Kangaroo Care is a simple, low-risk, and high-reward tool for parenting in the NICU. If you have one hour or more, Kangaroo Care is one of the most valuable ways you can spend time with your baby. If possible, aim to provide Kangaroo Care for your baby every time you visit. Begin with one hour and work up to 2-3 hours at a time, longer if you want to!
What You Should Know:
Kangaroo Care is developmentally appropriate care for low birth weight babies and babies born preterm, and it offers many benefits for both parents and newborns. When you are skin-to-skin with your baby during Kangaroo Care, they will hear your heart beating, smell your scent, and feel your skin. Mothers and babies synchronize and regulate each other’s biology. Did you know a mother’s chest will heat up or cool down in response to their infant’s temperature during kangaroo care? Your body is as effective as an incubator!
Important benefits of Kangaroo Care include:
Parent/infant bonding—rest and enjoy touching, holding, and snuggling with your baby.
Stabilizes a baby’s body temperature, breathing rate, oxygen levels, and heart rate.
Raises oxytocin and prolactin levels to boost milk supply, which will help you reach your human milk feeding goals.
Lowers your adrenaline and cortisol levels.
Improved weight gain, brain growth, longer time spent in quiet awake states, and deeper sleep for your baby.
Lower stress levels, less crying, and decreased pain for your baby.
Navigating NICU Policy:
You may be discouraged from holding your baby or simply not be offered the option. Parents are commonly told their baby is too sick or small or that intubated babies must wait to receive Kangaroo Care. Parents may be allowed to hold their baby only for arbitrary amounts of time, like 15, 30, or 45 minutes. While every baby’s medical needs are different, scenarios like these often reflect a combination of NICU rules and Provider preference, comfort level, experience, and bias—they do not necessarily reflect what is true.
A 2013 study reported that Parents value kangaroo care higher than nurses and that mothers of color are less likely than white mothers to be offered the opportunity to provide the benefits of kangaroo care to their infants.¹
As soon as your baby is born—or before, if time allows—begin a conversation with your baby’s nurses and doctors to learn more about what benefits and potential risks are relevant to your baby based on their current health status. As your baby’s Parent, this discussion should also include your preferences—how do you feel about what you are hearing, what is important to you right now, what do you want to do, and what follow-up questions do you have? Once you’ve listened to the information received and considered your thoughts and feelings, you can do your research and circle back with your baby’s providers to continue the discussion.
What to Ask:
What are the benefits and potential risks of Kangaroo Care for my baby right now (at this gestational age, weight, with this respiratory support level, health diagnosis, or other considerations, etc.)?
What can you or I do to mitigate any potential risks so that my baby and I can receive the well-documented benefits of Kangaroo Care?
Which NICU nurses are comfortable and willing to help me provide my baby with Kangaroo Care?
Not every nurse will make Kangaroo Care time possible for you and your baby, but some will! Identify those nurses who align with your values and beliefs about your role as a parent in the NICU because they are the ones you want on your baby’s team!
What You Will Need:
Your naked baby (in a diaper)
Your bare chest (with or without a bra)
A comfortable chair with a footrest
Confident nurses and respiratory staff on hand to help safely take your baby out of the isolette and return them after Kangaroo Care
A blanket to drape over baby
A breathable cotton robe for you to wear (Optional)
A Kangaroo Care wrap designed for premature babies is particularly helpful if your baby is very small or intubated to help support positioning (Optional)
Entertainment at your fingertips: a book to read, games or apps, earphones for music, meditation, or a book on tape.
When you arrive, let your baby’s nurse know that you would like to give your baby Kangaroo Care, and allow them the time they need to plan and coordinate the extra hands that may be required to assist you safely. Empty your bladder and grab a snack right before you begin so you can be as comfortable as possible. Take off your shirt (and bra, if you want), and change into your cotton robe up top.
Ready? Hold!
STEP 1: Position your baby upright, and place their bare belly in contact with the middle of your bare chest (between your breasts or nipples). If you have two babies, one can be placed on each side of your chest.
STEP 2: Position baby’s head to one side and ensure all wires and tubes are in place and secure.
STEP 3: If you are wearing a robe, wrap each panel of your robe around the baby. Drape a receiving blanket on top of the baby for extra warmth.
STEP 4: Rest like this with your baby for at least one hour, the longer the better! Do not fall asleep during Kangaroo Care.
A Few Considerations:
Don’t be afraid of your baby; stay curious! They may be fragile but there’s nowhere your baby would rather be than skin-to-skin with you.
Try to provide Kangaroo Care every time you visit your baby, and do it for as long as possible. Begin with one hour and work up to a few hours a day.
It’s ok to break up your Kangaroo Care sessions. If you will be in the NICU all day and can offer Kangaroo Care for an hour or two when you arrive and then again in the afternoon, do it!
The protocol and process to safely move your baby out of their isolette, set them up for success, and then do the reverse to put them back again can be a stressor for your baby. This is why Kangaroo Care should last a minimum of one uninterrupted hour: to allow your baby time to transition, settle, and receive all the good benefits. You will know your baby is “tolerating” Kangaroo Care once they have had time to settle in and by observing their heart rate, oxygen level, blood pressure, and temperature within optimal ranges. Sometimes your baby’s nurse may turn up the oxygen concentration or the ventilator parameters to give your baby a little boost and support their coping efforts.
Kangaroo Care time can become tedious for you if you do it for many hours in a row. A baby wrap specific for skin-to-skin will make it possible to safely hold even the smallest babies securely on your chest and allow you to have your hands free for texting, reading, journaling, or just resting quietly. Kangaroo Care-specific wraps are available online for micro-preemies, preemies, and twins, and some are pumping-friendly.
You can continue to do skin-to-skin at home after your baby is discharged. The benefits continue!
Opportunities to Optimize Kangaroo Care Time in the NICU:
Ask to Kangaroo Care during routine painful procedures like heel sticks.
Ask to Kangaroo Care during tube feeds.
Kangaroo Care Time is a great time for your baby to practice sucking, nuzzling, and licking the nipple and breast if still at an early gestational age and breastfeeding, too, if your baby is ready.
If you have a bra with hands-free pump access and will be kangarooing for a while that day, you can use Kangaroo Care Time to get in a pumping session. (Double win!)
Feel free to converse with staff during Kangaroo Care Time—catch up on everything you need and want to know about your baby and their care plan, and discuss any necessary updates with your baby’s team. It’s also a nice time to get to know your baby’s nurses on a personal level, and share a little about yourself too.
¹ Hendricks-Muñoz, Karen & Li, Yihong & Kim, Yang & Prendergast, Carol & Mayers, Roslyn & Louie, Moi. (2013). Maternal and Neonatal Nurse Perceived Value of Kangaroo Mother Care and Maternal Care Partnership in the Neonatal Intensive Care Unit. American journal of perinatology. 30. 10.1055/s-0033-1333675.