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Skin-to-skin/Kangaroo Care

Father and baby skin-to-skin.jpg

Supporting Families within the neonatal unit to build close and loving relationships with their babies is paramount. A big part of this is ensuring that every baby and family are given the opportunity to participate in regular skin-to-skin contact/kangaroo care. As a region, we pride ourselves in family-centred and family-integrated care and aim to deliver the highest standard of care. With that said, every baby is an individual and should be assessed daily for suitability.

What is skin-to-skin/kangaroo care?

Skin-to-skin is the practice of placing a baby, undressed, directly on the parent/carer's bare chest. This is most commonly done after birth when the baby is dried, placed on the mother/birth parent's chest and then covered with a blanket. However, it is also recommended on an ongoing basis due to the high number of evidenced benefits. Skin-to-skin is particularly important for babies who are born preterm or sick at birth and is common practice in neonatal units, often termed kangaroo care.

Benefits of skin-to-skin/kangaroo care

There are many benefits of skin-to-skin/kangaroo care for parents and their babies. 

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The benefits for babies receiving neonatal care include:

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  • Improved temperature regulation.

  • A more stable heart rate.

  • More regular breathing.

  • Improved oxygenation- lower oxygen requirements and reduced incidence of desaturations.

  • The release of oxytocin (the "happy hormone") and decreased cortisol (the "stress hormone").

  • Improved sleep patterns.

  • Longer alert states and less crying at six months of age.

  • Improved brain development.

  • Improved neurobehavioral and psychomotor development.

  • More successful breastfeeding.

  • Improved weight gain.

  • Non-pharmacological (non-medication) pain relief.

  • Engages all five senses.

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The benefits for parents/carers include:

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  • Improves parent-baby interaction.

  • Enhances recovery after preterm delivery.

  • Promotes recovery from postpartum depression and low mood.

  • Reduces stress and anxiety.

  • Provides the family with the opportunity to recognise and respond to their babies’ behavioural cues, thus, becoming aware of their babies’ individuality and promoting earlier attachment and an increased sense of confidence in caring for their baby.

  • Increased parental satisfaction with caregiving.

  • Promotes bonding and attachment.

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The benefits for breastfeeding/chestfeeding include:

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  • Facilitates access to breast and increases the production of breast milk.

  • Increases breastfeeding rates, the proportion of exclusive breastfeeding at discharge, and longer breastfeeding. 

  • Promotes breastfeeding by increasing milk volume and enhancing the duration of lactation.

Readiness for skin-to-skin/kangaroo care

Most babies on the unit are suitable for Kangaroo care and will benefit from having it regularly and for as long as possible, day or night. It is important for babies receiving intensive care support, particularly those who are ventilated, to have a daily ward round discussion to establish if it is safe to do skin-to-skin/kangaroo care.

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For babies in the special care nursery, it is important to remember that babies can still reap the benefits of skin-to-skin/kangaroo care; the baby can be undressed and will continue to benefit from having skin contact on a regular basis.

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Low temperature and desaturations should not prevent skin-to-skin/kangaroo care as it is known to improve temperature control and respiratory incidents. Night-time is also an appropriate time for kangaroo care if that is when best suited to the family and the baby.

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It is important, however, to consider the baby's readiness to be handled. This can be done by observing the baby's behavioural cues.

Indications for skin-to-skin/kangaroo care

  • Comfort for parent and/or baby.

  • Bonding.

  • Breastfeeding.

  • Non- pharmacological (non-medication) pain relief for baby.

  • Improving long-term outcomes.

Contraindications for skin-to-skin/kangaroo care

  • Unstable infants requiring ventilator support. Stable infants on long-term ventilation or for palliative care can be offered skin-to-skin/kangaroo care.

  • For surgical neonates and those with chest drains, suitability and appropriateness should be discussed with the medical and surgical team.

  • Babies with umbilical lines are often able to have skin-to-skin/kangaroo care where unit policy permits. However, lines should be assessed and secured. Any concerns should be discussed with the medical team.

  • Immediately after an invasive procedure or treatment, i.e. extubation. Simple procedures such as cannulation do not interfere with skin-to-skin/kangaroo care and can offer comfort for the baby.

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When skin-to-skin/kangaroo care is not possible, parents should be shown how to minimise separation by gentle comfort touch, talking, reading, and singing soothing lullabies and olfaction (smell) stimulation. 

Risks of skin-to-skin/kangaroo care

There are very few risks involved with skin-to-skin/kangaroo care.

 

However, some of the potential risks include:

 

  • Hyperthermia (overheating) due to maternal heat transfer.

  • Increased work of breathing, which is often due to poor positioning of the baby’s head.

  • Accidental extubation (dislodgment of the breathing tube).

  • Dislodgement of lines and cannula.

 

These risks are significantly reduced with experience and careful transfer from the incubator. 

 

No risks to parents have been documented. However, research suggests that some parents are discouraged from doing skin-to-skin due to a lack of support and information. Parents may also be scared to have skin-to-skin/kangaroo care for the first time or if their baby has not tolerated it well previously.

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If you are a parent/carer feeling unsupported or anxious about having skin-to-skin/kangaroo care with your baby/s, please speak to your neonatal nurse for advice and support.

Duration of skin-to-skin/kangaroo care

Skin-to-skin/kangaroo care should be done for a minimum of 1 hour to allow the baby to experience an entire sleep cycle whilst being held skin contact. If a skin-to-skin/kangaroo care session cannot be longer than an hour, any amount of skin-to-skin is better than none at all.

 

It often takes about 30 minutes for the baby to settle after transfer. Providing the baby is stable; no time limit should be set. Babies who are deeply asleep should be undisturbed for as long as possible.

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Termination of skin-to-skin/kangaroo care should be at the parent's request or if the baby exhibits any of the following:

 

  • Repeated or profound desaturation (drop in oxygen levels).

  • Repeated or profound bradycardia (drop in heart rate).

  • Repeated or profound apnoea (pause in breathing).

  • Dislodgement or concern about dislodgement of the breathing tube.

  • Dislodgement or concern about dislodgement of venous access (lines and cannula).

  • Unrelenting irritability AND attempts to make the infant more comfortable have failed.

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Babies who need a breast/cup or bottle feed during skin-to-skin/kangaroo care will need to change their position during the feed but can continue with skin-to-skin/kangaroo care after completing the feed.

Babies who are tube-feeding can continue to be fed as usual whilst under close observation.

Skin-to-skin/kangaroo care after discharge from hospital

Skin-to-skin/kangaroo care remains beneficial for parents/carers and their babies after discharge from the Neonatal Unit and is a practice which can be continued.

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It is important to remember to practice safe sleep. Guidance can be found on the Lullaby Trust website.

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