Kangaroo Mother

Care

Kangaroo Mother Care (KMC) is a special way of caring of low birth weight
babies. It fosters their health and well being by promoting effective
thermal control, breastfeeding, infection prevention and bonding.

In KMC, the baby is continuously kept in skin-to-skin contact by the

mother and breastfed exclusively to the utmost extent, KMC is initiated in
the hospital and continued at home.

Components of Kangaroo Mother Care

The two components of KMC are:
i. Skin-to-skin contact
Early, continuous and prolonged skin-to-skin contact between the
mother and her baby is the basic component of KMC. The infant is
placed on her mother's chest between the breasts.
ii. Exclusive breastfeeding
The baby on KMC is breastfed exclusively. Skin-to-skin contact
promotes lactation and facilitates the feeding interaction.

Pre-requisites of KMC
The two pre-requisites of KMC are:
i. Support to the mother in hospital and at home A mother cannot
successfully provide KMC all alone. She would require counseling
along with supervision from care-providers, and assistance and
cooperation from her family members. Skin to skin contact of the
infant on the mother’s chest
ii. Post-discharge follow up KMC is continued at home after early

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 discharge from the hospital. A regular follow up and access to health

providers for solving problem are crucial to ensure safe and

successful KMC at home.

Benefits of
KMC Breastfeeding: Studies have revealed that KMC results in increased
breastfeeding rates as well as increased duration of breastfeeding. Even
when initiated late and for a limited time during day and night, KMC has
been shown to exert a beneficial effect on breastfeeding.

Thermal control: Prolonged skin-to-skin contact between the mother and

her preterm/ LBW infant provides effective thermal control with a reduced
risk of hypothermia. For stable babies, KMC is at least equivalent to
conventional care with incubators in terms of safety and thermal
protection.
Early discharge: Studies have shown that KMC cared LBW infants could be
discharged from the hospital earlier than the conventionally managed
babies. The babies gained more weight on KMC than on conventional care.

Less morbidity: Babies receiving KMC have more regular breathing and
less predisposition to apnea. KMC protects against nosocomial infections.
Even after discharge from the hospital, the morbidity amongst babies
managed by KMC is less. KMC is associated with reduced incidence of
severe illness including pneumonia during infancy.
Other effects: KMC helps both infants and parents. Mothers are less
stressed during kangaroo care as compared with a baby kept in incubator.
Mothers prefer skin-to-skin contact to conventional care. They report a
stronger bonding with the baby, increased confidence, and a deep
satisfaction that they were able to do something special for their babies.
Fathers felt more relaxed, comfortable and better bonded while providing
kangaroo care.

Requirements for KMC implementation

• Training of nurses, physicians and other staff involved in the care of
the mother and the baby.
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 • Educational material such as information sheets, posters, video films on
KMC in local language should be available to the mothers, families and
community.
• If possible, reclining chairs in the nursery and postnatal wards, and beds
with adjustable back rest should be arranged. Mother can provide KMC
sitting on an ordinary chair or in a semi-reclining posture on a bed
with the help of pillows.
.

Eligibility criteria
Baby
All stable LBW babies are eligible for KMC. However, very sick babies
needing special care should be cared under radiant warmer initially. KMC
should be started after the baby is hemo -dynamically stable. Guidelines
for practicing KMC include:
I. Birth weight >1800 g :These babies are generally stable at birth.
Therefore, in most of them KMC can be initiated soon after birth.
II. Birth weight 1200-1799 g : Many babies of this group have significant
problems in neonatal period. It might take a few days before KMC can
be initiated. If such a baby is born in a place where neonatal care
services are inadequate, he should be transferred to a proper facility
immediately after birth, along with the mother/ family member. He
should be transferred to a refferal hospital after initial stabilization
and appropriate management, One of the best ways of transporting
small babies is by keeping them in continuous skin-to-skin contact
with the mother / family member during transport.
III. Birth weight <1200 g :Frequently, these babies develop serious
prematurity-related morbidity often starting soon after birth. They
benefit the most from in-utero transfer to the institutions with
neonatal intensive care facilities. It may take days to weeks before
baby's condition allows initiation of KMC.

Mother
All mothers can provide KMC, irrespective of age, parity, education, culture
and religion. The following points must be taken into consideration when

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 counseling on KMC:
i. Willingness: The mother must be willing to provide KMC. Healthcare
providers should counsel and motivate her. Once the mother realises
the benefits of KMC for her baby, she will learn and undertake KMC.
ii. General health and nutrition: The mother should be free from
serious illness to be able to provide KMC. She should receive
adequate diet and supplements recommended by her physician.
iii. Hygiene: The mother should maintain good hygiene: daily
bath/sponge, change of clothes, hand washing, short and clean finger
nails.
iv. Supportive family: Apart from supporting the mother, family
members should also be encouraged to provide KMC when mother
wishes to take rest. Mother would need family's cooperation to deal
with her conventional responsibilities of household chores till the baby
requires KMC.
v. Supportive community: Community awareness about the benefits
should be created. This is particularly important when there are
social, economic or family constraints.

Preparing for KMC

When baby is ready for KMC, arrange a time that is convenient to the
mother and her baby. The first few sessions are important and require
extended interaction. Demonstrate to her the KMC procedure in a caring,
gentle manner and with patience. Answer her queries and allay her
anxieties. Encourage her to bring her mother/mother in law, husband or
any other member of the family. It helps in building positive attitude of the
family and ensuring family support to the mother which is particularly
crucial for post-discharge home-based KMC. It is helpful that the mother
starting KMC, interacts with someone already practicing KMC for her baby.
Mother's clothing
KMC can be provided using any front-open, light dress as per the local
culture. KMC works well with blouse and sari, gown or shawl. A suitable
apparel that can retain the baby for extended period of time can be
adapted locally.
 Baby's clothing
Baby is dressed with cap, socks, nappy, and front-open sleeveless

shirt or 'jhabala'.

The KMC procedure

Kangaroo positioning
• The baby should be placed between the mother's breasts in an
upright position.
• The head should be turned to one side and in a slightly extended
position. This slightly extended head position keeps the airway open
and allows eye to eye contact between the mother and her baby.
• The hips should be flexed and abducted in a "frog" position; the arms
should also be flexed.
• Baby's abdomen should be at the level of the mother's epigastrium.
Mother's breathing stimulates the baby, thus reducing the occurrence
of apnea.
• Support the baby’s bottom with a sling/binder.

Monitoring
 Feeding
The mother should be explained how to breastfeed while the baby is in
KMC position. Holding the baby near the breast stimulates milk production.
Babies
She may express milk while the baby is still in KMC position. The baby
receiving
could be fed with paladai, spoon or tube, depending on the condition of
KMC should
the baby.
be monitored
carefully
especially
during the
initial stages.
Nursing staff
should make
sure that
baby’s neck
position is
neither too
flexed nor too
extended,
airway is
clear,
breathing is
regular, color
is pink and
baby is
maintaining
temperature.
Mother
should be
involved in
observing the
baby during
KMC so that
she herself
can continue
monitoring at
home.
 Privacy
KMC unavoidably requires some exposure on the part of the mother. This
can make her nervous and could be de-motivating. The staff must respect
mother's sensitivities in this regard and ensure culturally-acceptable
privacy standards in the nursery and the wards where KMC is practiced.

Time of initiation
KMC can be started as soon as the baby is stable. Babies with severe
illnesses or requiring special treatment should be managed according to
the unit protocol. Short KMC sessions can be initiated during recovery with
ongoing medical treatment (IV fluids, oxygen therapy). KMC can be
provided while the baby is being fed via orogastric tube or on oxygen
therapy.

Duration of KMC

• Skin-to-skin contact should start gradually in the nursery, with a

smooth transition from conventional care to continuous KMC.
• Sessions that last less than one hour should be avoided because
frequent handling may be stressful for the baby.
• The length of skin-to-skin contacts should be gradually increased up
to 24 hours a day, interrupted only for changing diapers.
• When the baby does not require intensive care, she should be
transferred to the post-natal ward where KMC should be continued.
.

Can the mother continue KMC during sleep and resting?

A comfortable chair with adjustable back may be useful to provide KMC
during sleep and rest. In the KMC ward or at home, the mother can sleep
with the baby in kangaroo position in a reclined or semi-recumbent
position, about 15 -30o degrees from above the ground. This can be
 achieved with an adjustable bed, if available, or with several pillows on an
ordinary bed. It has been observed that this position may decrease the risk
of apnea in a baby. A supporting garment to carry the baby in kangaroo
position will allow the mother or the father or the relatives to sleep even
with the baby in the kangaroo position. When the mother and the baby are
well adapted to KMC they can be discharged from the hospital.

From hospital to home

Criteria to transfer the baby from nursery to the ward
Standard criteria of the unit for transferring baby from the nursery to the
post-natal ward should be as follows :
• Stable baby
• Gaining weight
• Mother confident to look after the baby

Discharge criteria
The standard policy of the unit for discharge from the hospital should be
followed. Generally the following criteria is accepted at most centres:
• Baby's general health is good and no evidence of infection
• Feeding well, and receiving exclusively or predominantly breast milk.
• Gaining weight (at least 15-20 gm/kg/day for at least three
consecutive days)
• Maintaining body temperature satisfactorily for at least three
consecutive days in room temperature.
• The mother and family members are confident to take care of the
baby in KMC and should be asked to come for follow-up visits
regularly.
.

When should KMC be discontinued ?

When the mother and baby are comfortable, KMC is continued for as long
as possible, at the institution & then at home. Often this is desirable until
 the baby's gestation reaches term or the weight is around 2500 g. She
starts wriggling to show that she is uncomfortable, pulls her limbs out,
cries and fusses every time the mother tries to put her back skin to skin.
This is the time to wean the baby from KMC. Mothers can provide skin to
skin contact occasionally after giving the baby a bath and during cold
nights.

Post-discharge follow up
Close follow up is a fundamental pre-requisite of KMC practice. Although
each unit should formulate its own policy of follow up.
In general, a baby is followed once or twice a week till 37-40 weeks of
gestation or till the bay reaches 2.5-3 kg of weight. (Smaller the baby at
discharge, the earlier and more frequent follow-up visits should be).
Thereafter, a follow up once in 2-4 weeks may be enough till 3 months of
post-conceptional age. Later the baby should be seen at an interval of 1-2
months during first year of life.
The baby should gain adequate weight (15-20 gm/kg/day up to 40 weeks
of post-conceptional age and 10 gm/kg/ day subsequently). More frequent
visits should be made if the baby is not growing well or his condition
demands.