1. Feeding of Healthy Newborn
1

2. SKIN TO SKIN CONTACT
2

3. SSC position for baby
• SSC positions build on the Tummy to Mummy
position.
• Full SSC position entails the baby lying on top
of the mother:
Facing
Close
Touching
• Mother does not have to hold the baby.
Gravity maintains baby position
3

4. Full SSC Position
• Baby’s chest is in close contact with
mum’s body Contour.
• Unrestricted access to breast
4

5. Advantages offered by the
Breast Crawl
• Warmth
• Comfort
• Metabolic adaptation
• Quality of attachment
5

6. Warmth
• Prevents hypothermia
6

7. Comfort
• The infants in the cot cried for a
significantly longer time than the babies in
Breast Crawl position during all
observation periods.
7

8. Metabolic adaptation
• Babies kept in the Breast Crawl position had
higher 90 minute blood sugar levels and more
rapid recovery from transient acidosis at birth,
as compared to babies separated and kept in a
cot next to the mother (Christensson et al,
1992).
8

9. For the Mother
Expulsion of placenta and reduction
of postpartum haemorrhage
9

10. The effects of
Oxytocin
• Calm
• Lower heart rate
• Higher pain threshold
• Higher social interaction
• Less anxious
• Soporific
10

11. Advantages for Both:
Bonding
• A mother's feeling of love for the baby may not necessarily begin
with birth or instantaneously with the first contact. During the
Breast Crawl, while resting skin to skin and gazing eye to eye, they
begin to learn about each other on many different planes.
• For the mother, the first few minutes and hours after birth are a
time when she is uniquely open, emotionally, to respond to her
baby and to begin the new relationship. Suckling enhances the
closeness and new bond between mother and baby. Mother and
baby appear to be carefully adapted for these first moments
together
11

12. Finally.
SSC works for every other mammal on
the planet.. Why should we be any different?
12

13. • http://breastcrawl.org/video.htm
13

14. Benefits of breast milk to the baby
• Breast milk and human colostrum are
made for babies and is the best first food
• Easily digested and well absorbed
• Contains essential amino acids
• Rich in polyunsaturated essential fatty
acids
• Better bioavailability of iron and calcium
14

15. Benefits of breast milk (contd.)
• Protects against infection
• Prevents allergies
• Better intelligence
• Promotes emotional bonding
• Less heart disease, diabetes and
lymphoma
15

16. Protection against infection
1. WBC in
1. Mother mother’s
infected body
make
antibodies
to protect
mother
1. Some
WBCs go
1. Antibody to to breast
mother’s and make
infection antibodies
secreted in milk there
to protect baby
16

17. Benefits to mother
• Helps in involution of uterus
• Delays pregnancy
• Decreases mother’s workload, saves
time and energy
• Lowers risk of breast and ovarian
cancer
• Helps regain figure faster
17

18. Benefits to family
• Contributes to child survival
• Saves money
• Promotes family planning
• Environment friendly
18

19. Anatomy of breast
Myoepithelial cells
Epithelial cells
ducts
Lactiferous sinus
Nipple
Areola
Montgomery gland
Alveoli
Supporting tissue
and fat
19

20. Physiology of lactation
• Hormonal secretions in the mother
– Prolactin helps in production of milk
– Oxytocin causes ejection of milk
• Reflexes in the baby – rooting, sucking &
swallowing
20

21. Prolactin production
Enhanced by
• How early the baby is put to the breast
• How often and how long baby feeds at
breast
• How well the baby is attached to the
breast
21

22. Prolactin reflex
Hindered by
• Delayed initiation of breastfeeds
• Prelacteal feeds
• Making the baby wait for feeds
• Dummies, pacifiers, bottles
• Certain medication given to mothers
• Painful breast conditions
22

23. Prolactin “milk secretion” reflex
Enhancing factors Hindering factors
Emptying
of breast
Bottle feeding,
Sucking
Incorrect positioning,
Painful breast
Expression
of milk
Night
feeds
Prolactin in Sensory impulse
blood from nipple
23

24. Oxytocin “milk ejection” reflex
Oxytocin contracts
myoepithelial cells
Sensory impulse from
nipple to brain
Baby sucking
24

25. Oxytocin reflex
Stimulated by Inhibited by
•Thinks lovingly of baby •Worry
•Sound of the baby •Stress
•Sight of the baby •Pain
•CONFIDENCE •Doubt
25

26. Feeding reflexes in the baby
Rooting reflex
Mother learns to Sucking reflex
position baby
Baby learns to take
breast
Swallowing reflex
26

27. Composition of preterm and full term
milk (g/dl)
Full Term Preterm
Fat 3.5
3.5
1.0 Protein 2.0
7.0 Lactose 6.0
27

28. How breast milk composition varies
Colostrum Foremilk Hindmilk
Fat
Protein
Lactose
28

29. For successful breastfeeding
• A willing and motivated mother
• An active and sucking newborn
• A motivator who can bring both mother and
newborn together ( health professional or
relative )
29

30. Successful breastfeeding
• Have a written breastfeeding policy
• Motivate mother from antenatal period
• Put to breast within 30 minutes of birth
• Promote rooming -in of mother and baby
• Promote frequent breastfeeding
30

31. Successful breastfeeding
(contd.)
• Don’t give prelacteal feeds
• Don’t use bottle to feed
• Support mother in breastfeeding the baby
• Arrange mother craft classes in health facilities
• Treat breastfeeding problems early
• Exclusive breastfeeding till 6 months
• Addition of home-based semisolids after 6 months
31

32. Position of baby in relation to the
mother
1. The baby’s whole body should face the
mother and be close to her
3. The baby’s head and neck should be
supported, in a straight line with his body, to
face the breast
5. Baby’s abdomen should touch mother’s
abdomen, to be as close as possible to his
mother
32

33. Signs that a baby is attached well
at the breast
1. The baby’s mouth is wide open
2. The baby’s chin touches the breast
3. The baby’s lower lip is curled outward
4. Usually the lower portion of the areola
is not visible
33

34. Signs that a baby is attached well at the
breast
lower lip is curled outward baby’s mouth is wide open
chin touches lower portion
the breast of the areola is
not visible
34

35. Treatment of inverted nipple
Treatment should begin after
birth
• Syringe suction method
• Manually stretch and roll the
nipple between the thumb
and finger several times a
day
• Teach the mother to grasp
the breast tissue so that
areola forms a teat, and
allows the baby to feed
35

36. Treatment of inverted nipple by syringe
method
Cut along this
STEP 1 line with blade
Use 10 or 20cc syringe
STEP 2
Insert the plunger
from cut end
STEP 3 Mother gently pulls
the plunger
Before the feeds
5-8 times a day
36

37. Sore nipple
Causes
• Incorrect attachment : Nipple suckling
• Frequent use of soap and water
• Candida (fungal) infection
Treatment
• Continue breastfeeding and correct the
position & attachment
• Apply hind milk to the nipple after a
breastfeed
• Expose the nipple to air between feeds
37

38. Breast engorgement
Causes
• Delayed and infrequent
breastfeeds
• Incorrect latching of the baby
Treatment
• Give analgesics to relieve pain
• Apply warm packs locally
• Gently express milk prior to
feed
• Put the baby frequently to the
38
breast

39. Causes of “Not enough milk”
• Not breastfeeding often enough
• Too short or hurried breastfeeding
• Night feeds stopped early
• Poor suckling position
• Poor oxytocin reflex (anxiety, lack of
confidence)
• Engorgement or mastitis
39

40. Management of “Not enough milk”
• Put baby to breast frequently
• Baby to be correctly attached to
breast
• Build mother’s confidence
• Use galactogogues judiciously
Adequate weight gain and urine frequency 5-6
times a day are reliable signs of enough milk
intake
40

41. Expressed breast milk
Indications
• Sick mother, local breast problems
• Preterm / sick baby
• Working mother
Storage
• Clean wide-mouthed container with tight lid
• At room temperature 8-10 hrs
• Refrigerator – 24 hours, Freezer - 20° C – for
3 months
41

42. Ten steps to successful breastfeeding
Every facility providing maternity services and
care for newborn infants should
3. Have a written breastfeeding policy that is routinely
communicated to all health care staff
4. Train all health care staff in skills necessary to
implement this policy
5. Inform all pregnant women about the benefits and
management of breastfeeding
42

43. Ten steps to successful breastfeeding
(contd….)
1. Help mothers initiate breastfeeding within
half hour of birth
2. Show mothers how to breastfeed, and how
to maintain lactation even if they are
separated from their infants
3. Give no food or drink, unless medically
indicated
4. Practice rooming-in : allow mothers and
infants to remain together 24 hrs a day 43

44. Ten steps to successful breastfeeding
(contd….)
1. Encourage breastfeeding on demand
2. Give no artificial teats or pacifiers (also
called dummies or soothers) to
breastfeeding infants
3. Foster the establishment of
breastfeeding support groups and refer
mothers to them on discharge from the
hospital.
44

45. 45

46. Feeding
•The World Health Organization (WHO) recommends that
all babies be exclusively breastfed for six months
•Semi-solids can be introduced after six months, and baby
can continue to have breast milk for two years and beyond to
enjoy the maximum protection breast-feeding can provide.
46

47. Strategy for Successful
Breastfeeding
At the delivery suite: first breastfeed within 1 hour after birth unless
medically contraindicated
Post-natal Ward:
Mothers who have had a Caesarean delivery can breastfeed lying down
with help from the nursing staff
Once you are able to sit up, you can breastfeed using the football hold,
which is nursing the baby in a side lying position supported by your arm.
Rooming-in: Having your baby together with you after delivery helps to
build the mother-child bonding process.
47

48. Strategy for Successful
Breastfeeding
Frequency of feed:
√Newborns should be breastfed whenever they show signs of hunger,
for example rooting reflex or increased alertness.
√ at least 8 to 12 breastfeeds per day.
√The frequent breastfeeds help to stimulate the milk production
48

49. Strategy for Successful
Breastfeeding
Helpful tips to Mums:
√ Prepare your nipple, if retracted start pulling it outwards antenatally
√Your baby should be well positioned, correctly latched on and suckling
well when on the breast
√A baby who is sleepy on the breast needs to be coaxed to suckle
√Ensure you are drinking adequately, >3 lit /day
√Have adequate rest, are not stressed or distracted or in pain
√Observe your baby's suckling cues. Your baby may take 15 to 20
minutes to finish a feed from the first breast before offering the second
breast
•Breastfeeding is not always easy and sometimes, a lot of patience and perseverance is
required as mothers may find that breastfeeding is a totally new learning experience
49

50. How do you know if your
baby is getting enough?
Observe the following:
√Baby passes light yellow urine at least 6 to 8 times in 24 hours.
√The frequency of your baby’s bowel movement may vary a lot. On the
average, 3 or more bowel movements per day indicates that your
baby’s milk intake is sufficient.
√Your baby is generally alert, contented and gaining weight.
(There is some weight loss in the first few days of life. Your baby should
gain back the birth weight by 7 to 14 days of life and should then gain
weight weekly.)
50

51. Working And Breastfeeding
√Introduce a bottle of expressed milk to your baby about 2 weeks prior to your
commencement of work as some babies may take some time to get
√used to feeding from the bottle.
√Breastfeed your baby before going to work and when you return home.
√Express your milk regularly or at least once while at work.
√Store the expressed milk in the fridge or freezer.
√Use an ice-filled cooler box to keep the breast milk cool during transportation
51

52. Storage of expressed breast milk
Label the name, date and time of expression of breast milk
52

53. Storage of expressed breast milk
√Freshly expressed breast milk kept in the general compartment of
the fridge at a temperature of 4 degrees Celsius should be used within 48
hours.
√Breast milk kept in the freezer which has a separate door, should be
used within 3 months.
53

54. Thawing of frozen expressed breast milk
A bottle of frozen expressed breast milk can be thawed in the fridge by
placing it in a cup filled with water at room temperature
(Indicate the date and time that the milk is taken out from the freezer and
placed in the general compartment of the fridge. Use this milk in 24 hours.)
54

55. Warming up of expressed breast milk
√For immediate use, you can thaw a bottle of frozen or chilled
expressed milk by placing it in a mug of warm water
√Test the temperature of the milk before feeding
√Discard any unused remainder
√Do not boil or microwave the milk.
55

56. Goals of Breastfeeding
Mothers should be given every support
to exclusively breastfeed their infants
from birth to 6 months of age,
start complementary foods at 6 months
while continuing to breastfeed
till 2 years and beyond …
56

57. Breastfeeding Goals
About 2000 mothers surveyed
• 95% initiated breastfeeding
• 21% at 6 months
Exclusive breastfeeding
• 14% at 2 months
• Health Promotion Board Survey Singapore 2001
1% at 6 months
57

58. Benefits of Breastfeeding
• Infectious diseases
• Long term health outcomes
• Neurodevelopment
• Maternal health benefits
• Community benefits
Breastfeeding and the use of human milk.
Pediatrics. 2005;115:496–506
58

59. Health Outcomes
INFANTS WOMEN
Reduced risk of Reduced risk of
• Acute otitis media • type 2 diabetes by 12% for
• Nonspecific gastroenteritis each year of breastfeeding
• Severe lower respiratory tract • ovarian cancer by 21 %
infections
• breast cancer 28 % in those
• Atopic dermatitis whose lifetime duration of
• Asthma breastfeeding was 12 months
• Obesity or longer
• Type 1 and 2 diabetes
• Childhood leukemia
• SIDS
• Necrotising enterocolitis
59

60. Practical Aspects of
Breastfeeding
60

61. Mother’s position
Any comfortable position
61

62. Baby’s Position
Baby held close to mother’s body
• Infant faces breast with
head and body in straight line
• Upper lip opposite nipple
• Baby can reach breast easily
• Move baby to breast,
not breast to baby 62

63. Preparing for Latch
Insert video Clip
Ensure correct position of baby
• Stimulate rooting reflex with
nipple
• Wait for baby to open mouth
wide
• Baby’s bottom lip touches
base of areola
• Help baby take sufficient
areola into mouth
63

64. Correct Latch - CLAMS
• Chin touching lip
• Bottom Lip curling back
• More Areola visible above
top lip than below lower
lips
• Mouth wide open with big
mouthful of breast
• Sucking pattern change
from short sucks to long 64

65. Assessing Adequacy of Breastfeeding: 3rd day of
life
baby
• Weight loss less than 7%, Regain birth
weight by day 10 -14
• Urine 3 - 4 times/day
• Stools 3 – 4 times/day
• Stools yellow-green by 3rd-4th day
65

66. Assessing Adequacy of Breastfeeding: 3rd
day of life
Mother
• Respond appropriately to early infant
feeding cues and feeding 8 – 12
times in 24 hours
• Comfortable positioning and effective
latch
• Recognise signs of effective
breastfeeding
• Identify available breastfeeding
resources and help 66

67. Fully Breastfed Babies in First Week
Day of life Wet diapers in 24 Stools in 24 hours
hour
First 24 1 1 meconium
hours
Day 2 2 2 meconium
Day 3 3 Stool colour change
Day 4 4, light yellow Transitional stools
Day 5 5, colourless 3 - 4 yellow stools
Day 6+ 6+,colourless 4+ stools, freq and colour
varies 67

68. 68

69. 69

70. Formula Feeding
• Goal standard for nutrition is the
exclusively breast fed infant
• Wide range of commercial formulas,
mainly cows milk based
70

71. Formula Feeding in Infancy
• Caloric requirements 80 –120 kcal/kg/day
• Standard formula: 20 kcal/30 ml or 0.67 kcal/
ml
• Therefore, infant requires 120 – 180
ml/kg/day of formula
• Feeding on demand, generally 2 – 5 hourly, 71

72. Human versus Bovine milk:
Protein
• Higher protein content in bovine milk
• Whey – Casein ratio
• Human milk 70% whey and 30% casein
• Bovine milk 18% whey and 92% casein
Whey protein is digested more easily and
promotes more rapid gastric emptying
• Whey protein
– Human: α-lactalbumin, lactoferrin, lysozyme and
secretory Ig A
– Bovine β-lactoglobulin (? Cow milk protein
allergy) 72

73. Human versus Bovine milk: Lipid
• Human milk has variable fat components with
changes during day, among women and within
one feed
• Formulas mimic human milk fat content by adding
– Carnitine
– Higher Medium chain FA to increase absorption
– Essential fatty acids linoleic and linolenic acid
– Arachidonic acid (AA) and Docosahexaenoic
acid(DHA)
• LC-PUFA are phospholipids in brain, retina 73

74. Human versus Bovine milk:
Carbohydrate
• Human milk has high lactose (90-95%)
and oligosaccharides (10-5%)
• Softer stool consistency and non-
pathogenic bacterial fecal flora
• Oligosaccharides are natural prebiotics,
Lactobacillus and Bifidobacterium spp are
natural probiotics
74

75. Special formulas
• Preterm formulas
– Higher caloric content (24kcal/30ml)
– Higher protein, lipids
– Higher minerals ( Ca, Phosphate)
• Formulas for cows milk allergy
– Extensively hydrolysed milk
• Lactose intolerance
– Soy formula
– Lactose free cows milk formula 75

76. Complementary Feeding of the
Breastfed Baby
• Start weaning about 6 months (WHO guidelines)
• Nutritional basis
– Need for additional minerals e.g. sodium, iron,
zinc
– Caloric dense semi-solids
– Not as supplement to breast milk, as complement
• Developmental basis
– Refusal of solids if introduced too late
– Baby is developmentally ready
• Adequate head/neck/trunk control 76

77. Kangaroo Care
77

78. Kangaroo Care
Kangaroo Care (KC) is skin-to-skin
placement of a diaper clad infant
against the chest of another human
being (usually mother, father)
78

79. What is Kangaroo Mother
Care??
Definition:
• early, continuous and prolonged skin-to-skin contact
between the mother and the baby
• A universally available and biologically sound method of
care for all newborns, but in particular for premature
babies, with three components ...
• 1. Skin-to-skin Contact
2. Exclusive breastfeeding
3 .Support to the mother infant dyad.
79

80. Kangaroo Care
- Mother and Father
80

81. Why the title "Kangaroo
Mother Care"?
Mother kangaroo is a mammal (just like us), and
feeds its baby milk like we do (or like we should!)
from a nipple inside its pouch.
The pouch covers the baby with skin, and this not
only protects the very immature baby, but also
provides it with a total environment which is essential
for development.
This includes warmth, food, comfort, stimulation,
protection.
The baby is CARRIED for all this time, without
interruption !
81

82. At Manama (where birth skin-to-skin contact
started), phototherapy was also done.
The box has lights shining on the baby,
and mother!
The height of the box can be adjusted
using the pegs on the side, to get optimal
temperature and exposure., the round side
holes allowed for inspection.
Sheets in summer, and blankets in
winter, covered all the sides. Mother's
head can extend beyond the top side
cover, or be inside, in which case her eyes
are covered !!!
This picture is posed ... only 3 out of
126 skin-to-skin babies ever developed
jaundice. This box was used mainly to
treat the fullterm babies that developed
jaundice, and could be used without
mother present.
82

83. History
Sr Agneta Jurisoo studied what little literature was available on KMC during
1987. The following year she and Dr Bergman arrived at a small mission
hospital in Zimbabwe, where premature births were common. There were no
incubators, poor transport over great distances, and overloaded referral
centres: only one of ten premature babies survived.
In the absence of incubators, they started a care plan in which the mother
became the incubator. Instead of waiting for the baby to “stabilise”, the
mother was used to stabilise premature infants immediately after birth. It
was immediately clear this was highly effective, no matter how small or how
premature, stabilisation took a mere six hours. With this care, now five of ten
very low birth weight babies survived.
This work has been published:
The "kangaroo-method" for treating low birth weight babies in a developing
country.
83

84. History
• 1979 - Dr Rey and Martinez started program in Bogota,
Colombia, in response to shortage of incubators and
severe hospital infections.
• 1983 - UNICEF brought attention to program Spanish!
• 1985 - Number of visits from USA, UK and Scandinavia,
first English report published in The Lancet by Whitelaw
and Sleath, May 1985.
• 1986 onwards - Research in Europe and USA.
Implementation widespread in Scandinavia and
Germany. Early implementation in Mozambique and
other African countries.
84

85. History
1991 - First review of research published by Gene Cranston Anderson.
1996 - First International Workshop, Trieste, Italy, hosted by Adreano
Cattaneo and team. Noted over thirty different terms used, agreed to use
KMC (Kangaroo Mother Care), defining the program of skin-to-skin contact,
breastfeeding and early discharge. The term “K C” refers only to
intervention “intrahospital maternal-infant skin-to-skin contact”.
1998 - First International Conference on Kangaroo Care, Baltimore, Maryland,
USA, arranged by Susan Ludington-Hoe
1998 - Second International Workshop, Bogota, Colombia, arranged by
Nathalie Charpak and team; focus on research and implementation
2000 - Third International Workshop, Yogyakarta, Indonesia.
85

86. 86

87. OUTLINE
I. Definition & History of Kangaroo Care
II. Physical & Psychological responses
III. Intubated infants
IV. Applying K.C.
V. Kangaroo Care and Lactation
87

88. APPLYING KANGAROO
Normal Newborn NICU
• Temp stabilizer • Thermal regulation
• Slow respiratory rate • Less A’s & B’s
• Early breastfeeding • Weight gain
• Early attachment • Bonding
• process • Parent involvement
• Less crying • with care of baby
• Earlier discharge
88

89. Physical & Psychological
Responses from
Skin To Skin Contact
Infant
&
Maternal
89

90. Benefits of KC for Infants
Early Postpartum Period
• Cry 10 times less and for shorter periods than
infants in cots
• Less distress crying
• More flexor & few extensor muscle movements
• Greater physiologic stability, less crying, & fewer
grimaces during painful procedures (ex. Injections)
• Better attachment to mothers
90

91. RESPIRATORY RATE
• Stabilizes a preemie’s breathing rate 35-50 per minute
• Depth of each breath becomes more even
• Apnea decreases fourfold or is absent
during KC
• Length of apnea episode diminishes
• Periodic breathing is significantly
decreased with normal breathing taking
over.
91

92. THERMAL REGULATION
• Neutral thermal zone - the temperature
range at which a baby has minimal oxygen
needs.
• Baby’s temp rises quickly in the first 10
minutes and then stabilizes to their neutral
thermal zone for the remainder of K.C.session
92

93. OXYGENATION
• Increased oxygenation with increased
blood flow through the vessels the
oxygenation is increased.
• Tools to assess is clinical assessment of
baby
• Transcutaneous pressure of oxygen
(TCPO2), pulse oximeter , carbon dioxide
monitor or blood gases.
93

94. INFANT RESPONSE
CARDIAC
• CARDIAC STABILITY - blood flow is steady and
sustained to the brain with oxygen when there is
less variability of heart rate
• Babies with episodes of bradycardia may not
have bradycardia with Kangaroo Care
• K.C. improves post-extubation cardiorespiratory
parameters after open heart surgery continued
94

95. INFANT RESPONSES
• Increased regular sleep
• Increase states of alertness
• Self-regulatory feeding: relax & feed,
frequently repeat pattern, this aids in
sustained blood glucose levels
• Early opportunity to learn suckling and
breathing coordination
This can save calories thus better weight gain
• Reduces pain score with painful procedure
95

96. 96

97. Long Term Benefits of KC for
Infants- 1 year
• Fewer infections at 6 & 12
months
• Less fussy/crying and more alert states
• Infant in cribs cried 10 times
more frequently than KC infants
• Smiles more often at 3 months
• Ahead in social, linguistic, fine/gross motor
indices at 1 year
97

98. Long Term Benefits of KC for
Infants- 3 year
• Earlier urinary continence
• Earlier stubbornness
• In free play mothers & children were smiling &
laughing more
• Mothers more encouraging & instructing
towards children
Ref; (de Chateau & Weiberg, 1977a, 1977b, 1984)
98

99. Full Term Studies
• Breastfeeding Difficulties - 2003 Anderson & Chiu
Found 30 -90 minutes of KC before anticipated feeding increased
latch-on Increased mothers perception of getting enough display of
cues associated with breastfeeding
Thermal Regulation - Chiu et.al, 2005 and Durand et al, 1997
• Infants breastfed in the KC position stay warm and are warmer that
those breastfed while swaddled or in a cot (bed).
• Exclusive Breastfeeding - Mikiel-Kostryra et al. 2002
• KC promotes exclusive BF >20 minutes of KC is significant predictor
of exclusive BF duration, the more KC they have, the longer the
mother will exclusive BF.
99

100. FAMILIES WHO BENEFIT
FROM KANGAROO CARE
• All families benefit from Kangaroo Care
• Fathers & Support Persons
• Teen Parents
• Adoptive Families
• Substance Abuse Mothers
• Grandparents
• Siblings
100

101. FAMILY CENTERED CARE
• Earlier and increased bonding with mother
• Earlier parental involvement with care of
the baby
• Parents become more “in tune” with
their baby’s cues and responses
• Increase in parents readiness to care
for infant
101

102. KANGAROO CARE AND
LACTATION BENEFITS
• Skin to skin promotes hormone response
in mother to trigger increased milk
production
• Milk Ejection Reflex (MER) frequently
occurs in Kangaroo Care
• Babies will find their way to the breast for
a little “licking and loving”
• Nuzzling at the breast progressing on to
breastfeeding
102

103. MATERNAL RESPONSES
• Bonding to baby - aids in attachment
process for neonates that can already be
difficult to bond with.
• Increased sense of comfort with parenting and
caring for their baby at discharge.
• Strongly identify with their infants and felt
confidence in meeting their infants needs
• Reduces incidence of post partum depression
(PPD)
103

104. 104

105. MATERNAL RESPONSES
• Milk production - increased prolactin
levels with skin to skin
• Milk ejection reflex (MER) - Letdown
Increased oxytocin levels
• Mother more relaxed and confident
• Lactation longevity
105

106. Benefits of Kangaroo Care
for Mothers
• Enhanced maternal-infant attachment & bonding
• Increased maternal self confidence
• Increased maternal affectionate behavior
• Enhanced relaxation
• Experience less anxiety
• Less breast engorgement
• More rapid involution (uterus returning to pre-
pregnant size)
106

107. Benefits of kangaroo care to
institutions
• Shorter hospital stay Advanced healthcare technology only used in addition
to Kangaroo care
• More parental involvement with greater opportunities for teaching and
assessing
• Better use of resources
• Less morbidity and mortality especially in developing countries
• Opportunities for teaching and during pregnancy and follow up in
preparation of postnatal implementation
• Less drain on financial resources
• Promotion of total family health Benefits of Kangaroo care to community
107

108. KANGAROO CARE
AND THE DYING BABY
• For some families it can be comforting to
hold their baby until death occurs.
• This can provide the family with a sense of
comfort and bonding that may not have
been established due to the baby’s critical
status.
• Assists in the grieving process for the
family.
108

109. Which babies are not able to
Kangaroo care
• Unstable babies
• Baby at risk for IVH
• Baby with immature skin
• Baby on vasopressor drugs
• Babies with arterial lines
• Prolonged or severe apnoea
• Indwelling chest tubes
• UAC,UVC or peripheral arterial lines
• Severely jaundiced babies
109

110. Eligibility criteria: Baby
• Birth weight >1800 gm:
Start at birth
• Birth weight 1200-1799 gm:
Hemodynamically stable
• Birth weight <1200 gm:
Hemodynamically stable
• Hemodynamic stability is a MUST
110

111. Preparing for KMC
Counseling
• Demonstrate procedure
• Ensure family support
• KMC support group
Mother’s clothing
• Front-open, light dress as per the local culture
Baby’s clothing
Cap, socks, nappy and front-open sleeveless shirt or
‘jhabala’
111

112. Kangaroo care :Action
• Discuss with parent. Some may feel
reluctant or embarrassed
• if so, consider kangaroo care with
both dressed/ still providing skin to
skin at the chest and baby’s cheek
areas.
• Document parental decision.
112

113. Requirements for KMC
implementation
• Training
Nurses, physicians and other staff
• Educational material: Information sheets,
posters and video films on KMC
• Furniture
Semi-reclining easy chairs
Beds with adjustable back rest
113

114. How to do Kangaroo Care
• Equipment
• Prepare the environment, quiet, soft
lighting and relaxed.
• Comfortable chair, preferably with
arms, foot stool if desired.
• Screens (optional)
• Parent in opening shirt, Mother bra
less.
114

115. How to do Kangaroo Care
• Baby needs a nappy on and a hat
(optional)
• Blanket for baby.
• Provide cool drink for parent.
115

116. KMC procedure: Kangaroo
positioning
• Place baby between the mother’s breasts in an
upright position
• Head turned to one side and slightly extended
• Hips flexed and abducted in a “frog” position;
arms flexed
• Baby’s abdomen at mother’s epigastrium
• Support baby’s bottom
116

117. 117

118. Kangaroo Care : Action
• Parent should support baby’s buttocks
and back with hands, tucking limbs into
flexion.
• Head and neck positioned to protect
airway eg. not slumped, chin tucked so
that breathing is not compromised.
118

119. Kangaroo Care : Action
• Provide and prepare equipment.
• in addition face mask, oxygen
and suction in case of accidental
extubation/collapse.
• Take and record vital signs of baby and
dress accordingly
• Seat parent and place baby onto
chest.
119

120. Kangaroo Care : Action
• Cover baby with Parents shirt and
place blanket over.
• Consider reclining chair for extra
comfort or use of foot stool.
• Record vital signs after 15 minutes,
reposition ensuring parent and baby
comfortable
• If stable continue with usual
observations
120

121. Kangaroo Care : Action
• Encourage parent to follow babies
cues, if asleep encourage parent to
allow baby to sleep.
• Allow interactions if baby becomes more
alert encouraging eye contact, talking and
suckling at breast.
• Remain available to offer support to
family.
121

122. Kangaroo Care : Action
• Feeding can take place during
Kangaroo care.
• Kangaroo care should be for as long
as comfortable providing vital signs
of baby are satisfactory from
20minutes to a few hours.
122

123. Duration of Kangaroo Mother
Care
• Start KMC sessions in the nursery
• Practice one hour sessions initially
• Transit from conventional care to longer
KMC
• Transfer baby to post-natal ward and
continue KMC
• Increase duration up to 24 hours a day
123

124. KMC during sleep and
resting
Resting
• Reclining or semi-recumbent position
• Adjustable bed
• Several pillows on an ordinary bed
• Easy reclining chair
Sleep
• Supporting garment restraint for baby
124

125. 125

126. 126

127. Discontinuation of KMC
• Term gestation
• Weight ~ 2500 gm
• Baby uncomfortable
• Wriggling out
• Pulls limbs out
• Cries and fusses
• Mother can continue KMC after giving the baby a
bath and during cold nights
127

128. National & International
Endorsements
Kangaroo care has been endorsed as
the standard of care by:
• American Academy of Pediatrics (AAP)
• Academy of Breastfeeding Medicine
• World Health Organization
• Neonatal Resuscitation Program
(American Heart Association & AAP)
128

129. Universal KC
129

130. References
• Kangaroo care in full termKMC_term_table.pdf
• Kangaroo Care in preterm KMC_table.pdf
• KMC practical guide kmc_practical_guide.pdf
• KMC Manual KMC Partici Manual_Complete.pdf
• Guidelines for Infant Development in
the Newborn Nursery. Inga Warren 2001.
Holding your baby close: Kangaroo
care.
• www.MarchofDimes.com/prematurity
• Overcoming Emotional Barriers to
Kangaroo Care Step by Step guide.
• Bliss in association with JNN. 2004
(www.Bliss.org.uk)
130

131. References
• Bergman NJ, Linley LL, Fawcus SR. Randomized controlled trial of
maternal-infant skin-to-skin contact from birth versus
conventional incubator for physiological stabilization in 1200g to
2199g newborns. Acta Paediatr 2004; 93: 779-785. Stockholm.
ISSN 0803-5253
• Kangaroo care compared to incubators in maintaining body
warmth in preterm infants. Ludington-Hoe,S.M.,Nguyen, N.,
Swinth,J.Y, Satyrshur,RD. Biol Res Nurs2(1):60-73. 2000.
• Infant Holding policies and practices in neonatal units.
Neonatal network 21 (2):13-20.Franck, L.S.,Bernal,H., Gale,G
2002.
131

132. 132

133. Bibliography
• Anderson G (1986)Kangaroo care for
premature infants.American Journal
of Nursing July pg 807-809
• Gale G.,Franck L.,Lund (1993)Skin to
Skin (Kangaroo) Holding of the
intubated Premature Infant neonatal
Network Vol 12 No 6 pg49-57
133

134. Kangaroo Position :
• maternal infant skin-to-skin contact
• between the baby front and the mother's chest. The
more skin-to-skin, the better.
For comfort a small nappy is fine, and for warmth a cap
may be used.
• should ideally start at birth, but is helpful at any time.
• It should ideally be continuous day and night, but even
shorter periods are still helpful.
134

135. 135

136. Baby friendly hospital initiatives
136

137. 137

138. 138

139. 139

140. 140