Kangaroo Care
General Information
Kangaroo Care originated in Bogota, Columbia where there were insufficient numbers of isolettes available. Premature and sick babies were cuddled up on their mother's chests and covered to keep them warm. Doctors from more developed countries were surprised at how well the babies thrived in these circumstances and some moved to introduce Kangaroo Care to their hospitals.
Studies have shown that babies who are "kangarooed" often have higher levels of oxygen saturation, more stable temperature, are more settled, gain weight faster and go home sooner.
Some hospitals prefer that babies are off the ventilator before Kangaroo Care begins, but others allow it even while the baby needs assistance to breathe. Other hospitals may have minimum weight requirements.
To Kangaroo Care your baby, you will need either a shirt that opens at the front, or a hospital gown, or to take off your t-shirt; mothers should remove their bra as well. The baby is stripped down to his/her nappy only and then cuddled to your chest and covered with a blanket or bunny rug, often they will need to wear a hat too. Both mothers and fathers can Kangaroo Care their baby. Kangaroo Care can be a great way for Dads to bond with their babies and some babies take their first licks of milk from their mother this way.
Be guided by the nurses and doctors as to whether your baby is ready for Kangaroo Care. If you are interested and the opportunity hasn't been offered to you, ASK! It may be that your baby is not stable or well enough yet, or it may just be that the nurses have been busy and hadn't had the chance to offer you the opportunity yet.
You may find that you are able to kangaroo your baby some days and not others. It will depend on how your baby is doing and sometimes on how busy the nursery is and whether there is someone available to help you get set up. Try not to feel disappointed when you can't kangaroo, and enjoy your kangaroo sessions when you do have them.
For more information about Kangaroo Care, please see the journal articles, books and websites below. Also read about Angela's personal experience below.
Internet Links:
http://www.prematurity.org/baby/kangaroo.html
https://www.llli.org/breastfeeding-info/premies-kangaroo-care-skin-skin-contact/
http://www.infantmassage.org.au/
Books:
Kangaroo care : the best you can do to help your preterm infant Susan Ludington-Hoe
Baby massage Peter Walker
Baby Massage: Parent-Child bonding through touch Amelia D. Auckett
Infant massage: a handbook for loving parents Vimala Schneider McClure
Journal Articles:
Tactile Stimulation and Preterm Infants
Jen-Juian Liaw
Journal of Perinatal & Neonatal Nursing 14 (1) 84-103 June 2000
This article is a literature review, looking at previous research that has been done into touch and preterm infants in the NICU environment. It looks at the components of tactile stimulation including duration, location, action, intensity, frequency and sensation. These factors are defined and discussed and have previously been studied in both adults and children, but not in preterm infants whose NICU environment can be both sensory deprived (usually for tactile and vestibular senses) and excessively stimulating (especially for auditory and visual senses). The three different types of touch discussed are passive touch, active touch and social touch. All of these are important to the developing preterm infant, with social touch enhancing the social, emotional and physical development. The article critiques and synthesizes the results of previous studies on touch in the NICU environment and goes on to make suggestions for nursing and for further research. The author suggests that touch is supported by the theory and holds great potential for aiding the development of premature infants, but needs to be studied more thoroughly in order for protocols that provide the best benefit to the infant are followed, and to find the kinds of tactile stimulation that are most appropriate for all concerned.
Comparison of skin-to-skin (kangaroo) and traditional care : parenting outcomes and preterm infant development
Ruth Feldman, Arthur I. Eidleman, Lea Sirota and Aron Weller
Pediatrics 110(1) p16-26 July 2002
This study set out to examine whether parent-child interactions and infant development were affected by kangaroo care intervention. It compared 73 preterm infants who received kangaroo care with 73 controls who received standard care during their hospital stay. A number of factors, including motherinfant interaction and maternal depression were examined at 37 weeks gestational age. The infants looked at again at 3 and 6 months of age, and observations were made on factors such as infant temperament, the home environment and cognitive development. The research showed that at 37 weeks gestational age, interactions and touch were more positive, mothers had adapted better to infant cues and infants showed more alertness in the group that had kangaroo care. The mothers also reported less depression. At both 3 and 6 months the mothers and fathers of the children who received kangaroo care were shown to be more sensitive and the cognitive testing at 6 months showed higher scores for these infants. The conclusion is drawn that kangaroo care has a positive impact on both perceptualcognitive and motor development and on the parenting process. Further research is recommended to determine whether the positive impacts continue on into later infancy and childhood. Other developmental care interventions, such as massage therapy and enriched environments, need to be looked at to examine which method or combination of methods provides the most optimal care for the premature infant and their family.
A randomized, controlled trial of Kangaroo Mother Care: results of follow-up at 1 year corrected age
Nathalie Charpak, Juan G. Ruiz-Pelaez, Zita Figueroa de C., Yves Charpak.
Pediatrics 108(5) p1072-9 Nov 2001
Skin-to-skin contact (kangaroo care) promotes self-regulation in premature infants: sleep-wake cyclicity, arousal modulation, and sustained exploration
Ruth Feldman, Aron Weller, Lea Sirota, Arthur I. Eidelman
Developmental Psychology 38(2) p194-207 March 2002
Touch me, I'm yours: the benefits of infant massage
Sheila Koty Globus
Special Delivery 25 (1) p8-9 Spring
Infant massage as a component of developmental care: past, present and future..
Rosalie O. Mainous
Holistic Nursing Practice 16 (5) p1-16 Oct 2002
Personal Stories
Angela's Story - Kangaroo Care
When my daughter was born at 27 weeks in 1992 (Queen Victoria Hospital, Adelaide), Kangaroo Care was very new and neither staff nor we were comfortable with it. I was told it would be good for baby and me and my first and only experience of it was in an open space in the nursery, having a scrawny tube-yielding baby placed against my chest & two nurses anxiously fussing. A photo of the event tells the story well - I look more confused than contented. My husband's experience was similar - a tiny baby stuffed in his polo shirt - a great size compassion but both babe and parent looking stunned!
My son James was born at 23 weeks in 1997 at the Women's & Children's Hospital, Adelaide. Kangaroo care was better managed - many staff were effusive about its benefits and confident in supporting families to participate.
My first kiss of my baby was day 10 as he was on his way to have PDA surgery; my first cuddle was a skin to skin on day 17. This was a most wonderful experience - aided by a very supportive nurse, a privacy screen and soft music. It was the first time I really felt I was his Mum.
Kangaroo care became a daily very important ritual to both my husband and myself for days 17-47 in NICU and until in SCBU when breastfeeding was established. Even my mother was able to have a snugly skin to skin while James was in NICU! Sometimes the KC went for nearly 2 hours, sometimes 20 minutes - the latter was less satisfying for James and I - the energy he expended in being got in & out I felt required a longer recovery time.
I always sang to James the John Lennon song "Beautiful Boy"; although the screen was only fabric it allowed the illusion of privacy and a break in my "public parenting" role. Sometimes my 4 year old daughter would sit at my feet, drawing or playing, at other times I would read a book to her and James.
I learned quickly which rocking chair was the best and which screen provided the most coverage.
I also learned which staff I needed to stand my ground with and which I could trust to support me to luxuriate in this daily ritual.
I remember clearly the weekend James became really ill - he had a blood infection requiring heavy-duty antibiotics and 3 platelet transfusions. It was very scary. Amanda was the nurse looking after him in NICU and knew how much James enjoyed our cuddles so organised a skin to skin. Within minutes he had burrowed and his stats stabilised. He stayed with me for 2 hours - Amanda was on an afternoon shift followed by a morning and then another morning shift. She firmly believed that James drew strength from me in these lengthy cuddles and so strongly advocated that they continued in spite of his unwell state. James made a complete recovery.
Some staff were less comfortable or confident with the process, being unable to find time to get baby "out" (too close to lunch), hovered closely in fear or something going wrong and me being unable to tell, or wouldn't dim the lights (had to see if he was turning blue!), etc. but as a second time prem mum I felt clearer about what I wanted (I had done lots of reading between pregnancies) and seeing how settled James was during the cuddles I assertively "managed" the process.
James still loves his cuddles and likes to have his special song sung to him. My second experience of Kangaroo Care was wonderful and I believe an important element of James' move to wellness. It also effectively supported my transition to being a confident mum of a fragile baby through positive experiences in nurturing.
Angela
This information was originally published in Austprem Ink 1 (1) May 2003
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