Basics of Kangaroo Care

Basics of kangaroo care/skin to skin contact

First family photo in Wisconsin.  Photo used with permission and provided by Betsy R. 


Kangaroo Care, Skin-To-Skin Contact, and Kangaroo Mother Care are terms that relate to the holding of a diaper clad infant bare-chest to bare-chest, ventral-surface to ventral-surface by the mother, father, or others. (Source: USIKC).


This method was invented in Bogota, Colombia, and consists of skin to skin contact between the adult and baby, from the time of birth (from the delivery room or intensive, intermediate or basic care,) the food based on breastfeeding, and the early discharge from the hospital.

It is well known that while the attention of high–tech medical care is essential, babies have to endure the stress conditions from which they were supposed to be protected by the womb: noise, light, painful procedures and sleep and wakefulness cycles. All these noxious stimuli affect the development of the neurological system, which is still immature, unable to adequately respond to all this and become attacks that can leave short, medium and long term consequences.


Parents need to be present with their baby as soon as they can to provide an effective, more kinder and gentler environment in Kangaroo Care. They should hold as long as they can, no less than one hour which is the length of one full sleep cycle.


Many sessions a day if necessary and with minimal interruptions, as recommended by The American Academy of Pediatrics, The Academy of Breast Feeding Medicine, UNICEF, the World Health Organization, the Neonatal Resuscitation Program, and the United States Institute of Kangaroo Care.

“Best Practice is Kangaroo Care as soon as possible, for as long as possible, and as uninterrupted as possible” 
(Nyqvist et al., 2010, May Acta Paediatrica)

Parent/adult: sitting up or reclined (never horizontal, side lying, or prone).

Infant: Infant is placed between the parent’s bare breast, strictly vertical and in a prone position, with legs and arms flexed, head in midline and lateral position to allow maximum skin-to-skin exposure. The top of the baby’s head is placed a couple of inches lower than the mother’s neck.  Make sure the baby’s face is uncovered and the nose and mouth unobstructed.

Baby only wears diaper (no higher than the belly button) and a hat. Socks may be worn if the room is cold.

Birth Kangaroo Care Position:

During the first hour of life of a healthy or stable baby, when the baby is placed in birth KC position: strictly vertical between the breasts of the mother, and the eye level of the child is at the level of the mother’s nipples to reduce the length of the “natural journey” to the first breastfeed.

Resting in KC (World Health Organization)
Graphic by World Health Organization

Resting in Kangaroo Position:

Parents should be able to rest while doing Kangaroo Care. According to the World Health Organization, the mother will best sleep with the baby in kangaroo position in a reclined or semi-recumbent position, about 15 degrees from horizontal. It has been observed that this position may decrease the risk of apnoea for the baby

Some parents prefer sleeping on their sides in a semi-reclined bed (the angle makes sleeping on the abdomen impossible), and if the baby is secured as described there will be no risk of smothering.

A comfortable chair with adjustable back may be useful for resting during the day.d

Benefits of Kangaroo Care

The Science Behind Kangaroo Care

By Barbara Weaver, CCRN, Yamile Jackson, PhD, PE, PMP
Poster Presented at Graven’s Conference (2013):

Poster Science Behind KC

Benefits for the parents include:

  • Enhanced attachment and bonding (Tessier et al., 1998).
  • Resilience and feelings of confidence, competence, and satisfaction regarding baby care (Tessier et al., 1998; Conde Agudelo, Diaz Rossello, & Belizan, 2003; Kirsten, Bergman, & Hann, 2001).
  • Increased milk volume, doubled rates of successful breastfeeding and increased duration of breastfeeding (Mohrbacher & Stock, 2003).
  • Physiologically her breasts respond to her infant’s thermal needs (Ludington-Hoe et al., 2006).
  • Profoundly beneficial for adoptive parents with critically ill preterm infant (Parker L, Anderson GC. , 2002).

Benefits for the babies include:

  • Kangaroo Care reduces neonatal mortality (Conde-Agudelo et al, 2011).
  • Less incidence and severity of infection (Charpak N, Ruiz-Pelaez JG, Figuero de Calume Z, Charpak Y., 1997).
  • Accelerated autonomic and neurobehavioral development (Feldman R, Eidelman, 2003).
  • Promotes self-regulation in premature infants: sleep wake cyclicity, arousal modulation, and sustained exploration (Feldman R, Weller A, Sirota L, Eidelman A., 2002).
  • Consistently high and stable oxygen saturation levels, lower airway resistance, fewer apnea episodes, and an increased percentage of quiet sleep (Ludington- Hoe, Ferreira, & Goldstein, 1998).
  • Stable temperature within normal thermal zone, heart rate, and respiratory rate (Ludington-Hoe et al., 2010).
  • Reduced crying associated with painful procedures (Kostandy R, Ludington-Hoe SM, 2008).
  • Breast milk is readily available and accessible, and strengthens the infant’s immune system.
  • The maternal contact causes a calming effect with decreased stress and rapid quiescence (McCain, Ludington-Hoe, Swinth, & Hadeed, 2005; Charpak et el., 2005).
  • Reduced physiological and behavioral pain responses (Ludington-Hoe, Hosseini, & Torowicz, 2005).
  • Increased weight gain (Charpak, Ruiz-Pelaez, & Figueroa, 2005).
  • Enhanced attachment and bonding (Tessier et al., 1998).
  • Positive effects on infant’s cognitive development (Feldman, Eidelman, Sirota, & Weller, 2002).
  • Less nosocomial infection, severe illness, or lower respiratory tract disease (Conde-Argudelo, et. al., 2003).
  • Restful sleep (Ludington-Hoe et al., 2006).
  • Earlier hospital discharge (London et al., 2006).
  • Possible reduced risk of sudden infant death syndrome (SIDS) (see
  • Normalized infant growth of premature infants (Charpak, Ruiz-Pelaez, & Figueroa, 2005).
  • May be a good intervention for colic (Ellett, Bleah, & Parris, 2002).
  • Possible positive effects in motor development of infants (Penalva & Schwartzman, 2006).
  • The critical stimuli to which the baby is exposed during KC are:
    Vestibular: the chest movement of the breathing of the parent, and walking if allowed
    Tactile: the skin and natural warmth of the parent on the bottom (chest), on the sides (breast of mother),
    Olfactory: the scent of the parent and the maternal breast milk.
    Auditory: by the voices and heartbeat of the parent.

Kangaroo Care Sessions

To maximize the effectiveness of the Kangaroo Care sessions, parents and caregivers must have some basic knowledge.

Birth Kangaroo Care Competency Checklist by the USIKC (PDF)

Who can be kangarooed: If the baby is in condition to be moved or lifted to be weighed, s/he can be transfered to Kangaroo Care.

Time of holding: No less than one hour per session, and there is no maximum time – the more the better. Since a complete sleep cycle is one hour, it is NOT recommended that the babies are held on kangaroo if the parent cannot hold for at least that long (especially for small preemies as it may cause reverse effects). The stress of the transfer only is outweighed if the baby is held for at least one sleep cycle.

Rule of thumb: preemies are “Kangarooed” for 6 months and full-term babies within one minute from birth until the first feeding and as much as possible for 3 months.

Instructional Video about Skin-to-Skin Contact from the Institute of Neonatology, Belgrade, Serbia,
(English subtitles)

What parents should know before they hold their babies in KC:

  • Learn the benefits of Kangaroo Care and to distinguish signs of stability of the baby (to request a kangaroo session) and warning signs of instability (to stop the kangaroo session).
  • Learn the how to do standing and sitting transfer.
  • Allow the baby to sniff and explore the mother’s breasts, for breastfeeding/pumping, and numerous medical interventions while holding.
  • Know that they may do the transfer alone, but ONLY after the training and approval of a medical professional.
  • Learn basic monitor readings, and know what and when to communicate with the staff.
  • Wear nothing between the baby and the adult (no bra, shirt, etc.)
  • Remove jewelry that might come in contact with the baby.
  • Refrain from using powder, lotion or perfume on the chest before doing skin to skin care. The baby needs to feel the parent’s natural scent.
  • Be free of any lesions or skin breakdown on the chest.
  • Take care of their own personal needs (food, fluids, restroom, etc.).
  • Bring a camera and ask someone to take pictures or video  After all, it is an important time for everyone.
  • Kangaroo for long periods of time, so plan accordingly. Parents are not encouraged to sleep with the baby unless the baby is considered safe without the use of the hands of the parents, AND someone is supervising at all times.