Kangaroo Mother Care

RUPINDER DEOL
Assistant Professor
College of Nursing
AIIMS Rishikesh
What
is
it ?
 WHAT IS KANGAROO MOTHER CARE (KMC)
• Kangaroo Mother Care (KMC) is a special way of caring of low
birth weight babies. It started in year 1979 at Columbia.

• It fosters their health and well being by promoting effective

thermal control, breastfeeding, infection prevention and
bonding.

• In KMC, the baby is continuously kept in skin-to-skin contact by

the mother and breastfed exclusively to the utmost extent, KMC
is initiated in the hospital and continued at home.
 CREATION OF KMC 1978

Dr.Edgar Rey Sanabria,

pediatrician from the
Mother and child
Institute, Colombia
 THE COMPONENTS OF KMC ARE :
1. Skin-to-skin contact:
• Early, continuous and prolonged skin-to-skin contact between
the mother and her baby is the basic component of KMC.
• The infant is placed on her mother's chest between the
breasts.
ii. Exclusive breastfeeding:
• The baby on KMC is breastfed exclusively. ( i.e only giving
breast feeding for first 6 months of life)
• Skin to-skin contact promotes lactation and facilitates the
feeding interaction.
III. Support to mother infant dyad: It means medical, emotional,
psychological and physical well being of mother and baby is
provided without separating them.
 THE TWO PRE-REQUISITES OF KMC ARE:
i. Support to the mother in hospital and at home: A mother
cannot successfully provide KMC all alone. She would require
counseling along with supervision from care-providers, and
assistance and cooperation from her family members.

ii. Post-discharge follow up: KMC is continued at home after early

discharge from the hospital. A regular follow up and access to
health providers for solving problem are crucial to ensure safe
and successful KMC at home.
 Magnitude of Problem

270 lakh babies are born in India

every year;

30% Low Birth Weight Babies; 75%

of them die – direct or indirect
cause of LBW

Low birth weight rate in India the

greatest burden in the World
 PROBLEMS OF LBW
Hypothermia Hypoglycemia

Hypoxia Apnea

Poor weight gain Infection

Mortality Prolonged NICU stay

Decreased bonding
CONVENTIONAL CARE OF LBW

Caring for LBW infants :

Expensive and High risk of poor outcome
Care of Low birth weight babies

Cost Effective
Exorbitant Cost Intervention
Why
is it
important ?
BENEFITS
 BENEFITS TO THE BABY
Warmth-24 hrs
KMC Best Incubator
Physiologic Multimodal
stability stimulation

Reduced
Infection
 apnea
 oxygen requirement

Alertness &
quiet sleep
Earlier
growth spurt Better IQ
BENEFITS TO THE MOTHER
Self confidence

Successful Better maternal

breastfeeding
–baby bonding

Reduced
Economical Hospital stay

Satisfaction
 BENEFITS TO THE FAMILY

Saves money
Healthier baby Earlier discharge
•.

Breastfeeding Father returns

success to work earlier

 Child abuse
& abandonment Better follow up
Better IQ
 KMC SAVES MONEY
Artificial milk

Equipment
Antibiotics
&
Medications
Maintenance

Hospital stay
Health personnel

Health care beyond

neonatal period
 BENEFITS TO THE
NATION
Decreased Neonatal
& Infant mortality

Simple & applicable Cost-effective

everywhere

More intelligent babies

Nation’s wealth
 Kangaroo Mother Care
Cost effective
intervention
Is Need of the hour
for better survival & better quality
of life
for the benefit of the baby,
family, community and the nation.
 BENEFITS OF KMC
1. Breastfeeding: Studies have revealed that KMC results in
increased breastfeeding rates as well as increased duration
of breastfeeding.
2. Thermal control: Prolonged skin-to-skin contact between the
mother and her preterm/ LBW infant provides effective
thermal control with a reduced risk of hypothermia.
3. Early discharge: Studies have shown that KMC cared LBW
infants could be discharged from the hospital earlier than the
conventionally managed babies. The babies gained more
weight on KMC than on conventional care.
 BENEFITS OF KMC
4. Less morbidity: KMC protects against nosocomial infections.
Even after discharge from the hospital, the morbidity amongst
babies managed by KMC is less. KMC is associated with
reduced incidence of severe illness including pneumonia
during infancy.
5. Other effects: Mothers are less stressed during kangaroo care
as compared with a baby kept in incubator. Mothers prefer
skin-to-skin contact to conventional care. They report a
stronger bonding with the baby, increased confidence, and a
deep satisfaction that they were able to do something special
for their babies. Fathers felt more relaxed, comfortable and
better bonded while providing kangaroo care.
 ELIGIBILITY CRITERIA
1. BABY: All stable LBW babies are eligible for KMC. KMC should
be started after the baby is hemo -dynamically stable.
Guidelines for practicing KMC include:
a) Birth weight >1800 g : These babies are generally stable at
birth. Therefore, in most of them KMC can be initiated soon
after birth.
b) Birth weight 1200-1799 g :Many babies of this group have
significant problems in neonatal period. It might take a few
days before KMC can be initiated.
c) Birth weight <1200 g: It may take days to weeks before
baby's condition allows initiation of KMC.
 MOTHER
All mothers can provide KMC, irrespective of age, parity,
education, culture and religion. The following points must be
taken into consideration when counseling on KMC:
1. Willingness
2. General health and nutrition
3. Hygiene
4. Supportive family
5. Supportive community
Kangaroo Mother Care Position
how
is it
done ?
 Kangaroo MOTHER CARE

Upright positioning facing the mother’s

chest in between the breasts.
Baby’s chest and abdomen in skin-to-
skin contact with mother.
Head turned to one side in a slightly
extended position.
Avoid both forward flexion and
hyperextension of the head.
Frog positioning with hips flexed
•
 THE KMC PROCEDURE

KANGAROO POSITIONING

• The baby 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 airway open and allows eye to eye contact between the
mother and her baby.
• The hips should be flexed and abducted in a "frog“ position;
the arms should also be flexed.
• Baby's abdomen should be at the level of the mother's
epigastrium. Mother's breathing stimulates the baby, thus
reducing the occurrence of apnea.
• Support the baby’s bottom with a sling/binder.
Kangaroo Mother Care

Baby’s Right, Mothers Delight

 COMPONENTS
OF
KANGAROO MOTHER CARE
Body upright between mother’s breast
24 hour KMC
Exclusive Breast
feeding

KMC an ideal
prerequisite
to early Breast
feeding of
Preterm
 Human milk is not only
species specific but also
baby specific
Breastfeeding in kangaroo mother
care
• Kangaroo position is ideal for
breastfeeding
• KMC improves exclusive
breastfeeding

Encourage the mother to

breastfeed in kangaroo position
 FEEDING

• The mother should be explained how to breastfeed while the

baby is in KMC position. Holding the baby near the breast

stimulates milk production. She may express milk while the

baby is still in KMC position.

• The baby could be fed with paladai, spoon or tube, depending

on the condition of the baby.

 SIGNS OF GOOD ATTACHMENT DURING FEEDING INCLUDE:

1. Mouth wide open.

2. Baby’s chin touches the breast.

3. More of areola above the mouth is seen than below.

4. Lower lip turned outwards.

Who
should
do it ?
Kangaroo Mother Care

A way to humanize
high technology.
Early discharge & Follow up
Where should
it be done ?
Kangaroo Mother
care

• Hospital & Home

• Under developed &

Developed countries
 KMC to HRLBW
In Labor Ward
≤1800 NICU transfer- ≥1800 stable S-S-C
incubator/KMC initiate BF & tr to PNC
 …KMC to HRLBW
In Postnatal Care Ward
Counseling mothers & fathers
 KMC to HRLBW
NICU

Stable <1800 on IVF Weekly health talk

 Establishment of Transitional Care
24 hrs KMC : resting chairs and pillows & help from other family members
 K
• M
C
W
A
R
D
KMC in Triplets
AMBULATORY Kangaroo Mother Care
 AMBULATORY CARE
Growth monitoring-
15-20 g/kg/d
Dancis chart Breastfeeding
Psychomotor
assessment

Illness
Eye & ear
examination
Vaccination

Occupational
therapy Education
Pulse Ox – for
of mothers
babies on home
& family
oxygen therapy
Continue KMC
• light work at
home
• during travel
MONITORING IN KMC
(KANGAROO MOTHER CARE)
 Monitoring Parameters
• Temperature
• Airway, Apnea, Breathing
• Breastfeeding
• Compliance with Kangaroo Mother Care
• Danger Signs
• Education, Empowerment of KMC provider
• Follow up
• Growth and Wellbeing
57
 Temperature
• Axillary temp. every 6 hourly.

• Teach the mother to assess hypothermia by

“touch technique”.

• If mild hypothermia, ensure proper technique of

KMC. Provide additional warm clothing to
mother.

• Assess for possible causes for hypothermia.

58
 How to measure axillary temp.
• Ensure baby is warm during procedure.

• Use a clean thermometer & ensure mercury

column below 350C.

• Place the thermometer bulb high up in the

middle of the axilla with full contact of bulb to
the skin.

• Hold the baby’s arm against the side of the

chest gently; keep the thermometer in place
for three minutes.
59
 Airway, Apnea, Breathing
Educate the mother about apnea:
• Teach mother about baby’s breathing patterns &
normal variations.
• Explain about apnea and its effect on the baby.
• Emphasize if baby is blue - sign of a serious
disease.
• Teach to stimulate the baby.
 Monitoring a baby on oxygen therapy
• Some babies in KMC may require oxygen therapy in
NICU or at home.

• Provide oxygen with nasal prongs during KMC.

• Monitor oxygen therapy with pulse ox. 6 hrly.in NICU

& twice daily in postnatal wards. (Saturations 88% to
92%)

• Pulse ox monitoring during breastfeeding

 Breastfeeding

• Measured feeds - hind milk 2 hrly.

• Cal: 100-130 Kcal/kg/day & Protein: 3-3.5 g/kg/day
• Teach mothers to express, measure and feed
breastmilk
• Strict I/O chart maintained till adequate growth.
• Monitor feeding 2 hrly in NICU & 3-4 hrly in postnatal
wards.
• Daily caloric & protein intake of the baby noted on
kangaroo chart.
 Compliance

• Encourage mothers to provide 24

hours kangaroo care with the help of
close relatives.

• Explain “KMC chart”- keep a record of

the duration of kangaroo care provided.
 Monitoring of Danger Signs
• Apnea

• Breathing difficulty

• Cold hands & feet

• Convulsions

• Decreased feeding

• Decreased activity

• Hypothermia/ Hyperthermia.

65
 Danger signs
Educate the mother to recognize danger signs which are-
• Difficulty in breathing, chest in-drawing, grunting.
• Breathing very fast or very slow.
• Frequent and long spells of apnea.
• The baby feels cold; body temp. is below normal.
• Difficulty in feeding; baby doesn’t wake up for feeds
anymore, stops feeding or vomits.
• Convulsions
• Diarrhea
• Yellow skin
 Education, Empowerment
• How to provide Kangaroo Mother Care & fill
up Kangaroo Mother Care Chart?
• How to dress the baby?
• How to breastfeed the baby?
• How to respond to baby’s needs?
• How to daily sponge the baby?
• How to recognize danger signs?
• When to wean the baby from Kangaroo
Mother Care?
 Follow up
• Close follow up – a pre requisite for KMC.
• Baby is followed till once or twice a week till 37-40 wks of
gestation or till the baby reaches 2.5- 3Kg of weight.
• Smaller the baby at discharge, the earlier & more
frequent should be the follow up visits.
• Regular follow up – daily for 3 days till increase in weight
up to 15 to 20 grams / Kg. / day. Then on alternate day
for two weeks. Then once a week up to 40 weeks.
• Confirmation of Kangaroo Mother Care for 24 hours
• Confirmation of Exclusive Breastfeeding
• Examination of Baby
• Health talk
 Growth

Weight gain
• Aim at daily wt gain from second week

• No upper limit for wt gain for breastfed infants

• Weigh the baby daily once; naked with the same

calibrated & standardized weighing machine

• Plot wt on growth chart- Dancis chart

• Birth weight regained slowly usually by 15 days

Dancis Chart
 …Growth
Head circumference
• Important indicator of brain growth
• Measured once a week (grows @ 0.5-1
cm/wk)
Length
• Less reliable than weight
• Increases more slowly (grows @ 0.7-
1cm/wk)
 Inadequate weight gain
• Assess feeding technique, frequency, duration &
schedule; check night feeds.

• Advise the mother to increase the frequency or to

feed on demand.

• Encourage her to drink more fluids

• Encourage to give hind milk.

 …Inadequate weight gain
Look for other conditions :
• hypothermia
• occult sepsis
• urinary tract infection
• oral thrush
• medical disorders e.g, PDA,hyponatremia
• anemia
 PRIVACY
• KMC unavoidably requires some exposure on the part of the

mother. This can make her nervous and could be de-

motivating. The staff must respect mother's sensitivities in

this regard and ensure culturally acceptable privacy standards

in the nursery and the wards where KMC is practiced.

 WHEN SHOULD KMC BE DISCONTINUED ?

• When the mother and baby are comfortable, KMC is

continued for as long as possible, at the institution & then at
home. Often this is desirable until the baby's gestation
reaches term or the weight is around 2500 g. She starts
wriggling to show that she is uncomfortable, pulls her limbs
out, cries and fusses every time the mother tries to put her
back skin to skin. This is the time to wean the baby from KMC.
• Mothers can provide skin to skin contact occasionally after
giving the baby a bath and during cold nights.
• The baby should gain adequate weight (15-20 gm/kg/day up
to 40 weeks of post-conceptional age and 10 gm/kg/ day
subsequently).
 DURATION
• When the baby becomes uncomfortable,gets his
limb out ,cries and fusses when the mother tries
to put him in KMC position it is time to take him
out
• It usually happens around 37-38 weeks of
gestational age with an average weight of 2000-
2200 grams