KANGAROO MOTHER CARE

PROCEDURE

SUBMITTED TO: Mrs. Shailaja Madam

Asst. Professor
Child Health Nursing
SUBMITTED BY: Abdullah Bin Khalid
M.sc (N) 1st Year CHN
SUBMITTED ON: 08-07-2019
 KANGAROO MOTHER CARE
Caring low birth weight baby is a great challenge for the neonatal care unit and the family. Number
of low birth weight babies is still far beyond the expected target in our country. The cost of quality
management of these babies is increasing day by day. KMC is a low cost approach for the care of
low birth weight baby. This method of care was introduced and popularized by Dr. Edger Ray, Dr.
Martinez and Dr. Charpak in late 1970’s.

DEFINITION

Kangaroo mother care (KMC) is a special way of caring low birth weight (LBW) infants by skin-to-
skin contact. It promotes their health and wellbeing by effective thermal control, breastfeeding and
bonding. KMC is initiated in hospital and continued at home.

COMPONENTS OF KANGAROO MOTHER CARE

In KMC, the infant is continuously kept in skin-to-skin contact by the mother and breastfed
exclusively to the utmost extent. The two components of KMC are:

1. SKIN TO SKIN CONTACT

Direct continuous and prolonged skin-to-skin contact is provided between the mother and her baby to
promote thermal control.

2. EXCLUSIVE BREASTFEEDING

Skin-to-skin contact promotes lactation and feeding interaction with exclusive breastfeeding for
adequate nutrition and to improve desired weight gain.

BENEFITS OF KANGAROO MOTHER CARE

1. KMC helps in thermal control and metabolism. Prolonged, continuous and direct skin to skin
contact between mother and neonate provides effective thermal control and reduces risk of
hypothermia.
2. KMC results in increased duration and rate of breastfeeding.
3. KMC satisfies all five senses of the infant. Baby feels warmth of the mother through skin-to-
skin contact (touch), sucks the breast to feed (taste), smell the mother’s odor (olfaction) and
makes eye contact with mother’s (vision).
4. During KMC, the baby has more regular breathing and less predisposition to apnea.
5. KMC protects against nosocomial infection and reduces incidence of severe illness including
pneumonia during infancy.
6. Daily weight gain is slightly better with KMC, thus duration of hospital stay may be reduced,
LBW baby receiving KMC could be discharged from the hospital earlier than conventional
care.
7. KMC facilitates better mother infant bondage due to significantly less stress during
kangarooing than the incubator care of the baby.
8. KMC is one of the best methods of transporting small babies by keeping them in continuous
skin-to-skin contact with mother or family members.
 9. Mother feel increased confidence, self-esteem, sense of fulfillment and deep satisfaction with
KMC. Father feels more relaxed, comfortable and better bonded.
10. KMC does not require additional staff compared to incubator care.

REQUIREMENTS OF KMC IMPLEMENTATION

 Training of nurses, doctors and other staff on KMC, especially who are involved in care of
mother and baby.
 Educational material like information booklet pamphlet posters video in language local film,
etc. on KMC in local language.
 KMC does not require extra staff. Once KMC is implemental, care givers appreciate it
because of health benefits to the babies and the satisfaction expressed by the mothers.

ELIGIBILITY CRITERIA FOR KANGAROO MOTHER CARE

FOR BABIES

 All stable LBW babies are eligible for KMC, it is particularly useful for caring LBW infants
weighting below 2000 gm.
 In a stable baby, KMC can be initiated soon after birth.
 KMC should be started after the baby is hemodynamically stable.
 Sick LBW infants may take a few days to initiate KMC. So the sick baby needs transfer to a
proper facility immediately.
 Infants of birth weight less than 1200 gm with serious prematurity related morbidity may take
days to weeks to allow initiation of KMC.
 KMC can be initiated who is otherwise stable but may still be IV fluid therapy, tube feeding
and/or oxygen therapy.

FOR MOTHERS

 All mothers can provide KMC irrespective of age, parity, education, culture and religion.
 Mothers should be free of serious illness and able to take adequate diet and supplements
recommended by her doctor.
 She must be willing to provide KMC to her baby.
 She should be maintain good hygiene, daily bath/sponge, change of clothes, hand hygiene,
short and clean finger nails etc.
 She should have supportive family and community to be encouraged to continue KMC to her
baby.

PREPARATION FOR KANGAROO MOTHER CARE

COUNSELLING

 Explain the benefits of KMC to the mother and the family members.
 Demonstrate the procedure to the mother gently with patience.
 Answer the questions as asked by the mother and the family member to remove the anxiety.
 Allow the mother to interact with someone who have already practicing KMC for her baby.
  Discuss about the procedure to the mother-in-law husband or any other member of the amily.

MOTHER’S CLOTHING

 Mother should wear front-open, light dress, as per local culture.

 Mother can wear sari blouse, gown, shawl etc.

BABY’S CLOTHING

 Baby should be dresses with front-open sleeveless shirt, cap, socks, nappy and hand gloves.

KANGAROO MOTHER CARE PROCEDURE

KANGAROO POSITIONING

 The baby should be placed between the mother’s breast in an upright position.
 Baby’s head should be turned to one side and in a slightly extended position which helps to
keep the airway open and allow eye to eye contact between mother and baby.
 Baby’s hip should be flexed and abducted in a froglike position. The arms should also be
flexed and placed on mother’s chest.
 Baby’s abdomen should be placed at the level of mother’s epigastrium.

This position helps to reduce the occurrence of apnea, as mother’s breathing and heartbeat stimulate
the baby. Baby can be supported with a sling or binder or especially prepared KMC.

MONITORING DURING KMC

 During initial stage of KMC the baby should be monitored for airway, breathing, color and
temperature. Hands and feet should be examined to assess the warmth. Airway must be kept
clear with regular breathing, normal skin color and temperature.
 Baby’s neck position should be neither too flexed nor too extended.

FEEDING

 Mother needs help to breastfeed her baby during KMC. Holding the baby near the breast
stimulates milk production and the kangaroo position makes the breastfeeding easier.
 Baby could be fed with paladai, spoon and tube depending upon the baby’s condition.

PSYCHOLOGICAL SUPPORT TO MOTHER

 Mother needs motivation to continue KMC.

 She should be encouraged to ask question to remove anxieties.

PRIVACY

Privacy should be maintained to avoid unnecessary exposure on the part of the mother which makes
her nervous and de-motivating.
TIME OF INITIATION OF KMC

 KMC should be initiated gradually with a smooth transition from conventional care to
continuous KMC.
 KMC can be started as soon as the baby is stable in the neonatal care unit.
 Short KMC sessions can be initiated during recovery with ongoing medical treatment, i.e. IV
Fluid, oxygen therapy etc.
 KMC can be provided while the baby is with gavage feeding.

DURATION OF KMC

 Duration of KMC should not be less than one hour to avoid frequent handling which may be
stressful to the baby.
 Gradually the length of KMC sessions should be increased up to 24 hours a day. Interruption
only can be done for changing of diapers.
 KMC should be continued in postnatal ward and home.
 It may not be possible for mother to provide KMC prolonged period in the beginning.
Encourage her to increase the duration each time to provide KMC as long as possible.
 When mother is not available then other family members such as father, grandmother, aunt
can provide KMC.

CAN THE MOTHER CONTINUE KMC DURING SLEEP AND RESTING?

 Mother can sleep with baby in KMC position in a reclined or semi-recumbent position about
15-30 degree from above the ground.
 A comfortable chair with adjustable back may be useful to provide KMC during sleep and
rest at ward or home.
 Adjustable bed or several pillows or an ordinary bed can be used to maintain the position,
which usually decreased the risk of apnea of the baby.
 Supporting garment can be used to carry the baby in kangaroo mother position during rest
and sleep.
 Father and family members can provide KMC to relieve mother during rest and sleep.

DISCHARGING CRITERIA

The baby should be transferred from the neonatal care unit to the potential ward, when the baby is
stable and gaining weight and the mother is confident to look after the baby.

The baby should be discharged from hospital when the baby is having the following conditions:

 General health is good and there is no evidence of infection and apnea.

 Feeding well exclusively with breast milk.
 Gaining weight 15-20g/kg/day for at least three consecutive days.
 Maintaining normal body temperature satisfactorily for at least three consecutive days in
room temperature.
 Mother and family members are confident to take care of the baby at home and would be able
to come regularly for follow-up visits.
  Home environment should be suitable and congenial for continuation of KMC.

DISCONTINUATION OF KMC

 KMC can be continued until the baby gains weight around 2500 g or reaches 40 weeks of
post-conception age.
 KMC can be discontinued if the baby starts wriggling to show discomfort or pull limbs out,
cries and fusses every time, when mother tries to put the baby back into skin contact.
 When mother and baby are comfortable, KMC can be continued as long as possible at health
facility or at home.
 Mother can provide skin-to-skin contact occasionally after the baby bath and during cold
nights.

POST-DISCHARGE FOLLOW-UP

Each neonatal care unit should formulate its own policy for follow up.

 In general, baby is followed up once or twice a week till 37-40 weeks of gestation or till the
baby reaches 2.5-3 kg of weight.
 Thereafter a follow up once in a 2-4 weeks may be sufficient till 3 months of post
conceptional age. After that 1-2 months during first year of life. The baby should gain
adequate weight 15-20 g/kg/day up to 40 weeks of post conceptional age and 10 g/kg/day
subsequently.
 More frequent visits should be made, if the baby is not growing well or the condition
demands.

BIBILIOGRAPHY
A Padmaja, “A Procedure Manual of Pediatric Nursing”, 1 st Edition, (2014), Published by Jaypee
Brothers Publishers Ltd, India. Page No: 31-37.
Vicky A Bowden, “A Manual of Pediatric Nursing Procedures”, 1 st Edition, (2003), Published by
Lippincott Williams Pvt Ltd, India.