Skin-to-skin and kangaroo mother care

What is kangaroo mother care?

Skin-to-skin care means keeping a baby chest-to-chest and skin-to-skin with the mother or other care-giver. Kangaroo mother care is a broader term that includes early, prolonged skin-to-skin contact between mother and baby, exclusive breastfeeding or breast milk feeding, and a continuation of these practices at home after early discharge from hospital and with adequate support and follow-up. Premature babies who receive skin-to-skin care and other aspects of kangaroo mother care show benefits including fewer infections, better breathing rates, and less stress. They sleep better, grow better, and get out of hospital earlier. Some studies show long-term benefits including better school attendance and less aggression and hyperactivity.

A) What are skin-to-skin and kangaroo mother care?

A premature baby in skin-to-skin care with his mother. (Courtesy Dr. Angela Berg, Edmonton, Alberta.)

Here are some terms used to describe keeping mothers and babies together (Chan 2016):

  • Skin-to-skin care: Keeping the baby chest-to-chest and skin-to-skin with the mother or another caregiver
  • Kangaroo care: Extended periods of being skin-to-skin
  • Kangaroo mother care (KMC) (WHO 2003)
    • Early, continuous, and prolonged skin-to-skin contact between the mother and her premature baby
    • Exclusive breastfeeding or breast milk feeding
    • Early discharge after hospital-initiated KMC, which is continued at home
    • Adequate support and follow-up for mothers at home

The benefits for keeping premature babies in skin-to-skin care compared to keeping babies in incubators were first reported by doctors in Colombia in the 1970s (Charpak 2017). The concept of keeping mothers and babies together and supported expanded into kangaroo mother care.

Kangaroo care is at the core of KMC. Other aspects vary widely, depending on the hospital and local practices (Chan 2016). The definitions and application of skin-to-skin care, kangaroo care, and KMC also vary widely among researchers.

Neonatal intensive care units in high income countries frequently offer intermittent skin-to-skin care, a variant of kangaroo care that (Baley 2015):

  • Is used for varying, shorter periods.
  • Can be offered to less stable and technology-supported infants.
  • Can be performed by both parents.

B) Short-term benefits of skin-to-skin and KMC

Premature babies who receive skin-to-skin care and other aspects of KMC  are healthier with (Boundy 2016; Conde-Agudelo 2016; Pados 2019; WHO 2021):

  • Fewer infections (blood, pneumonia).
  • A lower risk of developing necrotizing enterocolitis.
  • Better breathing rates and blood oxygen levels.
  • Better heart function.
  • Less lung disease (bronchopulmonary dysplasia).
  • A lower chance of dying.

Excess stress is harmful to babies. Babies who receive skin-to-skin care and other aspects of KMC have been shown to have lower levels of stress hormones (Vittner 2018). They experience less stress as they (Bastani 2017; Shukla 2018; Smith 2018; Spittle 2016):

  • Are less likely to be cold.
  • Feel less pain during medical procedures.
  • Sleep better.
  • Get out of hospital faster.
  • Are better protected from noise.
  • Can hear their mother’s voice.

Babies who receive skin-to-skin care and other aspects of KMC have better short-term development with (Evereklian 2017; Korraa 2014):

  • Faster, better head and body growth.
  • More blood flow to the brain.
  • Improved neural development.
  • Faster weight gain.
  • Less need to return to hospital for further care.

Premature babies benefit markedly from breastfeeding. Skin-to-skin care and other aspects of KMC result in have better breastfeeding outcomes with (Chapman 2020; Ghojazadeh 2018; Jayaraman 2017; Mekonnen 2019; Renfrew 2009):

  • Earlier breastfeeding starts.
  • Increased breastfeeding rates when they leave hospital.
  • Longer periods of breastfeeding.

For mothers and fathers, skin-to-skin care for premature or sick babies is associated with (Baley 2015; Vittner 2018):

  • Improved bonding
  • Reduced feelings of helplessness
  • Less anxiety and stress

C) Long-term benefits of skin-to-skin care and KMC

Premature babies may experience many harmful stressors that can have long-term effects on brain development. Anxiety, cold, and separation from their mother and other caregivers while being in a very busy hospital setting are all sources of such stressors. 

Keeping babies skin-to-skin puts them in a familiar environment and limits harmful stress. Babies born as young as 32 weeks from conception are able to detect the smell of their mother’s breast (Frie 2019).

Premature babies often require painful and stressful medical procedures. The younger and sicker the baby, the more procedures. Minimizing pain through breastfeeding and skin-to-skin care benefits the baby’s long-term brain development (Doesburg 2013).

In one study, 10-year-old children who had received skin-to-skin care as babies had less response to stress and better sleep patterns and their mothers were more attuned to their children (Feldman 2014).

A study (Charpak 2017) of 20-year-olds showed that the ones who had had KMC missed less school, were less hyperactive and aggressive, and had larger brains (total gray matter, cerebral cortex, and left caudate nucleus).

D) Applying skin-to-skin care

Premature baby receiving skin-to-skin care. (Courtesy Dr. Angela Berg, Edmonton, Alberta.)

Ideally, when not breastfeeding, premature babies are kept skin-to-skin with their mother. The baby lies on the mother’s chest or is held there with a soft cloth wrapped around the baby and mother.  

Both parents of babies in neonatal intensive care units should be encouraged to provide skin-to-skin care with appropriate help (Baley 2015). It has been shown to be safe for babies as young as 26 weeks of gestation (Bier 1996).

Skin-to-skin care should not be delayed just because a baby needs a machine to help with breathing. Premature babies who get skin-to-skin care within four days of birth instead of waiting until they are off a breathing machine tend to have better breastfeeding rates and are less likely to stop breathing temporarily (apnea) once off the machine (Jayaraman 2017).

For premature or sick babies in neonatal intensive care units, skin-to-skin care is often intermittent. Moving babies in and out of skin-to-skin care can be disruptive and the number of these episodes should be minimized. One study (El-Farrash 2019) showed that there were many benefits for babies when they were kept in skin-to-skin care for two hours when compared to one hour.

E) Risks of skin-to-skin care

The risks of skin-to-skin care are few and rarely outweigh the benefits. The risks include:

  • The spread of infection (viruses, tuberculosis) between mothers, babies, and caregivers.
  • An increased risk of infection if the baby has open wounds.
  • A risk of blocking the baby’s airway or of moving life-support devices and other medical equipment.

F) Family-centered care

Another variant of caring for babies is family-centred care (PHAC 2018). In this system, health-care providers educate parents on looking after the baby and being the main caregivers. The families become more confident and calmer.

Babies (Hei 2020; O’Brian 2018; Ramezani 2014):

  • Have more breastfeeding success.
  • Spend less time in hospital.
  • Have fewer infections.
  • Require fewer antibiotics.
  • Are less likely to be re-hospitalized.
  • Require oxygen for shorter periods.
  • Gain weight faster.
  • Incur fewer health-care costs.


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