Kangaroo Mother Care Introduction and Components

Author: E v Rooyen, University of Pretoria, South Africa1

Kangaroo Mother CareKangaroo Mother CareIntroduction and ComponentsIntroduction and Components

Author: E v Rooyen, University of Pretoria, South Africa 2

What is Kangaroo Mother Care?What is Kangaroo Mother Care?

Kangaroo Mother Care (KMC) is care of newborn infants Kangaroo Mother Care (KMC) is care of newborn infants secured skin-to-skin to the mothersecured skin-to-skin to the mother

KMC is a powerful and easy to use method to promote KMC is a powerful and easy to use method to promote the health and well-being ofthe health and well-being of Low birth weight (LBW) Low birth weight (LBW) - infants with birth weight below - infants with birth weight below

2500g2500g Preterm infants – infants with gestational age less than 37 Preterm infants – infants with gestational age less than 37

weeksweeks Also term infantsAlso term infants

WHO KMC practical guideWHO KMC practical guide

PEP unit 43 Principles of KMCPEP unit 43 Principles of KMC


Reasons Why KMC was Reasons Why KMC was ImplementedImplemented

In In 19791979 Dr Dr Edgar Rey Edgar Rey && Hector Martinez Hector Martinez worked in worked in BogotáBogotá, Colombia, Colombia

Circumstances at the hospital where they workedCircumstances at the hospital where they worked Large numbers of LBW & preterm infants delivered Large numbers of LBW & preterm infants delivered

because of: because of: Poor Ante Natal Care attendancePoor Ante Natal Care attendance High incidence of toxaemia of pregnancy, anaemia & High incidence of toxaemia of pregnancy, anaemia &

infectionsinfections SShortages of staffhortages of staff & inadequate & inadequate equipmentequipment High High infection infection && mortality rate mortality rate because of overcrowding because of overcrowding LLarge numberarge numberss of infants of infants who were abandoned by their who were abandoned by their

mothersmothers Whitelaw A and Sleath K, 1985Whitelaw A and Sleath K, 1985


KMC Practice in ColombiaKMC Practice in Colombia

MMaternal-infant skin-to-skin contactaternal-infant skin-to-skin contact was introducedwas introduced to to stable LBW infants surviving the first few weeks of lifestable LBW infants surviving the first few weeks of life

EExclusive breast-feedingxclusive breast-feeding was encouraged was encouraged AAs long as s long as infantsinfants could feed and were gaining weight, could feed and were gaining weight,

they were discharged, regardless of weightthey were discharged, regardless of weight This practice resulted in:This practice resulted in:

ImprovedImproved outcome outcome for for LBW infants LBW infants HHumanizeumanizedd general care general care of infants in hospitalof infants in hospital DecreasedDecreased hospitalisation hospitalisation timetime LessLess overcrowding overcrowding Less abandoned infantsLess abandoned infants Improved staff moralImproved staff moral Whitelaw A and Sleath K, 1985Whitelaw A and Sleath K, 1985


KMC KMC in the in the Rest of the WorldRest of the World

FirstFirst reported by reported by UNICEF, 1984UNICEF, 1984 IIntriguing ntriguing && incredible survival of “kangaroo babies” incredible survival of “kangaroo babies”

unparalleled in medical literature unparalleled in medical literature

WhitelawWhitelaw (UK) (UK) visited Bogotá in 1985 visited Bogotá in 1985 11stst description of description of KMC in English medical literature KMC in English medical literature Continued Continued KMC researchKMC research - - found manfound manyy benefits benefits

Other visits to Bogotá Other visits to Bogotá followedfollowed VVarious forms of KMC practiced in many parts of the arious forms of KMC practiced in many parts of the

worldworld Supported by WHO and many organizations as a life Supported by WHO and many organizations as a life

saving method of caresaving method of care


Why is it called Kangaroo Mother Why is it called Kangaroo Mother Care?Care?

A newborn baby kangaroo (joey) is A newborn baby kangaroo (joey) is very immature at birth and very small very immature at birth and very small in sizein size

The mother kangaroo’s pouch The mother kangaroo’s pouch provides warmth, safety and a provides warmth, safety and a constant supply of food (milk) to the constant supply of food (milk) to the joeyjoey

Similar to kangaroo care giving the Similar to kangaroo care giving the human infant is also immature and human infant is also immature and especially the LBW infant benefits especially the LBW infant benefits from skin-to-skin care because it from skin-to-skin care because it provides warmth, safety and foodprovides warmth, safety and food

Whitelaw 1985, Malawi KMC Training ManualWhitelaw 1985, Malawi KMC Training Manual


The Components/Elements of The Components/Elements of KMCKMC

Kangaroo positionKangaroo position Skin-to-skin on the mother’s chestSkin-to-skin on the mother’s chest Secured with a wrapSecured with a wrap

Kangaroo nutritionKangaroo nutrition Exclusive breastfeeding whenever possibleExclusive breastfeeding whenever possible

Kangaroo dischargeKangaroo discharge Mother continues KMC practice at home after dischargeMother continues KMC practice at home after discharge

Kangaroo SupportKangaroo Support Health care staff provide support to the mother to take Health care staff provide support to the mother to take

care of her infant in the hospitalcare of her infant in the hospital Family support of mother in practicing KMC at homeFamily support of mother in practicing KMC at home



KMC PositionKMC Position

Place the baby between the mother’s Place the baby between the mother’s breasts in an upright positionbreasts in an upright position

Turn the head to the side, in a slightly Turn the head to the side, in a slightly extended positionextended position This is to keep the airway open This is to keep the airway open It also allows eye-to-eye contact between It also allows eye-to-eye contact between

mother and babymother and baby Avoid forward flexion & hyperextension of the neckAvoid forward flexion & hyperextension of the neck

Infant should be in a flexed position - legs & armsInfant should be in a flexed position - legs & arms Secure baby with a binder / wrapSecure baby with a binder / wrap

The top of the binder should be at the baby’s earThe top of the binder should be at the baby’s earWHO KMC practical guideWHO KMC practical guide


Skin-to-skin on mother’s chestSkin-to-skin on mother’s chest

Kangaroo PositionKangaroo Position


Securing Infant in KMC PositionSecuring Infant in KMC Position

Tie the binder firmly enough so that the baby will not Tie the binder firmly enough so that the baby will not slide outslide out

Make sure that the tight part of the cloth is across the Make sure that the tight part of the cloth is across the baby’s chest baby’s chest

The baby’s abdomen should not be constricted The baby’s abdomen should not be constricted Baby should have enough room for abdominal Baby should have enough room for abdominal

breathingbreathing Examples of different binders :Examples of different binders :

WHO KMC practical guideWHO KMC practical guide


Kangaroo NutritionKangaroo Nutrition

Exclusive breastfeedingExclusive breastfeeding

Initially tube or cup feeding Initially tube or cup feeding before breastfeeding is before breastfeeding is establishedestablished


Kangaroo DischargeKangaroo Discharge

The mother continues to practice KMC after the infant is The mother continues to practice KMC after the infant is discharged homedischarged home

Once the baby is feeding well, maintaining stable body Once the baby is feeding well, maintaining stable body temperature in KMC position and gaining weight, mother and temperature in KMC position and gaining weight, mother and baby can go homebaby can go home

WHO KMC WHO KMC

practical guidepractical guide

PEP unit 43 PEP unit 43

Principles of KMCPrinciples of KMC


Kangaroo SupportKangaroo Support

Health care staff support in hospital Health care staff support in hospital Emotional support – The mother Emotional support – The mother

needs encouragement if she is to needs encouragement if she is to give KMCgive KMC

Teaching mothers the skill to take Teaching mothers the skill to take care of their LBW infantscare of their LBW infants

After discharge infants need regular After discharge infants need regular follow-up to check satisfactory follow-up to check satisfactory weight gain at clinics close to home weight gain at clinics close to home

Support from the family at home to Support from the family at home to help mother take care of her infant help mother take care of her infant and practice KMC at homeand practice KMC at home

WHO KMC practical guideWHO KMC practical guidePEP unit 43 Principles of KMCPEP unit 43 Principles of KMC


Kangaroo Position

Kangaroo Nutrition

Kangaroo Discharge

Diagram of KMC ComponentsDiagram of KMC Components

KMC workbook AP BerghKMC workbook AP Bergh


Benefits of KMCBenefits of KMC

To the babyTo the baby

To the motherTo the mother

To the hospitalTo the hospital


KMC: KMC: Benefits to the BabyBenefits to the Baby

Improved Improved ccardiac ardiac and respiratory sand respiratory stabilitytability Fewer episodes of desaturationFewer episodes of desaturation & apnoeia & apnoeia Ludington, BergmanLudington, Bergman

KMC can successfully treat mild respiratory distress KMC can successfully treat mild respiratory distress LudingtonLudington,,Hoe & SHoe & Swinthwinth 1996 1996

Improved gastrointestinal functionImproved gastrointestinal function Higher initiation & duration of breastfeedingHigher initiation & duration of breastfeeding energy expenditureenergy expenditure & s & satisfactory weight gainatisfactory weight gain

WHO KMC practical guide, WHO KMC practical guide, PEP unit 43 Principles of KMCPEP unit 43 Principles of KMC

Protection against infectionsProtection against infections Decrease Decrease in in infections in poorly equipped unitsinfections in poorly equipped units but but

nowhere an nowhere an increaseincrease in infections in infections Sloan et al 1994, Kambarami et al 1998, Charpak N et al 1994, Cattaneo A et al 1998Sloan et al 1994, Kambarami et al 1998, Charpak N et al 1994, Cattaneo A et al 1998


KMC: KMC: Benefits to the BabyBenefits to the Baby

Effective thermal control Effective thermal control BBaby’s temperature aby’s temperature is maintained is maintained within a narrow within a narrow

temperature rangetemperature range A A thermal synchronythermal synchrony develop developss between between mother &mother & baby baby

WHO KMC practical guide, WHO KMC practical guide, PEP unit 43 Principles of KMCPEP unit 43 Principles of KMC

Infants are much less stressed and this provides Infants are much less stressed and this provides neurological protection to the infant and the result is:neurological protection to the infant and the result is: Improved neurodevelopmentImproved neurodevelopment Better organised sleep patternsBetter organised sleep patterns More mature and organised electrical brain activityMore mature and organised electrical brain activity

Ludington S, et al 2006Ludington S, et al 2006


Benefits to the MotherBenefits to the Mother

The mother\s confidence in caring for her infant is The mother\s confidence in caring for her infant is boostedboosted

Improved bonding between mother and infant due Improved bonding between mother and infant due to the physical closeness between themto the physical closeness between them

Mothers are empowered to play an active role in Mothers are empowered to play an active role in their infants caretheir infants care

Mothers are enabled to become the primary care Mothers are enabled to become the primary care giver of their infantsgiver of their infants

Breast feeding is promotedBreast feeding is promotedAffonso D, et al 1989, PEP unit 43 Principles of KMCAffonso D, et al 1989, PEP unit 43 Principles of KMC


Benefits to the HospitalBenefits to the Hospital

Significant cost-savingsSignificant cost-savings as well as well as better outcomesas better outcomes

Less dependence on incubatorsLess dependence on incubators

LessLess nursing staff nursing staff necessarynecessary

Shorter hospital stayShorter hospital stay

Improved morale & quality of Improved morale & quality of carecare

Better survivalBetter survivalPEP unit 43 Principles of KMCPEP unit 43 Principles of KMC


Types of KMC: IntermittentTypes of KMC: Intermittent

Intermittent KMC is practiced with infantsIntermittent KMC is practiced with infants Where incubators or warm rooms are availableWhere incubators or warm rooms are available Who are very small and still need incubator careWho are very small and still need incubator care Who are not on full oral feeds Who are not on full oral feeds Who are receiving oxygen therapyWho are receiving oxygen therapy

Intermittent KMC can range from many times per day to Intermittent KMC can range from many times per day to only once every few daysonly once every few days The time period can vary from minutes to hours at a timeThe time period can vary from minutes to hours at a time

The duration of intermittent KMC depends on the The duration of intermittent KMC depends on the condition of the infant and the availability of the mothercondition of the infant and the availability of the mother

It encourages the mother to take part in care of her It encourages the mother to take part in care of her infant while still in the nurseryinfant while still in the nursery



Types of KMC: ContinuousTypes of KMC: Continuous

It is KMC that is given continually, both day & nightIt is KMC that is given continually, both day & night KMC may discontinue for KMC may discontinue for very short periodsvery short periods when the when the

mother has to bathe or attend to other personal needsmother has to bathe or attend to other personal needs

It can be practiced in hospital or when doing KMC It can be practiced in hospital or when doing KMC at homeat home It should always be used where there are no incubatorsIt should always be used where there are no incubators

It requires support from the family members, It requires support from the family members, including the husbandincluding the husband

It is the ideal type of KMC for LBW infantsIt is the ideal type of KMC for LBW infants



1998 Bogotá Declaration1998 Bogotá Declaration

Kangaroo Mother Care is a basic right

of the newborn and should be an

integral part of the management of

low birth weight and full term infants

in all settings at all

levels of care and in all communities


ReferencesReferences

Affonso D, Wahlberg V, Persson B. Exploration of mother’s reactions to the Affonso D, Wahlberg V, Persson B. Exploration of mother’s reactions to the kangaroo method of prematurity care. Neonatal Network 1989; 7:43-51.kangaroo method of prematurity care. Neonatal Network 1989; 7:43-51.

Bergh A-M. Implementation workbook for kangaroo mother care. Pretoria: MRC Bergh A-M. Implementation workbook for kangaroo mother care. Pretoria: MRC Research Unit for Maternal and Infant Health Care Strategies; 2002.Research Unit for Maternal and Infant Health Care Strategies; 2002.

Cattaneo A, Davanzo R, Worku B, Surjono A, Echeverria M, Bedri A et al. Cattaneo A, Davanzo R, Worku B, Surjono A, Echeverria M, Bedri A et al. Kangaroo mother care for low birthweight infants: a randomized controlled trial in Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings. different settings. Acta PaediatricaActa Paediatrica 1998; 87(9):976-985. 1998; 87(9):976-985.

Charpak N, Ruiz-Pelaez JG, Charpak Y. Rey-Martinez Kangaroo Mother Program: Charpak N, Ruiz-Pelaez JG, Charpak Y. Rey-Martinez Kangaroo Mother Program: an alternative way of caring for low birth weight infants? One year mortality in a an alternative way of caring for low birth weight infants? One year mortality in a two cohort study. two cohort study. Pediatrics Pediatrics 1994; 94(6 Pt 1):804-8101994; 94(6 Pt 1):804-810

Kambarami RA, Mutambirwa J, Maramba PP. Caregivers' perceptions and Kambarami RA, Mutambirwa J, Maramba PP. Caregivers' perceptions and experiences of 'kangaroo care' in a developing country. Tropical Doctor 2002; experiences of 'kangaroo care' in a developing country. Tropical Doctor 2002; 32(3):131-133.32(3):131-133.

Ludington-Hoe S and Swinth JY. Developmental Aspects of Kangaroo Care. Ludington-Hoe S and Swinth JY. Developmental Aspects of Kangaroo Care. Journal of Obstetrical Gynaecological & Neonatal Nursing 1996; 25(8):691-703.Journal of Obstetrical Gynaecological & Neonatal Nursing 1996; 25(8):691-703.


References continueReferences continue

Ludington-Hoe SM, Johnson MW, Morgan K, Lewis T, Gutman J, Wilson D, Scher Ludington-Hoe SM, Johnson MW, Morgan K, Lewis T, Gutman J, Wilson D, Scher MS. Neurophysiologic assessment of neonatal sleep organization: Preliminary MS. Neurophysiologic assessment of neonatal sleep organization: Preliminary results of a randomized controlled trial of skin contact with preterm infants. results of a randomized controlled trial of skin contact with preterm infants. Pediatrics Pediatrics 2006;117(5) e909-e923. 2006;117(5) e909-e923.

Saving Newborn Lives Malawi.Saving Newborn Lives Malawi. Kangaroo mother care training manual Kangaroo mother care training manual (Final (Final editing: Dr. Betty Mkwinda-Nyasulu)editing: Dr. Betty Mkwinda-Nyasulu).. Lilongwe: Saving Newborn Lives Malawi; Lilongwe: Saving Newborn Lives Malawi; March 2005March 2005

Sloan NL, Leon Camacho LW, Pinto Rojas E, Stern C, and Maternidad Isidro Sloan NL, Leon Camacho LW, Pinto Rojas E, Stern C, and Maternidad Isidro Ayora Study Team. Kangaroo mother method: randomised controlled trial of an Ayora Study Team. Kangaroo mother method: randomised controlled trial of an alternative method of care for stabilised low-birthweight infants. Lancet alternative method of care for stabilised low-birthweight infants. Lancet 1994;344:782-5. 1994;344:782-5.

Woods DL, Principles of Kangaroo Mother Care unit 43 in Woods DL (ed) Mother Woods DL, Principles of Kangaroo Mother Care unit 43 in Woods DL (ed) Mother and baby friendly care, Cape Town: Perinatal education programme 2005and baby friendly care, Cape Town: Perinatal education programme 2005


References continueReferences continue

Whitelaw A and Sleath K. Myth of the marsupial mother: Home care of very low Whitelaw A and Sleath K. Myth of the marsupial mother: Home care of very low birthweight babies in Bogota, Colombia. The Lancet , 1985; 1:1206-1208birthweight babies in Bogota, Colombia. The Lancet , 1985; 1:1206-1208

World Health OrganizationWorld Health Organization. Kangaroo mother care: a practical guide. . Kangaroo mother care: a practical guide. Geneva: Geneva: World Health Organization, Department of Reproductive Health and Research; World Health Organization, Department of Reproductive Health and Research; 20032003

Kangaroo Mother Care Introduction and Components

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