KANGAROO MOTHER CARE
Kangaroo Mother Care (KMC) is a simple method of care for low-birth-
weight infants that includes early and prolonged skin-to-skin contact with the
mother (or a substitute caregiver) and exclusive and frequent breastfeeding.
Kangaroo mother care has following components:
1. Skin-to-skin contact
2. Exclusive breast feeding
Duration of KMC
Short: 4 hours daily
Extended: 5-8 hours daily
Long: 9-12 hours daily
Continuous: More than12 hours daily
Who can provide KMC?
KMC can be provided by mothers, fathers and other adult family
members. The KMC provider should be willing, in good health, free from
serious illness and should maintain basic standards of hygiene such as
hand washing, daily bath, clipped fingernails, tied up hair and clean
clothes. It is recommended that jewellery, watches and sacred threads must
be removed as they may be a barrier to maintain hygiene and might cause
injury to the new-born.
Which infants should be provided KMC?
All LBW infants and premature neonates.
The timing of initiation of KMC depends on the birth weight and stability of the
infant.
1. Birth weight more than 1,800 grams and less than 2500 g: These infants
are generally stable at birth. Therefore, in most such cases KMC can be
initiated soon after birth in the postnatal ward.
2. Birth weight more than 1,200g and less than 1800 g: It might take a few
days before KMC can be initiated. Such infants may need care in a Special
New born Care Unit (SNCU) or a New born Intensive Care Unit (NICU)
3. Birth weight less than 1,200 g: These infants frequently experience serious
prematurity related morbidity often starting soon after birth. It may take
days to weeks before the infant’s condition allows initiation of KMC.
How to Provide KMC?
Counselling
Effective counselling for the initiation of KMC is a prerequisite to
overcome socio-cultural barriers and anxiety regarding handling a LBW
infant both by the mother and other care providers.
STEPS/Procedure:
A few basic tips for getting started with kangaroo care include:
• Skin-to-skin contact. You can use clothing that opens in the front for
kangaroo care, so that the baby can be held close to the parent’s bare skin.
• Placing the baby — only wearing a diaper and head cover — on your bare
chest. Your baby will be in an upright position, with his or her chest against
your chest.
• Covering the baby’s back. Once you’re settled skin-to-skin, drape a
blanket or your shirt or gown over your baby’s back. Keep your baby warm
and comfortable while snuggled against your chest.
• Relaxing together. During your session, try and relax as you hold your
baby. Remember to breathe normally and focus on your child.
• Planning on multiple sessions. You should plan to do kangaroo care more
than once — at least one hour, four or more times each week.
• Letting your baby rest. Allow your baby to snuggle in and fall asleep
during the session. The baby may breastfeed during the Kangaroo mother
care.
CLOTHING
Mother: KMC can be provided using any front-open, light dress as per the local
culture. KMC works well with sari-blouse, gown or shawl. A suitable apparel
like Kangaroo bag, baby bag, sari, binder that can retain the infant for an
extended period can be adapted locally.
Infant: The infant should be dressed in cap, socks, disposable diapers and
front-open sleeveless shirt or ‘jhabala’ made of a soft natural fabric like cotton.
KMC Position
Baby:
The infant 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 air way open and
allows eye to eye contact between the mother and her infant.
The hips should be flexed and abducted in a “frog” position; the arms should
also be flexed. The infant’s abdomen should be at the level of the mother’s
epigastrium. Mother’s breathing stimulates the infant, thus reducing the
occurrence of apnoea. Support the infant from the bottom with a sling/binder
Mother:
A semi-reclining position (40º-45º) is to be adopted while sleeping. This can
be achieved with the help of 3-4 pillows on the hospital bed or special semi-
reclining chairs.
The mother carrying an infant in the KMC position can walk, stand, sit, or
engage in different activities. If comfortable, the mother can sleep with the
infant in kangaroo position in a reclined or semi-recumbent position.
Benefits:
• Better mother-infant bonding and maternal satisfaction with the method
of care, as compared with conventional methods.
• KMC is associated with reduced incidence of severe illness including
pneumonia during infancy.
• More effective than incubator care for stable new-borns in: providing
adequate thermal care, reducing nosocomial infections, improving
exclusive breastfeeding and weight gain, and fostering greater maternal
and family involvement in care—all at a lower cost than incubator care.
• Improved weight, length and head circumference,
• Increased breastfeeding rates,
• KMC satisfies all five senses of the infant. The infant feels the mother’s
warmth through skin-to-skin contact (touch), listens to her voice and
heartbeat (hearing), sucks breast milk (taste) has eye contact with her
(vision) and smells her odour (olfaction).
DISCHARGE FROM HOSPITAL AND FOLLOW-UP
The infant is
1.Stable and not on parenteral medication.
2.Maintaining temperature in mother’s bed for 3 consecutive days at room
temperature.
3.Gaining 15-20 grams per day for at least 3 consecutive days.
4.Accepting feeds directly from breast (preferable) or by spoon, paladai
feeding or cup.
Usually, the infant’s weight is around 1,500 to 1,600 grams at the time of
discharge.
DON’T’S OF KANGAROO MOTHER CARE
1.Do not bathe the infant till infant weighs 2,500 g, sponging may be done.
2.Do not give bottle feed.
4.Do not allow infant to be in contact with sick people.
5. Do not wear jewellery, watches and sacred threads during KMC as they
may be a barrier to maintain hygiene and might cause injury to the new-born
KMC at Home:
In hospital, mothers are sensitized and taught KMC. They are expected to
continue practicing it at home with regular returns to the hospital post-
discharge.
When should KMC be discontinued?
Often an infant is taken off kangaroo mother care when gestation reaches term
or the weight is around 2,500 grams. By this time the infant starts wriggling
to show that he or she is uncomfortable, pulls out the limbs from the kangaroo
garment and cries and fusses every time the mother tries to put the infant back
in skin-to-skin contact. This is the time to wean the infant from KMC.
REFERENCES:
Operational_Guidelines-KMC_&_Optimal_feeding_of_Low_Birth_Weight_Infants.pdf (nhm.gov.in)
