family life was found to be more nurturing and protective; and children spent more time in school and were less aggressive, hyperactive and stressed.

“This study indicates that kangaroo mother care has significant, long-lasting social and behavioural protective effects 20 years after the intervention,” said lead researcher Dr Nathalie Charpak, of the Kangaroo Foundation in Bogotá.

“We firmly believe that this is a powerful, efficient, scientifically based healthcare intervention that can be used in all settings, from those with very restricted to unrestricted access to healthcare.”

According to the World Health Organisation, nearly one in 10 babies worldwide is born preterm (before 37 completed weeks of gestation), with resulting birth complications the leading cause of death among children under five. Preterm birth rates are rising globally every year, yet more premature babies are born in low-income countries (9%) – where they face a greater risk of complications – than high-income countries (12%). In Malawi, for example, 18 in every 100 births are preterm.

Many survivors face a lifetime of disability – including learning disabilities and visual and hearing problems – and require extra care to avoid illness and death from secondary, preventable complications including hypothermia. In developing countries, where incubators are often scarce and unreliable, kangaroo mother care could save lives, said Dr Peter Singer, chief executive officer of Grand Challenges Canada, which supported the research.

“A premature infant is born somewhere in the world every two seconds,” he said. “This study shows that kangaroo mother care gives premature and low birth-weight babies a better chance of thriving. Kangaroo mother care saves brains and makes premature and low birth-weight babies healthier and wealthier.”

While the technique does not replace modern science or neonatology, it is an excellent complement, said Charpak. Hospitals in Scandinavia, among them the NICU in Uppsala, Sweden, are using KMC to stabilise preterm babies. Grand Challenges Canada is funding two “centres of excellence” and 10 treatment centres to deliver kangaroo care across Cameroon and Mali, where preterm birth rates are among the highest in the world.

The study’s positive findings are impossible to attribute to one reason alone, said Charpak. Rather, they result from a multidisciplinary approach involving regular skin-to-skin contact, breastfeeding, education of the mother and family, and support over a 12-month follow-up period.

“One of our hypotheses is that, by placing the infant in the mother, father or caregiver’s chest, the infant’s brain is in a less stressful environment,” said Charpak. “KMC also creates a climate in which the parents become progressively more aware of the child and more prone to sensitive caring.”

In contrast, said Charpak, a preterm baby born at 30 weeks could spend seven weeks in an incubator, where it is separated from its mother and faces a steady stream of light and noise. “It is easy to understand why this may not be the place for the baby’s immature brain to grow correctly,” she added.

Although a Cochrane review of 21 randomised control trials concluded that kangaroo mother care significantly reduces mortality among preterm babies and is a safe and effective alternative to conventional care, global use of the technique remains low. The Every Newborn action plan, endorsed by the World Health Organisation in 2014, set a target to reach at least 50% of the world’s low birth-weight infants with kangaroo mother care by 2020.

Charpak is hopeful that research efforts like the Colombia study will change attitudes to the care of preterm babies, not least among health workers.

“There are barriers related to the implementation of KMC programmes, particularly from health staff,” she said. “We believe long-term results will help convince the doubtful about the benefits of implementing KMC.”

Jodi Dolezel, RN, is a neonatal intensive care nurse and founder/CEO of Peekaboo ICU Baby.

Lyndsey Garbi, MD, is a pediatrician who is double board-certified in pediatrics and neonatology.

Everyone has a vision during pregnancy of what is supposed to happen, and that vision never includes the NICU or having a premature baby. The feeling of loss of a term baby and ability to immediately bond and care for that baby is often coupled with feelings of sadness and guilt. Babies in need of immediate neonatal care are often quickly taken away and the parents may feel disconnected from their new baby. With this separation comes uncertainty regarding the infant’s future health and developmental potential, and the immediate and long-term effects this separation from bonding with the family can have.


Kangaroo Care was originally developed in the early 1980s by two neonatologists in Bogota, Colombia South America.   Because the hospital could not afford high-tech equipment such as incubators to keep these small premature babies warm, they used what they had to keep these infants body temperatures stable, their mother. The concept of Kangaroo Care was born.

In Kangaroo Care mothers would hold their babies skin-to-skin on their chest for 24 hours a day, sleep with them, and let them suckle at the breast.

Dramatic improvements were seen in these infants. Not only did they survive, but they thrived- gained weight faster, kept their temperatures stable, their heart rate and breathing were regulated, and they were discharged home from the hospital sooner.  


The concept of Kangaroo Care has since been proven to be safe and very beneficial to even the smallest of preterm babies. Holding your baby skin-to-skin is one of the best ways for you to get involved in the care and bonding of your preemie and help your baby thrive.   Babies are calmed by the presence of their mother, and maternal-infant bonding is improved. With breast milk easily accessible, kangaroo care can often help facilitate breastfeeding in babies who are old enough to begin to suckle. Kangaroo care can even improve a mother’s milk production.

Both mothers and fathers can benefit from improved bonding with their baby. Often parents will become more in tune with their infant's needs and begin to feel more comfortable and confident in their ability to care for their premature baby. Kangaroo Care also helps to reduce the stress of the NICU for both parents and babies.

Science has proven that kangarooed babies thrive better.   Preterm infants that have this skin-to-skin connection with their parents gain weight faster, cry less, have a more stabilized body temperature, sleep better, breathe better, are often more alert, and have more stable heart rates.

Kangaroo Care should be performed at an optimal time for your baby and is often best coupled with caregiving times.

It’s best to select a time when your baby will be getting fed or hands-on care by the NICU team. If you are planning on breastfeeding, this timing will help the baby learn to suckle at your breast and help with your milk supply. An optimal time for pumping is right after a Kangaroo Care session.   Keep in mind the importance of sleep cycling in premature babies. It is best if you can commit to at least an hour of time to your kangaroo sessions as to not interrupt these important developmental and neurological growing cycles.

It is important to know that each individual NICU has their own protocol on Kangaroo Care and when it is an appropriate time to begin skin-to-skin care with your baby.   Ask your nurse when you can start this very important and exciting process, and empower yourself and your baby with the healing power of touch.

How to give kangaroo care to preemies

Cuddling small and premature babies in a style known as “kangaroo mother care” helps them in life decades later, researchers reported Monday.

They found that babies held upright and close to bare skin and breastfed, instead of being left in incubators, grew up with fewer social problems. They were far less likely to die young.

How to give kangaroo care to preemies

Young baby (5 weeks old) with mother. DaveLongMedia / Getty Images

It’s a reassuring finding for parents who may worry that tiny and premature babies are safer in an incubator than in their arms, the team wrote in their report, published in the journal Pediatrics.

Kangaroo mother care was first described in Colombia, and the team of experts there who first showed it was safe did a 20-year follow-up to see how the babies fared as they grew up. They tracked down 494 of the original 716 children who were born prematurely from 1993 to 1996 and randomly assigned to get either kangaroo mother care or standard handling.

“The effects of kangaroo mother care at one year on IQ and home environment were still present 20 years later in the most fragile individuals, and kangaroo mother care parents were more protective and nurturing,” Dr. Nathalie Charpak and colleagues at the Kangaroo Foundation in Bogota, Colombia, wrote in their report.

“At 20 years, the young ex-kangaroo mother care participants, especially in the poorest families, had less aggressive drive and were less impulsive and hyperactive. They exhibited less antisocial behavior, which might be associated with separation from the mother at birth,” they added.

"They exhibited less antisocial behavior, which might be associated with separation from the mother at birth."

“Kangaroo mother care may change the behavior of less well-educated mothers by increasing their sensitivity to the needs of their children, thus making them equivalent to mothers in more favorable environments.”

Twenty million babies are born at a low birth weight every year around the globe, the World Health Organization reports. The U.S. has one of the highest rates of pre-term and low-weight births — about one in 12 births, according to the March of Dimes.

It defines low birthweight as being when a baby is born weighing less than 5 pounds, 8 ounces.

Most of these small babies are premature and they are at high risk of dying, of developing cerebral palsy, or having learning disabilities, and they can grow up more prone to a range of diseases.

High-tech care can help, but WHO promotes the simpler, low-tech approach alongside modern medical care — or instead of it in some poor settings.

“Kangaroo mother care is care of preterm infants carried skin-to-skin with the mother. It is a powerful, easy-to-use method to promote the health and well-being of infants born preterm as well as full-term. Its key features are: early, continuous and prolonged skin-to-skin contact between the mother and the baby; exclusive breastfeeding (ideally); it is initiated in hospital and can be continued at home; small babies can be discharged early; mothers at home require adequate support and follow-up,” WHO said.

“It is a gentle, effective method that avoids the agitation routinely experienced in a busy ward with preterm infants.”

And it’s safe, WHO added. “Almost two decades of implementation and research have made it clear that kangaroo mother care is more than an alternative to incubator care.”

Charpak’s team found the babies randomly assigned to get this treatment were 39 percent more likely to live into adulthood. They had stayed in school longer and earned more as adults.

“We firmly believe that this is a powerful, efficient, scientifically based health intervention that can be used in all settings.”

It didn’t work miracles. Children with cerebral palsy were equally likely to have symptoms whether they had the kangaroo care or not, and more than half the people in the entire group needed glasses. The children given standard care had higher math and language scores in school, while IQ levels were about the same in both groups.

But overall, the findings support the benefits of kangaroo mother care, the team concluded.

“Our long-term findings should support the decision to introduce kangaroo mother care to reduce medical and psychological disorders attributable to prematurity and low birth weight,” they wrote.

“We suggest that both biology and environment together might modulate a powerful developmental path for these children, impacting until adult age,” they added.

“We firmly believe that this is a powerful, efficient, scientifically based health intervention that can be used in all settings.”

Maggie Fox is a senior writer for NBC News and TODAY, covering health policy, science, medical treatments and disease.

Touching and holding your premature or ill baby helps you to connect with them. Your doctor, nurse or midwife will tell you when your baby is ready.

You may be able to try the comfort hold if your baby is in an incubator or on a breathing machine. There may be tubes and wires attached to your baby.

When they are stronger, you can do skin-to-skin contact using kangaroo care.

Comfort hold for premature babies

At first, you might not be able to hold your premature or ill baby in your arms. But you can use the comfort hold to connect with them.

To do the comfort hold:

  1. Wash your hands.
  2. Place 1 hand on your baby’s head.
  3. Place the other hand on your baby’s feet.

You may also like to gently hold your baby’s hands and touch their feet.

If your baby is extremely premature, you should not stroke them. Ask your doctor, nurse or midwife for advice on the best way to touch your baby.

Kangaroo care for premature babies

When your baby is strong enough, you can try kangaroo care.

Kangaroo care is skin-to-skin contact holding your baby against your bare chest. Your baby wears just a nappy with your top and a blanket over their back. But they can wear clothes if they need to.

All babies benefit from the close contact, relaxation and warmth of kangaroo care.

Kangaroo care helps:

  • increase your levels of oxytocin, the feel-good hormone
  • stimulate your milk production
  • develop your baby’s feeding and sucking instincts

Your baby will benefit from as much skin-to-skin contact as possible each day. You and your support person or partner can do kangaroo care.

Doing kangaroo care

Talk to your nurse or midwife to plan a time to do kangaroo care with your baby.

Before you do kangaroo care, have a shower and wear clean clothes. Wear a shirt that opens at the front or a loose t-shirt with no bra or vest. You can hold your baby under your shirt or top.

To do kangaroo care:

  1. Wash your hands.
  2. Greet and touch your baby to let them know you are there.
  3. Find a comfortable position.
  4. When you are ready, your nurse or midwife will gently put your baby on your chest under your top.
  5. With your baby’s head on your breastbone, support their back and bottom with your hands.
  6. Put a blanket over your baby’s back with the top of the blanket just under your baby’s ear.

Your nurse or midwife will check the position. You can use a mirror or camera phone to see your baby’s face.

For the most benefit, do kangaroo care for at least an hour so your baby goes through a full sleep cycle.

Page last reviewed: 5 November 2021
Next review due: 5 November 2024

The results of a new clinical trial published today in the New England Journal of Medicine, show that immediate kangaroo mother care, which involves skin-to-skin contact with the mother and exclusive breastfeeding, started as soon as a preterm or low birthweight baby is born, dramatically improves survival.

Current World Health Organization (WHO) recommendations indicate starting kangaroo mother care only after the baby is stabilized in an incubator or warmer, which can take on average 3-7 days. This new study suggests that, when compared with the existing practice, starting kangaroo mother care immediately after birth can save up to 150,000 more lives each year.

“Keeping the mother and baby together right from birth with zero separation will revolutionize the way neonatal intensive care is practiced for babies born early or small,” said Dr Rajiv Bahl, Head of the Newborn Unit at WHO, and the coordinator of the study. “When started at the soonest possible time, kangaroo mother care can save more lives, improve health outcomes for babies and ensures the constant presence of the mother with her sick baby.”

The results of the immediate kangaroo mother care study indicate the need for a global paradigm shift in the care of small babies with zero separation of babies from their mothers by having dedicated Mother-Newborn ICUs. “The best way to nurture the newly born low birthweight baby, including in high-income countries, is through ongoing skin-to-skin contact with the mother, in a mother-newborn couplet care unit that provides care and medical treatment for both,” said Dr Bjorn Westrup, of the Karolinska Institute, Sweden, and a technical expert for the study.

Kangaroo mother care is already known to be effective, reducing mortality by 40% among hospitalized infants with a birth weight less than 2.0 kg when started once they are clinically stable. However, this important new study provides new evidence to show a further 25% reduction when it is initiated immediately after birth, either with the mother or a surrogate.

Dr Queen Dube, one of the study investigators, and Director of Health Services in Malawi said, “Separating mothers from small and sick newborns adds stress for both mum and baby, at a time when they often both need close contact – immediate Kangaroo Mother Care overcomes this barrier. Keeping the mother and the baby together helps the baby to survive and thrive.

Mother-Newborn ICUs have been established in some countries so that mothers can always be with their babies to provide continuous kangaroo care. Mothers receive their own post-birth care in these wards without being separated from their baby. If a mother is unwell, the selection of a surrogate ensures that the provision of kangaroo care continues until the mother recovers.

During the clinical trial, which was conducted across five countries in Africa and Asia, mothers or surrogates provided approximately 17 hours of skin-to-skin contact per day while in a Mother-Newborn ICU. Delivery of the intervention required close collaboration between obstetric and neonatal departments. It is crucial to note that quality care for all newborns and mothers was provided in the trial which included provision of respiratory support if required, thermal care, breastfeeding support and prevention and management of infections.

Immediate kangaroo mother care had several other benefits in addition to improved survival. It reduced infections and hypothermia, which are two big killers of small babies. The babies also had more opportunity to breastfeed.

Dr Harish Chellani, one of the study investigators, from Vardhman Mahavir Medical College and Safdarjung Hospital, India, observed, “Health care providers have been separating small and sick babies from their mothers for decades believing that was best for them. The new evidence from this study means we must establish the practice of immediate kangaroo mother care globally”.

WHO is in the process of reviewing its current recommendations on kangaroo mother care, published in 2015, in light of the new evidence that has become available .

About the study

This study was a two arm, randomised controlled trial set in high volume, public tertiary care units in Ghana, India, Malawi, Nigeria and Tanzania. The babies in the immediate kangaroo mother care group started the intervention as soon as possible after birth and got an average of 17 hours per day in the Mother-Newborn ICU in the first three days. In the control group, kangaroo mother care was started only after the baby was stable and the babies got about 1.5 hours per day in the neonatal ICU; both the study groups got kangaroo mother care thereafter (about 19 hours / day). The study planned to include 4200 infants but was stopped early due to clear evidence of benefit on survival.

Kangaroo mother care and COVID-19:

The COVID-19 pandemic is affecting the quality of care provided to babies in all regions of the world and threatening implementation of life-saving interventions like breastfeeding and kangaroo mother care. A recent analysis showed that there is an increased risk of death among preterm or low birth weight babies if kangaroo mother care is not practiced, and this risk is 65-fold higher than the risk of death due to COVID-19 infection among newborns.

Dr Suman P N Rao, St. John’s Medical College, Bangalore, India, co-author of both papers said, “Kangaroo mother care is one of our most cost-effective ways to protect small and sick newborns. Now it is more critical than ever to ensure mothers are supported to do kangaroo mother care and that healthcare professionals feel safe and comfortable to support this lifesaving intervention.”

How to give kangaroo care to preemies

Kangaroo care (KC) is a method of skin-to-skin contact that provides a nurturing and supportive experience for your premature infant. The practice is called “kangaroo care” since it simulates how marsupials hold their young in protective pouches as the babies continue to develop and grow.

To perform kangaroo care, the baby will be bare-skinned (except for a diaper) and lay against the parent’s bare chest. The parent can then cover the baby with a receiving blanket (or the parents clothing) to create the “pouch” and hold the baby.


What is the Origin of Kangaroo Care?

Kangaroo care originated in the late 1970s in Bogotá, Colombia. Caregivers encouraged mothers to hold their infants to mitigate overcrowding in hospital wards and to reduce infant mortality rates. Research found that preterm babies held against their mother’s chests survived and thrived. Fifty years later, kangaroo care is now a standard practice among NICUs across the globe.


What are the Benefits of Kangaroo Care?

Benefits of kangaroo care range from relaxation and bonding to increased milk production. From an anthropological standpoint, mothers instinctively hold their infants to their chests frequently during the first few months. Kangaroo care starts this natural process even if the baby needs to spend some time in the NICU first.

Research has found that some of the top advantages of kangaroo care include the following:

  • Psychological stability (increased bonding from skin-to-skin contact (SSC) along with a decrease in stress)
  • Physiological stability (promotes stabilization of temperature blood pressure, heart rate, and respiratory rate)
  • Increased deep sleep (most infants snuggle and fall asleep within minutes)
  • Balance of sleep and quiet alert state (the steadiness of the parent’s heartbeat soothes the infant)
  • Body warmth from parent to infant
  • Decreased crying
  • Increased weight gain
  • Increased breastfeeding
  • Improved brain and cognitive development
  • Possible decrease in length of NICU stay

Parents also benefit from kangaroo care. Some of the major benefits include:

  • Encouraging the bonding process
  • Increased awareness and responsiveness to infant
  • Improved confidence in future care for infant at home
  • Increased breast milk production
  • Decrease in the likelihood of postpartum depression


Can Dads Give Kangaroo Care?

Certainly! Contact the NICU ahead of time so that you are not overwhelmed with the process. Most NICUs or nurseries have rocking chairs that staff can place directly in your child’s area. You can wear a shirt that opens in the front or use a hospital gown if provided. Snuggle the baby upright against your chest or lay the baby’s head across your chest. If you have any concerns, the staff can also assist you in help positioning your child.

How to give kangaroo care to preemies

Photo credit: Alter Family

Kangaroo care is a form of developmental care that has benefits for all newborns, especially those who are in the neonatal intensive care unit. Also known as skin-to-skin contact or kangaroo mother care, kangaroo care involves direct contact when a newborn is placed skin-to-skin on mom or dad’s bare chest. Mom or dad may gently hold their baby where they can be rocked, cuddled and hear comforting sounds of their parent’s heartbeat and voice. Even in the stressful environment of the NICU, parent and child can quietly bond and get to know one another. Kangaroo care is easy to do, inexpensive and highly rated by parents 4 .

Benefits for Baby

Many of the benefits of kangaroo care to a newborn revolve around their feelings of safety, warmth and comfort. Research shows greater bonding with parents and as a result more calm and less stress 2 , which positively impacts their brain and emotional development 1 .

Kangaroo care can help NICU babies

  • Regulate their heart rate, breathing and temperature 2
  • Improve head circumference growth and weight gain 2,4,5
  • Stabilize their organ function and self-regulation abilities 1,3
  • Experience less pain and less crying 6
  • Facilitate better sleep patterns 1
  • Avoid infections 2,4,5
  • Take advantage of improved nutrition from mothers’ increase in breastmilk production 1,2
  • Be more willing to breastfeed 2,4,5
  • Enjoy a shorter hospital stay 7

In addition to benefits that are observable in the NICU, research points to long-term advantages as well. Newborns who experienced kangaroo care in the NICU were more attached and bonded to their mothers over time. Babies were more alert after six months and their mothers were more attuned to their infant’s cues and experienced less depression 1 . In early childhood, children receiving kangaroo care also show increased social competence, a positive sense of self and improved cognitive and motor development 1,4 . These benefits are all signs of healthy brain development. In 2016 a study was released that revealed kangaroo care held significant, long-lasting social and behavioral protective effects even 20 years later. 8

How to give kangaroo care to preemies

Photo credit: Beverly Demafiles Photography

When to Start Kangaroo Care

Depending on your baby’s condition, kangaroo care can begin immediately after delivery or may start after they are more stable. Even very small babies with major health issues or on a mechanical ventilator can benefit from these short sessions. Once your baby is stabilized, sessions should be at least an hour (even up to 24 hours though NICU policies vary) as anything less can be stressful for your baby 2 . Your nurse or other neonatal professional should be able to give advice about when a baby is ready for kangaroo care and help prepare parents for this special time together.

Getting Ready for the Big Moment

Kangaroo care usually requires a comfortable place to sit with several pillows for support and to help position the baby, though it can also be done standing up. Many hospitals provide a privacy curtain or screen to make it easier for a parent to undress from the waist up to prepare to hold their child. If a privacy screen is not available, parents may be offered a wrap or a stretchy shirt with a large neck opening that can be worn with space for baby to be tucked inside for privacy.

During kangaroo care, a baby will be undressed down to the diaper and placed directly on mom or dad’s chest. Any wires or tubes will be carefully positioned, and parent and child will be covered with a lightweight blanket or wrap to stay warm and for privacy. The nurse will likely take your baby’s temperature several times to make sure they are maintaining their temperature and will probably watch the monitors pretty closely the first few times.

NICU moms share how Kangaroo Care made them feel

“Like I was able to serve a purpose for her. If I couldn’t hold her on the inside, I was going to do all I could on the outside.”

“Wonderful, connected, close, calm, almost like a normal mom (minus all those wires)”

“Hopeful. I could see on the monitors when holding my twins that everything would level out with them. It really made a difference.”

“Truly like my son’s mom….not just a visitor. Some of my most cherished moments early on in our NICU stay.”

Mothers Bond with Their Babies

The transition from pregnancy to a birth with complications and caring for a child in the NICU can be traumatic and stressful. Feelings of anxiety, fatigue, anger, guilt and depression, all emotions which can impact a mother’s confidence to interact with their baby, are common 1 . Meeting the instinctual need to hold and soothe a newborn with kangaroo care helps mothers feel needed and re-connected to their baby, which melts away stress and leaves them feeling more fulfilled and empowered 2 . In addition, research shows mothers find it easier to bond with their infant, improving their ability to care for a medically fragile child 3,5 .

Dads Have a Role to Play, too

It is not uncommon for dads to feel like a visitor or spectator when their baby is in the NICU 3 . Moms often spend more time in the NICU and have the role of providing breast milk. Kangaroo care can empower dads so they also feel like a significant person in their infant’s life. Fathers also learn specific knowledge about caring for their baby, become a part of their schedule, and gain the nursing staff’s confidence as well by participating in skin-to-skin care 3 . Kangaroo care is a great time for dads to practice practical skills related to caring for their child, while building a lasting bond.

Many times it feels that there are very few things you can do for your baby while in the NICU. Kangaroo care can be an opportunity for mothers and fathers to do something positive for their precious newborn. Kangaroo care is a great time to talk softly, sing or hum quietly to your baby, or sit quietly and be grateful for the small things. Ignore the monitors and concentrate on the feeling of your baby’s skin, her breath, her smell, the sweet noises, the weight of her on your chest. This is a precious moment and that hour will fly by. Before you know it you will be asking when can I do it again?

How to give kangaroo care to preemies

Salma Shabaik holds her newborn son, Ali. When he was born, she held him naked against her bare skin, a practice called kangaroo care. Ali is wearing an ear cap to correct a lop ear. Morgan Walker for NPR hide caption

How to give kangaroo care to preemies

Salma Shabaik holds her newborn son, Ali. When he was born, she held him naked against her bare skin, a practice called kangaroo care. Ali is wearing an ear cap to correct a lop ear.

Morgan Walker for NPR

When Ali Andrew Li was born on Jan. 7, he was gently placed on his mother’s chest, where doctors cleaned and examined him and covered him with a warm blanket.

“I just loved it,” his mother, Salma Shabaik, a family physician who lives in Los Angeles, says. “It was really nice to have the baby right there beneath my eyes where I could feel him, touch him, kiss him.”

That was different than the birth of her son Elias two years ago; he was whisked away to a bassinet to be examined. And unlike Elias, who cried a lot after delivery, Shabaik says Ali stopped crying “within seconds” after being placed on her chest.

Kangaroo mother care has been widely used worldwide to care for premature babies, and it’s gaining popularity in caring for healthy full term babies like Ali as well. It is as it sounds: Like a kangaroo’s pouch, mothers hold their naked newborns on their bare chest for the first few hours of life.

At Ronald Reagan UCLA Medical Center where Ali was born, the technique is routinely practiced for healthy mothers and newborns. The baby gets to know their mother immediately, says Dr. Larry Gray, behavioral and developmental pediatrician at Comer Children’s Hospital, University of Chicago Medicine. “The baby gets landed in a trusting environment,” he says, reassuring them that life outside the womb can also be “soft, comfortable and warm.”

How to give kangaroo care to preemies

Shabaik with her husband Andrew Li, 2-year-old Elias and newborn Ali. Morgan Walker for NPR hide caption

How to give kangaroo care to preemies

Shabaik with her husband Andrew Li, 2-year-old Elias and newborn Ali.

Morgan Walker for NPR

The benefits are many, according to Dr. Lydia Kyung-Min Lee, an ob-gyn at UCLA. Not only is the baby happier, she says, but his or her vitals are more stable. Body temperature, heart and breathing rate normalize more quickly. The close contact also allows the baby to be exposed to the same bacteria as the mother, which can protect against allergies and infection in the future. Infants who receive kangaroo care breast feed more easily, Lee says, and their mothers tend to breast feed for longer periods of time, which is “all good.”

Babies also seem to suffer less pain. Almost 20 years ago, Gray studied how babies respond to a heel prick to draw blood, a procedure that screens newborns for genetic disorders. He found that when healthy newborns had kangaroo care, there was less facial grimacing and crying suggesting pain, compared to babies who had been swaddled and had the procedure in their bassinets, “sort of alone.”

Shots – Health News

Saving Newborns: ‘Kangaroo Care’ Could Go A Long Way

One of the first places to show how this technique can help preemies was Colombia in the 1990s. There, hospitals with no access to incubators and other equipment often sent home preemies with no expectation that they would live. But doctors were surprised to see that babies whose mothers carried them close, skin to skin, not only survived but thrived.

This was a “serendipitous magical finding,” says Gray, suggesting that skin-to-skin contact acted something like a “natural incubator.”

Gray also points to the work of Myron Hofer, a psychiatrist with Columbia University Medical Center who studies attachment between mother and infants. Hofer coined the term “hidden regulators” that pass between mother and baby. It’s not just that mother and baby are together, Gray says, but also that the mother is in some way “programming the baby, the breathing, temperature and heart rate.”

That “magic” can also happen between baby and father, too, says Gray, if there’s skin-to-skin contact. And if mothers or babies are very sick and have to be isolated, Gray suggests mothers take any opportunity to hold their infant skin to skin. Even a little bit of kangaroo contact, he says, can be beneficial.

Kangaroo care, otherwise known as skin-to-skin care, is a way that parents can hold their baby directly against their bare skin. It encourages bonding with your baby and helps support their emotional and physical development. Both a mother and their partner – as well as the baby – can benefit from kangaroo care.

What is kangaroo care?

Kangaroo care is when you hold your baby to your bare chest so your baby has direct skin-to-skin contact with you. The baby is held upright with their head to one side between the mother’s breasts or against the partner’s chest. One hand should support the baby’s head and the other over their bottom. Often, a blanket is placed over the top of the baby to help keep them warm.

When is kangaroo care used?

Many maternity hospitals encourage skin-to-skin contact straight after birth if the baby and mother are both stable. Kangaroo care can be given to babies who are full term, but it’s usually provided to babies who are premature and being cared for in a neonatal intensive care or special care unit.

Even babies who need breathing support and are on a ventilator receiving oxygen, can have kangaroo care. Ideally, kangaroo care happens straight after birth or within the first few days of birth.

Maternity care providers generally recommend that parents practise kangaroo care as soon and as frequently as possible, and for as long as the baby is well and stable. Babies of any age benefit from kangaroo care, but particularly in the time they’re being cared for in hospital.

How do babies benefit from kangaroo care?

Kangaroo care has a range of benefits and can:

  • regulates a baby’s heartbeat and breathing
  • increases a baby’s weight gain and decreases the risk of mortality — this is especially important for premature babies
  • improve oxygen saturation levels
  • help to maintain body temperature
  • supports longer periods of quiet, calm sleep
  • help a baby access their mother’s breasts so breastfeeding is easier
  • decrease a baby’s perception of pain and reduce stress and crying — kangaroo care before heel prick blood collections and injections has been shown to reduce pain and distress for a baby

How do parents benefit from kangaroo care

Kangaroo care provides parents with many benefits, particularly in:

  • boosting the bonding process and emotional attachment
  • building confidence in handling their baby
  • supporting early breastfeeding and milk production
  • helping to support the baby’s brain development

What are the benefits of kangaroo care to partners?

Connection is the key benefit for partners. Skin-to-skin contact helps build an emotional connection and ease the sense of separation as well as boosting confidence in handling their baby.

Will hospital staff support me in providing kangaroo care?

Most maternity hospital staff are mindful of the benefits of kangaroo care and will do all they can to support you. If your baby’s condition is not stable or they are unwell and need to stay in their humidicrib so they can be more carefully monitored, it won’t be the right time for kangaroo care.

Planning kangaroo care around your baby’s other care needs and feeding times will help you both to get the most out of this special time of connection.

Sometimes the nursery will be busy and perhaps the staff aren’t able to support you. It will help to let them know that you’re keen to hold your baby as often as possible.

Ways to prepare for kangaroo care

It’s important that you are mindful and ‘present’ when you’re providing kangaroo care:

How to give kangaroo care to preemies

Kangaroo Mother Care is a method of care practiced on babies, usually on a preterm infant, where the infant is held skin-to-skin with his mother, father, or substitute caregiver. Kangaroo Mother Care (KMC) was initially developed in Colombia as a way to keep stable preterm infants warm and decrease time spent in overcrowded hospital environments. However, Kangaroo Mother Care is not limited solely to environments where incubators are unreliable or unavailable, but is practiced in leading neonatal centers all over the world. Research conducted worldwide has quickly revealed that this special way of holding your infant has an extraordinary effect on preterm babies.

How do you “Kangaroo” an infant?

How to give kangaroo care to preemiesUsing the Boba Baby Wrap for Kangaroo Care – 3 lbs 11.9 ounces – just about 32 weeks gestation/1 month old

A baby is held in continuous skin to skin contact as close to 24 hours a day as possible with his mother. This is accomplished by placing the baby in the kangaroo position, a strictly upright position and stomach down (prone) on the mother’s bare chest. Technology can be added on as needed. Exclusive breastfeeding is the ideal. The mother may recline in a chair with blanket draped over her chest or she may stand upright if sling or wrap is available.

Who should practice Kangaroo Mother Care?

  • Preterm or low birth weight babies admitted to a neonatal intensive care unit or special care baby unit when medically stabilized. It is possible even if your baby is incubated.
  • Well preterm and low birth weight babies.
  • Full term, well babies.
  • Babies who have been separated for some reason from their mothers to aid in maternal attachment
  • Mothers and babies who wish to establish breastfeeding and maintain milk supply

Kangaroo Mother Care provides intimate form of protection so that rest, growth, and natural healing may occur. Although it was initially developed for use with preterm and low birth weight babies Kangaroo Mother Care is beneficial for all babies as constant contact with their mothers and her warmth, breast milk, love, and protection are all the basic requirements needed for their well being and survival.

Requirements for KMC

  • A mother (works with fathers too)
  • Supportive atmosphere
  • A carrying cloth or stretchy baby wrap as an option
  • A reclining chair if blanket is used

The Latest on Kangaroo Mother Care

The World Health Organization, Unicef, The March of Dimes, and the National Institute of Health all recommend the use of Kangaroo Mother Care and deem it a scientifically sound, low cost, and a high impact developmental intervention for both baby and mother.

New research by Dr Joy Lawn shows that Kangaroo Mother Care is one of the most powerful and effective ways to save preterm babies all over the world. Below are some of his statements.

The Boba Baby Wrap Baby Carrier and Kangaroo Mother Care

The Boba Baby Wrap is a stretchy baby wrap carrier that frees the hands of parents carrying even the tiniest of babies. Top neonatal centers worldwide are advising Kangaroo Mother Care, yet in many NICU’s no special shirts or equipment are used. Most often the parents are reclining on a chair skin to skin with their naked baby covered by nothing more than a blanket.

Wrapping mother and her preterm baby together with a Boba Baby Wrap is not only practical, but it

  • helps maintain the correct head and neck positioning of baby
  • conforms perfectly and clings to the contours of baby’s and mom’s body
  • offers just the right amount of elasticity providing a familiar womb-like feeling of confinement
  • envelops the baby’s entire body that is not in contact with mother so that heat is better conserved
  • allows mother to move freely
  • provides ultimate softness for such delicate baby skin
  • may encourage parents to practice KMC for longer periods of time as parents are less apt to tire

+How to give kangaroo care to preemiesSilas was born 5 weeks prematurely, and suffered grave hypoxia due to complications during the delivery.

Our son Silas was born 5 weeks prematurely, and suffered grave hypoxia due to complications during the delivery. His heart stopped, and he was not breathing for the first 6 minutes after birth – we were told that he would almost certainly suffer brain damage. My husband and I are both doctors, and are familiar with the importance of skin-to-skin-contact with a newborn, so we had actually bought our Boba Baby Wrap whilst I was still pregnant, and as soon as Silas was taken off his respirator, we started using it. It was eye opening to see the effect it had on him; watching the monitors we could see his heartbeat drop 30-40 beats per minute as soon as he was put in the wrap – from being stressed and in pain, he became completely relaxed in his Boba Baby Wrap! We`ve used the Boba Baby Wrap every day since – and our respect for this wrap just keeps growing – besides being nice and snuggly for the baby, it is a miracle cure against colic and overstimulation! The intimacy, comfort and safety a Boba Baby Wrap offers for the baby is just exceptional – I love that it allows skin-to-skin contact with the baby whilst still discrete for the mother!

Silas is now 6 months old, and there is no sign of complications what so ever from his difficult birth – we are convinced that all those hours in the Boba Baby Wrap, with skin-to-skin contact with us, has played a major role in his amazing recovery and development.

As baby wraps are not very common in Denmark, we`ve gotten a lot of attention using the Boba Baby Wrap (and we`ve been using it EVERYWHERE). First from the nurses and doctors in NICU, and later on from family, friends and even strangers coming up to us in the street asking about it. We have recommended it to everybody we meet, and even bought it for friends with babies, and they have all loved it just as much as we have.”

– Renee

So now that you’ve educated yourself about what Kangaroo Care looks like, come over and check out all the incredible health benefits of Kangaroo Care. Help your preemie develop into a healthy baby. Empower yourself!