Kangaroo Mother Care A Complete Guide for Mothers and Families
Kangaroo Mother Care A Complete Guide for Mothers and Families A CSR initiative by Himalaya BabyCare Editors Dr. Suman Rao PN Professor and Head, Department of Neonatology, St. John’s Medical College Hospital, Bengaluru Dr. Ranjan Kumar Pejaver Chief Neonatologist at PeopleTree @ Meenakshi Hospitals, Bengaluru
First published in India by HarperVantage 2025 An imprint of HarperCollins Publishers India 4th Floor, Tower A, Building No. 10, DLF Cyber City, DLF Phase II, Gurugram, Haryana – 122002 www.harpercollins.co.in 2 4 6 8 10 9 7 5 3 1 Copyright © Himalaya Wellness Company 2025 Illustrations © Shutterstock 2025 Images © Himalaya Wellness Company 2025 P-ISBN: 978-93-6213-367-0 E-ISBN: 978-93-6213-294-9 This book and its content represent the viewpoint of the editors backed by factual data as reported by the editors. Dr. Suman Rao PN and Dr. Ranjan Kumar Pejaver assert their moral right to be identified as the editors of this work. This book only intends to provide educational and informational value and is not a substitute for professional medical advice, diagnosis, or treatment. Nothing contained herein may be construed to be a treatment. Readers should consult medical experts for the latest childcare information. The publisher is not liable for the opinions and endorsements shared in the book. All rights, including copyright, are reserved. Reproduction, storage, or transmission of any part of the book requires written consent from the publisher and Himalaya Wellness Company. Printed and bound at Thomson Press (India) Ltd.
5 It all began in 1930 in the forests surrounding Dehradun. Mr. M. Manal, the founder of Himalaya Wellness Company, curiously looked on as villagers fed the roots of a local herb to calm a herd of agitated elephants. This herb was Rauwolfia Serpentina, the inspiration that led to the creation of Serpina®, the world’s first natural antihypertensive drug which was launched in 1934. Mr. Manal embarked upon the journey of uncovering the mysteries of Nature at a time when herb-based healthcare was looked at with skepticism. Fuelled by his vision of bringing the best of Nature’s solutions backed by scientific research to people suffering health concerns, he was determined to contemporize Ayurveda through modern technology. With a single hand-operated tableting machine bought after pawning his mother’s bangles, he strode ahead on the road less travelled and full of challenges. It took him four years of extensive research to formulate the first offering, Serpina®, which laid the foundation for Himalaya’s strong foothold in research. In 1955, came the historic breakthrough that established Himalaya as a symbol of trust in the Indian healthcare landscape. Liv.52®, a formulation for liver health, became the best-selling flagship offering and a name synonymous with brand Himalaya. Ever since, as a head-to-heel problem-solving brand, Himalaya has introduced many other iconic products such as Septilin®, Cystone®, Bonnisan®, and Rumalaya® forte, which reinforced the trust of millions of customers, making Himalaya a household name. Broadening horizons, Himalaya diversified into Personal Care, BabyCare, Wellness, and Animal Health while consolidating all portfolios under one umbrella, “Himalaya Since 1930”. Today, Himalaya is a leading global health and personal care brand with close to 500 products sold in over 100 countries – touching millions of lives every day and realizing the promise of Happiness through Wellness in every home and heart. OUR STORY
Kangaroo Mother Care A Complete Guide for Mothers and Families 6 At Himalaya, we believe every baby deserves the gentlest care from the very beginning. Rooted in Ayurveda and backed by science, Himalaya BabyCare offers safe, effective products enriched with the goodness of herbs and free from harsh chemicals, crafted to nurture, protect, and support an infant’s natural development. Beyond creating trusted baby care products, Himalaya is committed to supporting parents with knowledge and baby care initiatives. This booklet on Kangaroo Mother Care (KMC) is part of our ongoing effort to help families of premature newborns. Rooted in skin-to-skin contact, warmth, and bonding, KMC is a simple, proven method that supports healthy growth and stabilizes vital signs. With clear guidance and practical tips, this resource empowers parents and caregivers to practice KMC confidently—even in challenging conditions—while highlighting the vital role of healthcare providers in making this life-saving care accessible. This initiative reflects Himalaya’s steadfast belief that every baby deserves the best start in life—and every parent deserves the support to ensure their baby thrives with love and care from Day 1. Our Purpose
products are free from harsh chemicals such as Synthetic Colors/Dyes, Lanolin, Phthalates, Alcohol, Mineral Oil, SLS/SLES/ALS/ALES,* and Parabens, hence safe for babies. *SLS - Sodium Lauryl Sulfate; SLES - Sodium Lauryl Ether Sulfate; ALS - Ammonium Lauryl Sulfate, ALES - Ammonium Lauryl Ether Sulfate #Based on independent market research survey. For more details visit https://bit.ly/3NnnO0g Himalaya Baby
Research at the Heart The legacy of researching Nature forms the foundation of Himalaya’s opertions. Our baby care products are researched to ensure they are safe, efficacious, and gentle on baby’s delicate skin. Himalaya Baby H
Why Moms Trust Himalaya BabyCare When a baby is born, a mother makes a promise - to protect, nurture, and love unconditionally. Himalaya BabyCare has stood by moms, offering a head-to-heel range of baby care products, inspired by Ayurveda, enriched by Nature, and validated by science, ensuring gentle, effective, and safe care for babies from day 1. Himalaya Baby
Kangaroo Mother Care (KMC) is the best gift a mother can give her preterm or low-birth-weight (LBW) baby to nurture him/her back to optimum health. If you have or are going to have a baby, this booklet is for you.
Foreword.......................................................................... 12 Introduction..................................................................... 14 Concept of KMC............................................................ 15 Benefits of KMC for a Low BirthWeight (LBW) baby.................................................................... 16 Benefits of KMC for a mother...................................... 23 Components of KMC..................................................... 26 Kangaroo position.......................................................... 27 How to provide KMC..................................................... 28 How to prepare a mother or provider for KMC......... 32 How to prepare the baby for KMC.............................. 34 —KMC Binder.............................................................. 34 When to start KMC....................................................... 36 Where to provide KMC................................................. 38 Duration of KMC. .......................................................... 39 Kangaroo feeding policy: Exclusive breastfeeding...... 41 Feeding methods:Tube feeds, palladai feeds, and direct breastfeeding....................................................... 42 Expression of breast milk.............................................. 45 Monitoring a baby in KMC............................................ 48 KMC discharge and follow-up....................................... 51 KMC at home................................................................. 53 Dos and Don’ts of KMC. ................................................. 55 FAQ.................................................................................. 56 Key Messages................................................................... 59 References. ...................................................................... 60
Kangaroo Mother Care A Complete Guide for Mothers and Families 12 FOREWORD Welcome to this important booklet on Kangaroo Mother Care (KMC) for mothers and families edited by Dr. Suman Rao PN and with valuable inputs from other contributors. Dr. Suman Rao PN is DM Neonatology; professor and head at St. John’s Medical College, Bengaluru; WHO consultant; and has published and presented several research papers. Dr. Ranjan Kumar Pejaver is a former president of National Neonatology Forum, India, and as the executive editor, he has coordinated the whole exercise of bringing this booklet together. Kudos to the Himalaya BabyCare division for publishing this as part of their public health education initiative. This booklet on KMC aims to provide you with essential information about Kangaroo Mother Care in a simple and straightforward way, with relevant pictures. I am honored to introduce you to its informative pages and look forward to the profound impact it will have on the lives of mothers, fathers, families, and newborns around the world. KMC is a practical and caring approach to help newborns, especially premature babies, grow and develop in a safe and loving environment. It’s all about keeping your baby close to your skin, just like a kangaroo keeps her joey in her pouch.KMC has a profound impact on breast milk production, early hospital discharge, and the well-being of both premature and full-term newborns. It is also essential in fostering emotional and physical connection between parents and their babies. In the following pages, you’ll find easy-to-understand explanations about what KMC is, how to do it, and why it’s beneficial
13 for your baby. There are tips and guidance that can help you and your family understand and practice KMC effectively. KMC isn’t just a medical technique. It is a high-impact intervention, not only for better survival, but also for better neurodevelopmental outcomes. It’s a way to strengthen the love and affection between you and your baby during those early days and weeks when your little one needs it the most. You will witness the remarkable resilience of newborns who thrive against all odds after being cradled skin-to-skin against their mothers’ chests.You will gain insight into the work of the dedicated healthcare professionals and advocates who tirelessly champion the cause of KMC, working to ensure that every family, regardless of their circumstances, has access to this invaluable practice. This book serves as a testament to the enduring power of human connection and the profound impact that simple acts of love and nurturing can have on the most fragile and vulnerable among us. So, dear reader, let this book be a source of knowledge, compassion, and empowerment for mothers, fathers, families, and healthcare professionals alike, as we collectively strive to create a world where the healing power of KMC is within reach of all who need it. We hope this booklet serves as a helpful resource for you and your family. By learning about KMC, you are taking an important step in giving your baby the best start in life.Thank you for taking out time to read and learn about Kangaroo Mother Care. Best wishes for a healthy and happy journey with your newborn. Dr. Rekha H. Udani Retired Professor & Head Seth GS Medical College and KEM Hospital Mumbai, India
Kangaroo Mother Care A Complete Guide for Mothers and Families 14 INTRODUCTION Kangaroo Mother Care (KMC) is an innovative approach to promote the health and well-being of premature infants. It has gained recognition for its remarkable benefits. KMC is the best method of caring for a baby born too small or one that has come too soon. KMC is the simple act of continuous skin-to-skin contact between a mother and her newborn baby where the baby is kept between the mother’s breasts for a continual and prolonged period and fed only the mother’s breast milk. A ‘preterm’ baby is a baby born too soon, delivered before 37 weeks of pregnancy; and a low birth weight (LBW) baby is a baby born too small, with weight less than 2.5 kg.The best place for a baby to grow well is the mother’s womb, and for a baby born too early or too small, the next best place to recover is on the mother’s chest, between her breasts.This is called Kangaroo Mother Care (KMC). KMC is the most important highimpact intervention for a preterm and LBW baby. KMC is recognized worldwide, not only for better survival outcomes of the baby but also for better neurodevelopmental outcomes. It has numerous benefits not only for the baby but also for the mother. LBW baby in KMC in NICU Kangaroo Mother Care is a comprehensive package of care for the preterm and/or LBW baby that includes early and continuous skin-to-skin contact, breastfeeding support, and early discharge from the hospital.
15 CONCEPT OF KANGAROO MOTHER CARE The concept of KMC is derived from the marsupial model of caring for newborn babies.The baby kangaroo (joey) is born just an inch in size and is cared for in the mother kangaroo’s pouch for 6-8 months till the joey becomes independent enough to live outside the pouch. Human babies are the least mature of all mammals, and the preterm baby is particularly vulnerable. KMC facilitates optimal growth and development in the safest place a baby can possibly be: close to his/her parent. In 1978, doctors in Bogotá, Colombia, were battling with overcrowding, shortage of staff, inadequate incubators, and high newborn mortality. In such a dire scenario, the doctors, based on the knowledge of how the kangaroo cares for her baby, suggested the mothers keep their babies on their chests. This served as a natural incubator. Babies were fed only their mother’s milk and discharged in KMC early to overcome the high burden in the neonatal intensive care unit (NICU). This dramatically improved the survival of preterm babies. Since then, newer benefits of KMC are being discovered every year, and the scientific evidence on the benefits of KMC is overwhelming. Considering the numerous benefits of KMC, the World Health Organization recommends KMC for all preterm and LBW babies. Baby kangaroo (joey) grows in the mother kangaroo’s pouch for 6-8 months.
Kangaroo Mother Care A Complete Guide for Mothers and Families 16 BENEFITS OF KMC FOR A LBW/PRETERM BABY Through the simple act of skin-to-skin contact between the baby and a parent, typically the mother, KMC has proven to offer a multitude of advantages, spanning from physiological improvements to emotional bonding. Though KMC was introduced as an alternative to the incubator to provide warmth to the baby, it is now known that it helps the LBW baby in several ways resulting in not only improved survival outcomes but also improved development. 24-hour warmth: KMC provides a baby the best natural incubator. One of the primary benefits of KMC is its role in temperature regulation. Premature infants often struggle to maintain their body temperature due to underdeveloped thermo-regulatory systems. Incubators have long been the standard solution, but KMC provides a more natural and effective alternative.Close physical contact with the mother's body allows the KMC BENEFITS TOTHE LBW BABY
17 baby to absorb her warmth, creating a conducive environment for temperature regulation.This phenomenon not only reduces the risk of low body temperature but also conserves energy that the baby can use for growth and development. Physiological stability: Beyond temperature regulation,KMC has been shown to stabilize heart rate and breathing patterns in premature infants. Apnea (pauses in breathing) and bradycardia (slow heart rate) episodes are common challenges faced by premature infants. Skin-to-skin contact has a soothing effect that helps regulate these vital physiological functions, leading to improved overall health and reduced medical interventions. KMC is the best method of care for the LBWbaby. KMC keeps the baby warm, better than the incubator.
Kangaroo Mother Care A Complete Guide for Mothers and Families 18 Protection from infections: KMC goes beyond the physiological realm, extending its benefits to infection prevention.The skin is the body's first line of defense against harmful pathogens.The close contact between a baby and the mother's skin forms a protective barrier, reducing the risk of infections commonly associated with premature infants. This natural immunity boost is an essential aspect of KMC's impact on overall infant health. KMC reduces medical interventions and handling by doctors and nurses, further reducing the chance of infections. Very small baby < 1000 g on respiratory support in KMC Early breastfeeding A preterm and LBW baby is at high risk of several complications and death. KMC addresses almost all the problems of the LBW baby and improves survival by 40%. Breastfeeding benefits: A significant advantage of KMC is its positive impact on breastfeeding. Breast milk is the optimal source of nutrition for infants, particularly, for those born prematurely. However, premature babies often face challenges with latching and breastfeeding due to their underdeveloped sucking reflexes. KMC addresses this by placing the baby near the mother's breast, triggering innate feeding reflexes.
19 Weight gain is another crucial aspect that is positively influenced by KMC. Infants who receive Kangaroo Mother Care tend to exhibit better weight gain compared to those in traditional incubator care. Combining skin-to-skin contact and improved breastfeeding results in better absorption of vitamins and minerals, and optimal growth—neither fat nor thin, but just right. KMC saves lives! It improves breastfeeding and helps a LBW baby gain more weight than a baby in incubator care. Emotional bonding: The emotional benefits of KMC are equally gratifying. Bonding and attachment with the parent are critical components of a baby's early development. The intimate closeness between a baby and the parent during KMC fosters a sense of security and belonging. This early bonding can positively affect the child's emotional development and well-being. Studies have indicated that babies who experience early bonding through skin-to-skin contact exhibit stronger emotional development and social relationships as they grow. For parents, KMC serves as an avenue for emotional connection with their infants, instilling a deep sense of caregiving and nurturing. KMC is equivalent to a warm hug which makes you feel instantaneously better when you are sick. Reduction of stress and pain: This is another noteworthy advantage of KMC. Premature infants are often subjected to a range of stimuli that can be overwhelming for their delicate nervous systems. Skin-to-skin contact has a calming effect that
Kangaroo Mother Care A Complete Guide for Mothers and Families 20 soothes the baby's stress responses. Procedures such as a heel prick and blood sampling are less painful during skin-to-skin contact. Similarly, parents experience reduced stress and anxiety when they are actively involved in providing KMC.This mutual benefit reinforces the parent-infant bond and contributes to a more positive caregiving experience. Sleep: KMC also improves sleep in a LBW baby.While sleep is essential for every being, it is of special importance for a baby as this is the time that the brain cells are connecting and growing. KMC destresses a baby and promotes the right kind of sleep so that, when awake, the baby is more alert. KMC helps the LBW baby sleep well KMC reduces pain and stress in a preterm baby.
21 Lower readmission rates: A preterm/LBW baby needs special care beyond the newborn period.The baby is at increased risk of illness and hospitalization in the first few years of life. By improving the overall health of a LBW baby, KMC reduces need for readmission and hospitalization. Higher intelligence: Scientific research suggests that KMC has long-term neurodevelopmental benefits. The stimulation and sensory experiences gained through skin-to-skin contact contribute to healthy brain development. Stimulating the five senses for a baby most appropriately helps the brain’s development. KMC provides the best sensory inputs of touch, smell, taste, protects hearing, and promotes vision. This leads to improved intelligence and motor skills as the child grows. KMC provides a foundation for future learning and exploration. The benefits of KMC extend to adult life. It is found that the brain functioning during adulthood of LBW babies who got KMC during the newborn period is very similar to normalweight term babies. Thus, you saw how Kangaroo Mother Care has revolutionized the care of premature infants through its profound benefits: regulating temperature and stabilizing KMC babies with birth weight < 1000 g at school age
Kangaroo Mother Care A Complete Guide for Mothers and Families 22 physiological functions to promoting emotional bonding and breastfeeding success. By emphasizing the importance of skinto-skin contact and early parent-infant bonding, KMC paves the way for healthier growth, improved neurodevelopment, and enhanced overall well-being. As this method continues to gain recognition and research evolves, the potential for KMC to shape the landscape of neonatal care remains promising, offering a brighter and healthier start for premature infants worldwide. KMC improves cognition and the neurodevelopment of a preterm baby.
23 BENEFITS OF KMC FOR THE MOTHER Preterm birth is a stressful and, at times, traumatic period for a new mother. In addition to the common ups and downs affecting the mother’s psychological state that are often seen in the immediate period after birth, the mother and the family have to cope with the small baby who might be unwell and separated from her and kept in the NICU. The baby may not suckle well at the breast, and the mother will have to express milk to feed her baby. This may have negative consequences for the natural establishment of the mother-infant relationship, affecting the mother’s psychological state, bonding, and interactions with her baby. Kangaroo mother care is an intervention that can reduce stress and enhance attachment and emotional bonding between the mother and her preterm infant. This is essential for the emotional and social development of the baby. KMC has several benefits for the mother too!
Kangaroo Mother Care A Complete Guide for Mothers and Families 24 Self-confidence, emotional satisfaction, and empowerment of the mother: When a baby is too small or sick and admitted in the NICU, the role of the mother may be limited and reduced to a silent spectator. The mother is often too scared to touch or care for her small and sick baby. KMC restores the mother as the main caregiver. KMC empowers parents by fostering confidence and self-esteem in their caregiving abilities. Engaging in hands-on care through skinto-skin contact allows parents to actively participate in their baby's development. This involvement Breastfeeding success: One of the most useful benefits of KMC is its positive impact on breastfeeding. KMC improves breast milk production and helps the mother who is separated from her baby to express adequate milk for her baby. Even a short period of half an hour of skin-to-skin contact improves the volume of milk during each session of milk expression. Mothers learn about their baby’s unique cues for hunger. KMC improves the effect of breastfeeding on the baby. Breastfeeding has several health benefits for the mother including reducing postpartum hemorrhage and the risk of diabetes, breast, and ovarian cancer, and serves as a natural contraception method till 6 months. KMC instills better parenting and coping skills. Triplets in KMC
25 enhances their understanding of their infant's cues and needs, ultimately promoting better bonding and parenting practices. The improved parenting ability and practice may have a role in improving the baby’s intelligence. Reduces stress and postpartum depression: KMC has a direct impact in reducing the mother’s stress and postpartum depression (PPD). PPD or feeling sad after delivery is a very common problem after birth. KMC, by improving coping skills and resilience, reduces PPD. Mothers are able to sleep better and feel more relaxed during the KMC phase. Furthermore,KMC holds economic implications, particularly in resource-limited settings.Traditional incubator care can be expensive and resource-intensive. KMC offers a cost-effective alternative that requires minimal medical equipment. KMC reduces hospital stay and facilitates early discharge. Moreover, KMC can be easily taught to parents, allowing for continuity of care even after discharge from the hospital. By saving lives of LBW babies and improving their health, KMC aids in the development of well-adjusted, intelligent children who become responsible citizens. It is a simple high-impact tool that can be applied anywhere and is the core comprehensive intervention strategy for the small preterm/LBW baby.
Kangaroo Mother Care A Complete Guide for Mothers and Families 26 COMPONENTS OF KMC There are 3 components of KMC: 1. Kangaroo position:Continuous skin-to-skin contact between mother and baby 2. Kangaroo feeding policy: Exclusive breastfeeding 3. Kangaroo discharge: Early discharge and continuation of KMC at home
27 The mother’s chest is the best place for a preterm/LBW baby. The baby is placed naked between the mother’s breasts.This area particularly is warm. The mother or the provider should rest comfortably, preferably in a reclining chair. Ensure the baby is in a semiupright position. Even when the mother sleeps, she should be inclined at an angle of at least 30-45 degrees. The head of the baby should be turned to one side with the chin slightly up; this keeps the airway open and allows eye-to-eye contact between the mother and the baby. The hips of the baby should be bent in a frog-like position, and the arms should be flexed. The baby’s abdomen should be at the level of the mother’s abdomen. The baby should not be too high or too low. If you are able to kiss the top of the baby’s head, the position is optimal. Kangaroo position KANGAROO POSITION
Kangaroo Mother Care A Complete Guide for Mothers and Families 28 HOWTO PROVIDE KMC THE PROCEDURE OF KMC Who is the KMC provider? Ideally, KMC needs to be given by the mother as it has multiple benefits to the mother and the baby, as described previously. KMC is not limited to only mothers; other caregivers such as fathers, grandparents, and trained caregivers, can also provide KMC for the baby's well-being, growth, and development. Foster/Surrogate KMC is a modified version of traditional Kangaroo Mother Care, designed for babies who cannot receive direct KMC from their mother due to various reasons, such as medical conditions or separation. In foster KMC, a designated caregiver, often a family member, takes on the role of providing the essential skin-to-skin contact that supports the baby's development. Mother, father, grandmother, or any other family member can be the KMC provider.
29 In fact, involving other caregivers in providing KMC can have several advantages: Support for the mother: In cases where the mother is recovering from childbirth or has other responsibilities, involving other caregivers can provide support and some relief from the caregiving responsibilities. It may not be possible for the mother to provide KMC if she is sick or if she’s just given birth or has undergone a cesarean section and the baby is in NICU. The surrogate is also needed for continuous prolonged KMC as the mother, at times, needs a break to attend to her own needs. Bonding: Often, the fathers are hesitant to provide KMC as they may not be used to handling a baby, let alone a small LBW baby or they are concerned about their chest hair. Temperature maintenance is very good with the father providing KMC, and it is also an excellent opportunity for the father to bond with his baby. Allowing other caregivers, especially fathers, to provide KMC
Kangaroo Mother Care A Complete Guide for Mothers and Families 30 promotes bonding and a sense of connection with the baby. This is important for building strong relationships between the baby and the family. Flexibility: Allowing different caregivers to participate in KMC sessions offers flexibility in providing continuous care for the baby, ensuring that KMC can be provided throughout the day. Enhanced emotional well-being: Involving family members in KMC can contribute to their emotional well-being as they actively engage in nurturing and caregiving. Encouraging inclusivity: Encouraging other caregivers to participate in KMC promotes an inclusive approach to parenting and caregiving, involving different family members in the baby's care and development. Twins/Triplets: The mother will need the support of a surrogate to provide KMC for twins or triplets. But with appropriate binders (described below) the mother is encouraged to provide KMC to her twins or triplets. Twins breastfeeding in KMC
31 While the mother's physical closeness and breasts can have specific benefits, the primary goal of KMC is to provide a nurturing and comforting environment for the baby, regardless of the caregiver's gender or relationship with the baby. There are several occasions where even a nurse or a doctor in the NICU has become a KMC provider for a baby who has nobody to provide KMC. A semi-reclining chair is required for KMC. In a KMC ward,Mother-Newborn Intensive Care Unit (M–NICU), and at Neonatal nurse providing KMC home, the adult bed should have an adjustable backrest, or 3-4 pillows should be provided to the KMC provider to maintain the 30-45 degree angle. Father providing KMC in reclining chair Maintain a semi-reclining position of 30-45 degrees during KMC.
32 Kangaroo Mother Care A Complete Guide for Mothers and Families HOW TO PREPARE A MOTHER OR PROVIDER FOR KMC You can use any front-open, light dress that the mother feels comfortable using. A shirt or wrap-around blouse which fully opens in the front is best while providing KMC to a sick NICU baby. All jewelry from the neck and hands are best removed. The nails should be clipped short. Practice basic hygiene measures such as daily bathing and a clean set of clothes.
33 Practice hand hygiene diligently.The steps of hand hygiene are shown below: Steps for hand hygiene Hygiene of the KMC provider is a prerequisite to practicing KMC.
Kangaroo Mother Care A Complete Guide for Mothers and Families 34 HOW TO PREPARE THE BABY FOR KMC Dress the baby in a cap, socks, and leak-proof diaper. You can make the baby wear a front-open sleeveless shirt made of a soft natural fabric like cotton, if the weather is cold. But the front of the baby should be naked. All the essentials for the baby for KMC are shown in the figure below: cap, socks, diaper, and binder. KMC BINDER The baby should be securely bound to the mother or KMC provider. It is important to ensure that the binder supports the neck and lower part of the head of the baby.The binder should be made of soft clothing material like cotton, flannel, or lycra. Several types of binders can be used. A dupatta/piece of cloth may be enough for a short duration of KMC. The KMC bag is a binder made of soft flannel cloth, with a KMC essentials
35 loop that can be adjusted around the neck and two unequal cords that can be tied around the waist of the provider. It is designed in such a way that the provider on her/his own can take the baby in and out of the KMC position. For prolonged hours of KMC, during sleep or ambulation (moving/walking), a binder that supports the baby from below is necessary to ensure safety. Please note that the mother also relaxes and sleeps during KMC. Hence, a binder is essential to prevent the baby from slipping down when the mother sleeps. A binder is essential, especially for prolonged KMC and for ambulatory KMC. Different KMC binders
Kangaroo Mother Care A Complete Guide for Mothers and Families 36 WHEN TO START KMC A LBW or preterm baby is ready for KMC immediately after birth. Earlier, the doctors and nurses would wait for baby to stabilize (to breathe well without any respiratory support) before starting KMC. Now it is known that starting immediate KMC is more beneficial to the baby. To initiate KMC immediately after birth, we need to consider the following: Awareness of KMC Identification of the surrogate Skills in providing KMC to sick LBW babies Setting up a M-NICU The families of a LBW or preterm baby need to be aware of the benefits of KMC before birth. Antenatal counseling of Start KMC immediately after birth even if the baby is not stable. Mother and baby in MNICU
37 the benefits of KMC will improve the conviction in KMC as the best method of care.The family can identify a surrogate who can start KMC immediately if the mother is unable to provide continuous and prolonged KMC. The doctors and nurses providing immediate KMC need special skills to transfer a sick baby to the position, provide respiratory support like ventilation and oxygen, and monitor the sick baby in the KMC position. The small, sick baby may be taken to the NICU in KMC position. Some hospitals have converted the NICU to Mother-NICU (M-NICU), where an adult bed is placed in the NICU, and the mother and her sick newborn baby are cared for together to facilitate immediate and continuous KMC. Immediate KMC is a newWHO recommendation, and hospitals are currently in transition to follow this recommendation. Start KMC immediately after birth, even if the baby is not stable.
Kangaroo Mother Care A Complete Guide for Mothers and Families 38 WHERE TO PROVIDE KMC KMC can be provided in the NICU for a very small or sick baby. For a stable LBW baby, KMC can be provided in the KMC ward or in the postnatal ward. KMC should be continued at home after discharge. KMCWard DURATION OF KMC Every KMC session should last at least 1 hour to prevent frequent handling of the baby. The duration of each KMC session should be increased for as long as the mother can comfortably provide KMC. A minimum of 8 hours per day of KMC is a must for the baby to get the benefits of KMC.
39 Providing continuous and prolonged KMC for more than 20 hours per day has maximum benefits. Recording the daily hours of KMC in a KMC sheet both during hospital stay and at home helps in improving the duration of KMC. Sheet to document the hours of KMC
40 Kangaroo Mother Care A Complete Guide for Mothers and Families Tips to increase the duration of KMC To increase KMC to more than 8 hours per day, some hospitals prescribe KMC for 2 hours, 4 times a day. Many hospitals encourage nurses and doctors to examine, monitor, and treat the baby in the KMC position. Get the support of your family members to increase the total duration of KMC. To ensure that each session can continue without interruption for at least two hours, finish your meal and make a trip to the restroom before beginning KMC. Feed the baby in the KMC position, whether on tube feeds, palladai, or direct breastfeeding. KMC can be done for twins or triplets at the same time. You can move around, listen to music, read to your baby, or read books during KMC to increase the duration. Provide KMC for a minimum of 8 hours per day. Each session of KMC should last for at least 1 hour.
41 KANGAROO FEEDING POLICY: EXCLUSIVE BREASTFEEDING Breast milk is the best for a preterm baby. Your breast milk is the lifeline for your preterm LBW baby. While breastfeeding is important for all babies, it holds more importance for preterm babies. Preterm breast milk is more nutritious with higher protein and sodium content and fulfills the special needs of the small baby. Each mother’s milk is unique and is designed for her baby, and so mother’s own milk (MOM) is preferred over any other breast milk, like donor milk from a milk bank. No other milk comes close to the magnificence of MOM for a baby. Exclusive breastfeeding Exclusive breastfeeding means providing only breast milk for feeding. No other milk or food or water is given to the baby, except medicines. Small babies need some nutrients such as calcium, phosphorus, multivitamins, and iron which can be given mixed in a small amount of breast milk. Some small babies need “fortifiers”, which need to be added in the breast milk.These will be prescribed by your doctor. Exclusively breastfeed for 6 months and continue breastfeeding for at least one year along with optimal complementary feeds.
42 Kangaroo Mother Care A Complete Guide for Mothers and Families FEEDING METHOD:TUBE FEEDS, PALLADAI FEEDS, AND DIRECT BREASTFEEDING Tube feeding:A feeding tube is passed through the mouth/ nose into the baby’s stomach.The tube is fixed with a small plaster on the cheek. Palladai feeding: Palladai is a traditional spoon with a spout. Cup feeding:A smooth rimmed cup, or special plastic cups can be used for feeding. Small amounts of feed can also be given with a syringe or a spoon. Alternate methods of feeding a LBW baby No bottle-feeding No pacifiers Mother’s Own Milk (MOM) is the best for a preterm baby.
43 Gestational age Method of feeding Explanation <32 weeks Tube (Gavage) feeding Sucking and swallowing abilities are present at birth but are not mature. 32-34 weeks Palladai feeding Swallowing and breathing are coordinated by 32 weeks, hence palladai feeding can be given. >34 weeks Direct breastfeeding + palladai feeding By 34 weeks, babies can coordinate sucking, swallowing, and breathing, so direct breastfeeding can begin. But, the small baby may tire easily, and so it is necessary to offer palladai feeding after feeding directly. The signs of good attachment are: More areola is visible above the baby’s mouth than below. The baby’s mouth is wide open. The lower lip is turned out. The chin is touching the breast. Good attachment Preferred ways of feeding as per gestational age
Kangaroo Mother Care A Complete Guide for Mothers and Families 44 The preferred position for the preterm LBW baby is the cross-cradle or football position. Avoid feeding the LBW baby in a lying position. Some babies may feed well with the dancer hold (see picture below) position. Babies should be fed at a fixed schedule of 2-3 hours, in addition to responsive feeding (based on the baby’s hunger cues). Once the baby is of good weight, feeding can be only responsive, but should be at least 8 times per day. Preterm babies and sick babies may not be able to breastfeed immediately after birth. Some babies may even be kept “nil per oral” i.e. no feeding at all with nutrition provided intravenously. The small baby may be started on small amounts of feeding which is gradually increased to full feeds.There may be occasions when feeding is stopped or reduced based on baby’s condition. Awareness that these ups and downs are quite routine help the family deal with the situation more confidently. Preterm/LBW babies need alternative methods of feeding like tube feed, palladai, or cup-feeding.
45 EXPRESSION OF BREAST MILK BY HAND Wash your hands thoroughly and pat themdry with a clean cloth. Sit or stand comfortably and hold a clean wide-mouthed container near the breast. Put the thumb above the nipple and areola, and the first finger or first two fingers on the breast below the nipple and areola, opposite the thumb, like the letter“C”.Support the breast with other fingers. Press the thumb and the index finger or first two fingers slightly inwards towards the chest wall. Press the breast behind the nipple and areola between the first or first two fingers and the thumb. Press and release. Repeat. At first, no milk may come, then milk will start to drip out; it may flow in streams. Press the same way from the sides, to make sure that milk is expressed from all parts of the breast. Expression of breast milk
46 Kangaroo Mother Care A Complete Guide for Mothers and Families Avoid rubbing or sliding the fingers along the skin. Avoid squeezing close to the nipple. Express one breast for at least 3-5 minutes after the flow slows; then express the other side and then repeat on both sides. To express breast milk adequately, it takes 20-30 minutes, especially in the first few days. It is important not to try expressing in a shorter time than that. Alternatively, milk can be expressed by breast milk pump. Storing expressed milk Master the art of breast milk expression.The more you express, the more you produce. Storage location and temperatures Type of breast milk Room temperature (16-29°C) Refrigerator (-4°C) Freezer (<-4°C) Freshly expressed or pumped Up to 4 hours is optimal; 6-8 hours is acceptable under very clean conditions. Up to 4 days; 5-8 days under very clean conditions. Within 6 months is optimal;12 months is acceptable. Previously frozen or thawed 1-2 hours Up to 24 hours Never refreeze mother’s milk after it has been thawed. Left over from a feeding Use within 2 hours after the baby has finished feeding
47 Tips for successful breastfeeding in a preterm infant Start expressing milk immediately after birth. Colostrum is the first vaccine. Express milk at least 8-12 times a day even if the baby is not fed. Express milk/pump the breast for 20-30 minutes. Express at night, too. Practice non-nutritive sucking i.e a small/ sick baby sucking on an empty breast. Massage the breast before expression. Back massage is also helpful. Express milk with baby in the Kangaroo position. Quantify the milk expression and work towards the goal of 500 ml per day by 10-14 days. Eat well and drink plenty of water. Remember breast milk is 88% water. Traditional food known to increase milk production including methi and garlic, can be consumed. Believe that you will be able to successfully breastfeed your baby.With the support of doctors, nurses, and family, every mother can successfully breastfeed her small baby.
Kangaroo Mother Care A Complete Guide for Mothers and Families 48 Back massage Breast massage Nurse supporting breastfeeding Transitioning to full direct breastfeeding All babies on tube feed should be allowed to practice non-nutritive sucking. Once the baby is about 32-weeks, palladai/cup-feeding can be tried. While transitioning from palladai feeding to direct feeding, always offer direct breastfeeds first.You may need to express a small amount of milk first so that the baby is not overwhelmed with the full flow. Watch out for coughing or choking. Offer palladai or a cup of expressed breast milk after direct breastfeeds. Gradually, the amount of intake of expressed breast milk (EBM) will be reduced. Continue to watch the weight gain of the baby every week. All preterm/LBW babies can successfully be exclusively breastfed for 6 months.
49 MONITORING A BABY IN KMC Preterm/LBW babies need intensive monitoring in immediate KMC as they are still not stable.This monitoring will be done by the nurses and doctors.The mother and the KMC provider also need to monitor the baby during KMC and alert the health personnel, if necessary. The monitoring done by the mother contributes to the improved outcomes with KMC. Temperature: Touch the soles of the baby and the tummy. Both should be equally warm. If the soles are cold, check the temperature with a digital thermometer placed in the axilla till the beep sound is heard. Normal temperature is 36.5 – 37.5°C. If lower, then cover yourself with an extra layer of clothing. If low temperature persists, seek care. Monitoring a baby’s weight and temperature Airway, apnea, and breathing: Ensure that the neck is slightly extended so that the breathing is normal. Feel the breathing of the baby against your chest. If breathing ceases, gently stimulate the baby. If it persists, seek care urgently.
Kangaroo Mother Care A Complete Guide for Mothers and Families 50 Breastfeeding: Feed the baby 8-12 times a day. If the baby who has been feeding well stops feeding well, then seek care. Compliance with Kangaroo Care: Document the duration of KMC on the KMC chart. Danger Signs: Look for danger signs and seek care if any are present. Education and Empowerment: Ensure that you are educated on all aspects of KMC. Follow-up: Be aware of the follow-up schedule and bring the baby for regular follow-ups in the KMC position. Growth andWell-being: At all visits, monitor for weight gain and any new illnesses. Monitoring a preterm/LBW baby in KMC should be done by the KMC provider along with the health care personnel. Monitoring of the baby in KMC position
51 KMC DISCHARGE AND FOLLOW-UP The benefits of KMC and improved health of the preterm LBW baby aid in earlier discharge. Early discharge and adequate follow-up is the third component of KMC. Babies are usually discharged after 34 weeks and at least a weight of 1.5 kg, though this may differ between hospitals. Discharge criteria for a baby Weight gain of 15-20 g/kg per day Feeding well at breast or by palladai Maintaining temperature without assistance No evidence of illness Mother is confident of KMC and care of the small baby Danger signs Stopped feeding well History of convulsions Fast breathing (breathing rate >60 per minute) Chest is drawn in No spontaneous movement Fever (temperature>37.5°C) Low body temperature (temperature<35.5°C) Jaundice in the first 24 hours after birth or yellow palms and soles at any age
52 Kangaroo Mother Care A Complete Guide for Mothers and Families Pre-requisites for discharge The mother and family must be aware of the danger signs to bring the baby immediately to the hospital immediately. Discuss how to: ► Care for the baby at home— when to bathe, traditional practices that are helpful (massage) and harmful (that need to be avoided, such as oil instillation in the nose/mouth) ► Early intervention therapy (including nurturing and responsive care) ► How to provide KMC at home; have a plan to aim at >20 hours/day of KMC. Continue to fill the KMC chart. The follow-up plan (when, where, and how often) should be clear to the family. Small babies need follow-ups weekly till they are at least 2 kgs. A small baby is at high risk of developmental problems and should be on a detailed developmental surveillance till 2-3 years. Baby should be transported home and for follow-up visits in the KMC position. KMC promotes early discharge, but frequent follow-up is essential. Pre-discharge counseling
53 KMC AT HOME It is advised to continue KMC until the baby reaches at least >2.5 kg. Babies are discharged early from the hospital with the understanding that KMC will also be continued at home. At home, the family should provide continuous KMC aiming at >20 hours/day. This is possible with family support. Even in nuclear families, careful planning can achieve prolonged hours of KMC. The KMC provider carrying an infant in the KMC position can walk, stand, sit, or engage in different activities. Continue to document the daily duration of KMC in the compliance sheet. A follow-up visit in 2-7 days after discharge will ensure that home KMC is well-practiced. Continued motivation, counseling, and support may be needed. KMC at home: Chores including cooking, laundry, feeding other kids, and reading can be done with baby in KMC.
Kangaroo Mother Care A Complete Guide for Mothers and Families 54 Discontinuation of KMC Usually by about 37-40 weeks of gestational age or around 2.5 kg, the baby shows signs of discomfort like wriggling, trying to pull out limbs, crying, and being fussy during KMC, which is the time to wean the baby from KMC. KMC can be continued as long as the mother and baby are comfortable even beyond 40 weeks or 2.5 kg. Do not stop abruptly, but reduce the duration gradually. Continue KMC at home as long as the baby accepts KMC, usually until the baby is at least 2.5 kg.
55 DOS AND DON’TS OF KMC DOS OF KMC Prepare to give at least 1 hour of uninterrupted KMC. Wear a full front-open gown for easy placing and good skin-to-skin contact. Ensure the baby is wearing a cap, socks, and if needed, a front-open shirt. Before keeping in KMC, change baby’s diaper to a fresh one. Ensure baby’s head is turned to one side and slightly extended. Use locally available binders to ensure safety. Sing a lullaby; read a book; tell stories or talk to your baby while in KMC. Wear a mask while doing KMC if you have cough or cold. Don’t clean the chest every time before keeping the baby in KMC. Don’t use perfumes before giving KMC. Don’t smoke or use tobacco while doing or before doing KMC. Don’t use mobile or other electronic devices while giving KMC, as they can be distracting. Don’t do KMC if you have any local (chest) skin infections. Do not lie down flat while giving KMC.Maintain at least a 30-45o angle. Do not bottle-feed the baby. Do not bathe the baby till she/he is 2.5 kg. DON’TS OF KMC
Kangaroo Mother Care A Complete Guide for Mothers and Families 56 FAQ 1.Why should I practice Kangaroo Mother Care? The preterm/LBW baby is immature and vulnerable to many problems. KMC provides the best environment for growth and development. KMC has been shown to double survival in LBW infants. It also keeps babies warm and protects them from infections. It increases breastfeeding rates, helps babies breathe better, improves growth, and promotes good bonding between mothers and their babies. It is one of the key components of developmental supportive care and thus helps in brain development. It is the best gift you can give your small baby. 2. My baby is born at term. Can I give KMC? KMC is currently recommended for preterm babies< 37 weeks at birth and/or weighing < 2.5 kg. However, all babies should receive skin-to-skin contact at birth, and the practice can be continued if the KMC provider and baby are comfortable. It is particularly useful if the baby has difficulty in latching or if the mother feels she has less milk. 3. Can my sister or mother give KMC? Yes. Any of the close family members can give KMC. However, benefits are maximum when mother gives KMC. 4.My husband has a lot of hair on his chest.Can he give KMC? Yes. KMC can be given. In fact, the hairy chest helps maintain temperature well.
57 5. Should I bathe or clean my chest every time before giving KMC? Bathing once a day and wearing clean clothes should be enough. There is no need to clean the chest each time. 6. Can I feed my baby in KMC? Yes, feeding the baby in KMC is recommended. Though it may be challenging initially, you can master it. It is good to wear a full front-open shirt or gown; you can loosen the binder and feed the baby in the same position or with minor adjustments. 7. Can I express milk during KMC? Yes, you can express milk during KMC by adjusting the binder. You can either use hand expression or a breast pump. 8. For how long should we keep the baby in the KMC position? KMC is initiated right after birth and practiced all day and night, every day. A minimum of 8 hours is recommended, but baby can be kept in KMC as long as possible. Many families are able to provide >20 hours of KMC per day. 9. Does giving KMC increase the risk of infection for my baby? No, in fact providing KMC reduces the infection by 45%, and more so, if started immediately after birth. 10. How long should I continue KMC? KMC is continued until the baby does not want to be in the position any longer. Most babies will stay in KMC till they reach about 2.5 kg and are able to suck and breastfeed.
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