KANGAROO MOTHER CARE

INTRODUCTION
Some 20 million low-birth-weight (LBW) babies are born each year, mostly in less
developed countries. Of the estimated 4 million neonatal deaths, preterm and LBW babies
represent more than a fifth.
Modern technology is either not available or cannot be used properly for the care of these
neonates, often due to the shortage of skilled staff. Incubators are often insufficient to meet
local needs or are not adequately cleaned. Under such circumstances good care of preterm
and LBW babies is difficult: hypothermia and nosocomial infections are frequent,
aggravating the poor outcomes due to prematurity.
However, kangaroo mother care (KMC) is an effective way to meet baby’s needs for
warmth, breastfeeding, protection from infection, stimulation, safety and love. KMC is a
universally available, a simple, and inexpensive and biologically sound method of care
for LBW infants. The method was first introduced in Bogotá, Columbia in the late 1970s by
Dr. Martinez and Rey and later used in different facilities.

DEFINITION:
Kangaroo mother care (KMC) refers to the practice of providing continuous skin-to-skin
contact between mother and baby, exclusive breast milk feeding, and early discharge from
hospital.

COMPONENTS OF KANGAROO MOTHER CARE:

The major components are:
 Kangaroo position
- Direct Skin-to-skin contact on the mother’s chest secured with a wrap
- Should be initiated early and continued for prolonged period of time.
Kangaroo nutrition
- Exclusive breastfeeding whenever possible
- Most babies below 2000gms would gain weight adequately on exclusive
breastmilk feeding
Kangaroo discharge
- Mother continues KMC practice at home after discharge
Kangaroo Support
- Health care staff provide support to the mother to take care of her infant in the
hospital
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 - Family support of mother in practicing KMC at home 

PURPOSES OF KANGAROO MOTHER CARE:

 Helps in thermal control and metabolism
 Results in increased duration and rate of breast feeding
 Satisfies all five senses of the infant
 Results in more regular breathing and less apnoea
 Protects against nosocomial infections
 Daily weight gain is slightly better with LMC
 Facilitates better mother infant bondage
 It is the best method for transporting small babies
 Mother gains increased confidence, self-esteem, sense of fulfilment and deep
satisfaction
 Does not require additional staff
BENEFITS OF KANGAROO MOTHER CARE:
The benefits of Kangaroo Mother Care are
a. Benefits to the mother
b. Benefits to the father
c. Benefits to the infant
d. Benefits to the health care provider

Benefit to the Mothers:

- The mother’s confidence and bonding are encouraged.
- They feel less stressed.
- Mothers are empowered to play an active role in their infant’s care.
- Breast feeding is promoted.
- Less neglect and abandonment.
Benefit to the Fathers:
- Fathers are able to play a far greater role in the care of their infants.
- It improves bonding between fathers and infants, which is particularly important in
countries with high rates of violence towards children.
Benefit to the Infants:
- Most low-birth-weight infants can be kept warm and stable with KMC.
- Infants grow faster.
- Serious infection is less common in the infant.
- Less apnoea (stopping breathing).
Benefit to the Health care providers:
- Fewer staff and less equipment are needed in hospital nurseries.
- Infants can be discharged home earlier.
- It is cheaper.

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REQUIREMENTS FOR KMC IMPLEMENTATION:
- Training of doctors, nurses, and other staff members on KMC, especially who are
involved in care of mothers and baby.
- Educational materials like information booklets, pamphlets, posters, video films etc,
on KMC in local language.
- Reclining chairs or beds with adjustable backrest or pillow or ordinary chair.
- KMC does not require extra staff. Once KMC is implemented, care givers appreciate
it because of health benefits to the babies and the satisfaction expressed by the
mothers.
ELIGIBILITY CRITERIA:
1. For infants:
All babies are eligible for KMC. Some guidelines for practicing KMC include:
i. Birth weight ≥ 1800gms: If stable, can be started on KMC soon after birth.
ii. Birth weight 1200-1799gms: In such case the delivery should take place in an
equipped facility, which can provide neonatal care. Should delivery occur
elsewhere, the baby should be transferred to such facility soon after birth,
preferably with the mother.
One of the best ways of transporting small babies is keeping them in
continuous skin to skin contact with the mother. It may take a couple of days
for a sick baby to become stable before KMC can be initiated.
iii. Birth weight < 1200gms: These babies benefit most from transfer before birth
to a hospital with neonatal intensive care facilities. It may take days to weeks
before baby’s condition allows initiation of KMC.

2. For mothers:
All mothers can provide KMC irrespective of age, parity, education, culture and
religion. The following aspects must be taken into consideration when counseling for
KMC.
i. Willingness: the mother must be willing to provide KMC. Health care
professionals should counsel her adequately regarding different aspects of
KMC. Once mother knows about KMC, she will be willing to provide KMC
to her baby.
ii. General Health: If the mother has suffered from complications during
pregnancy or delivery or is otherwise ill, she should recover reasonably well
before she can initiate KMC.
iii. Supportive Family: The mother needs support to deal with other
responsibilities at home. The other family members e.g. father or grandmother
should also be encouraged to provide kangaroo care to the LBW baby.
iv. Supportive Community: This is particularly important when there are social,
economic or family constraints.
PREPARATION FOR KMC:
1. Counseling:
 Explain the benefits of KMC to the mother and family
 Demonstrate the procedure to the mother gently with patience
 Answer the questions asked by the mother and the family members to remove
anxiety

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  Allow the mother to interact with someone who have already been practicing
KMC for her baby
 Discuss about the procedure to the mother-in-law, husband or any other
members of the family.

2. Mother’s clothing:
 Mother should wear front open, light dress, as per local culture.

3. Baby’s clothing:
 Baby should be dressed with front open sleeveless shirt, cap, socks, nap kin and
hand gloves.
INITIATION OF KMC:
 KMC should be gradually initiated with a smooth transition from conventional care to
continuous KMC.
 KMC can be started as soon as the baby is stable in the neonatal care unit.
 Short KMC sessions can be initiated during recovery with ongoing medical treatment’
i.e., IV fluids, Oxygen therapy, etc.
 KMC can be provided while the baby is with gavage feeding.
KMC PROCEDURE:
1. Kangaroo positioning
- The baby should be placed in between the mother’s breast in an upright
position
- Baby’s head should be turned to one side and in a slightly extended position
which helps to keep the airway open and allow eye to eye contact between
mother and baby.
- Baby’s hip should be flexed and abducted in a frog like position. The arms
should be flexed and placed on mother’s chest
- Baby’s abdomen should be placed at the level of mother’s epigastrium.
- This position helps reduce the occurrence of apnea, as mother’s breathing and
heartbeat stimulate the baby. Baby can be supported with a sling or binder or
especially prepared KMC bag.

2. Feeding
- Mother needs help to breastfeed her baby during KMC.
- Holding the baby near the breast stimulates milk production and kangaroo
position and makes the breastfeeding easier.
- Baby could be fed with paladai, spoon and tube depending on the baby’s
condition.

3. Monitoring during KMC

- During the initial stage of KMC the baby must be monitored for airway,
breathing, color and temperature.
- Hands and feet must be examined to assess the warmth.
- Airway must be kept clear with regular breathing, normal skin color and
temperature.

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 - Baby neck position should neither be too flexed nor too extended.

4. Psychological support to mother

- Mother needs motivation to continue KMC
- She should be encouraged to ask questions to remove anxieties.

5. Privacy
- Privacy must be maintained to avoid unnecessary exposure on the part of the
mother which makes her nervous and demotivating.
DURATION OF KMC:
 The duration of KMC should not be less than one hour to avoid frequent
handling which may be stressful to the baby
 Gradually the length of KMC sessions should be increased upto 24 hours a day.
Interruption only can be done for changing of diapers.
 KMC should be continued in postnatal ward and home.
 It may not be possible for mothers to provide KMC for prolonged periods in
the beginning. Encourage her to increase the duration each time to provide
KMC as long as possible.
 When mother is not available then other family members such as father,
grandmother, aunty can provide KMC.
KMC DURING SLEEP AND RESTING:
 Mother can sleep with baby in KMC position in a reclined or semi-recumbent position
about 15 to 30 degrees above the ground.
 A comfortable chair with adjustable back may be useful to provide KMC during sleep
and rest at ward or home.
 Adjustable bed or several pillows or an ordinary bed can be used to maintain the
position, which usually decreases the risk of apnea of the baby.
 Supporting garments can be used to carry the baby in kangaroo position during sleep
and rest.
 Father and family members can provide KMC to relieve mother during rest.
DISCONTINUATION OF KMC:
 KMC can be continued until the baby gains weight around 2500gms or reaches 40
weeks of post conception.
 KMC can be discontinued if the baby starts to show discomfort or pulls limbs out,
cries and fusses every time, when mother tries to pull the baby back into skin contact.
 When mother and baby are comfortable, KMC can be continued as long as possible at
health facility or at home.
 Mother can provide skin to skin contact occasionally after and during cold nights.
DISCHARGE CRITERIA:
The baby should be transferred from neonatal care unit to the postnatal ward, when the baby
is stable and gaining weight and the mother is confident to look after the baby. The baby
should be discharged from the hospital when the baby is having the following conditions:
 General health is good and there is no evidence of infection and apnea
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  Feeding well exclusively with breast milk
 Gaining weight 20g/kg/day for at least three consecutive days
 Maintaining normal body temperature.
 Mother and family members are confident to take care of the baby at home and would
be able to come regularly for follow up visits
 Home environment should be suitable and congenital for continuation of KMC.
POST DISCHARGE FOLLOW-UP:
Each neonatal care unit should formulate its own policy for follow up
 In general, a baby is followed up once or twice a week till 37 to 40 weeks of gestation
or till the baby reaches 2.5 to 3 kg of weight
 Thereafter a follow up once in 2 to 4 weeks may be sufficient till 3 months of post
conventional age. After that 1 to 2 months during first year of life. The baby should
gain adequate weight 15 – 20g/kg/day upto 40 weeks of postconceptional age and
10g/kg/day subsequently.
 More frequent visits should be made, if the baby is not growing well or the condition
demands.

REFERENCE:
1. Dutta Parul, Paediatric Nursing, 4rd edition, Jaypee Publications, New Delhi.
2. WHO: Kangaroo Mother Care- A practical guide, 2003, Publications of the World
Health Organization
3. https://en.wikipedia.org/wiki/kangaroo_care