Kangaroo Mother Care (KMC) – Nursing Notes

Kangaroo Mother Care (KMC)
Comprehensive Nursing Notes

Quick Overview

Kangaroo Mother Care (KMC) is an evidence-based, cost-effective approach to care for low birth weight (LBW) and preterm infants. It involves continuous or prolonged skin-to-skin contact between the mother (or caregiver) and baby, ideally with exclusive breastfeeding and early discharge from hospital with appropriate follow-up.

Introduction

Kangaroo Mother Care was first developed in 1978 in Bogotá, Colombia by Dr. Edgar Rey Sanabria as a response to overcrowded neonatal intensive care units and lack of incubators. The practice was named after marsupials (like kangaroos) who carry their premature offspring in pouches.

Today, KMC is recognized globally by organizations including the World Health Organization (WHO) as an essential intervention for improving outcomes of low birth weight and preterm infants, particularly in resource-limited settings.

Did You Know?

According to WHO research published in 2021, Kangaroo mother care started immediately after birth reduces mortality by 40% among hospitalized infants with birth weight less than 2.0 kg.

Components of Kangaroo Mother Care

The “K-CARE” Mnemonic

K Kangaroo Position – Skin-to-skin contact in an upright position

C Continuous Contact – Prolonged and ideally continuous contact

A Adequate Nutrition – Preferably exclusive breastfeeding

R Responsive Support – For mother, infant, and family

E Early Discharge – With appropriate follow-up

1. Kangaroo Position

The baby is placed vertically between the mother’s breasts in direct skin-to-skin contact. The baby wears only a diaper, a hat, and sometimes socks. The baby’s head is turned to one side with the neck slightly extended to keep the airway open and allow eye-to-eye contact with the mother.

The baby’s hips should be flexed and legs spread in a “frog-like” position, with arms also flexed. The baby’s abdomen should be at the level of the mother’s epigastrium.

Kangaroo Mother Care position showing proper alignment

Key Point

The baby should be secured with a cloth/wrap that supports the baby’s back while keeping the baby’s face, chest, abdomen, and arms free. This prevents the baby from sliding down and keeps them secure even when the mother is moving around.

2. Kangaroo Nutrition

Exclusive breastfeeding is the ideal form of nutrition for infants in KMC. For preterm or low birth weight infants who may not be able to breastfeed initially, alternatives include:

Expressed breast milk given by cup, spoon, or nasogastric tube
Supplementation with formula when necessary
Fortification of breast milk for very preterm infants

The skin-to-skin contact in KMC has been shown to improve breastfeeding success rates and milk production in mothers of preterm infants.

3. Kangaroo Support

This encompasses support for the mother, the baby, and the family, including:

Emotional support and education for the mother
Involvement of other family members, including fathers and grandparents
Healthcare support and monitoring
Community support after discharge

4. Kangaroo Discharge

Early discharge from the hospital with the infant in KMC is encouraged when:

The baby is gaining weight consistently (at least 15g/kg/day for at least 3 consecutive days)
The baby maintains stable temperature in the KMC position
The mother is confident and able to provide KMC at home
Breastfeeding or alternative feeding is established
There is no medical issue requiring hospitalization

Regular follow-up after discharge is essential to monitor weight gain, feeding, and overall health status of the infant.

Benefits of Kangaroo Mother Care

Infographic showing benefits of Kangaroo Mother Care

Benefits for Infant

Benefit Category	Specific Benefits	Evidence Level
Physiological	Better thermoregulation Improved cardiorespiratory stability Reduced apnea episodes Improved oxygen saturation	Strong
Growth & Development	Improved weight gain Better head growth Enhanced neurodevelopmental outcomes Improved brain maturation	Strong
Behavioral	Decreased crying Better sleep patterns (increased quiet sleep) Reduced stress Decreased pain response	Moderate to Strong
Feeding	Higher breastfeeding rates Longer duration of breastfeeding Earlier establishment of breastfeeding	Strong
Infection Prevention	Reduced incidence of hospital-acquired infections Reduced mortality from infection Improved immune function via breastfeeding	Moderate to Strong
Long-term	Improved parent-infant bonding Better cognitive outcomes Reduced mortality (up to 40% reduction)	Moderate to Strong

Benefits for Mother

Physiological Benefits

Increased milk production
Earlier establishment of milk production
Increased oxytocin release (helps uterine involution)
Improved sleep patterns

Psychological Benefits

Reduced postpartum depression rates
Decreased anxiety
Increased confidence in caring for the infant
Improved maternal-infant bonding
Sense of empowerment and active participation

KMC Implementation: Nursing Guidelines

Eligibility Criteria

KMC can be initiated for infants who are:

Clinically stable (even if still requiring some medical interventions)
Low birth weight (typically <2000g)
Preterm infants (typically <37 weeks gestation)
Term infants who are small for gestational age

Note: Even infants on respiratory support (CPAP, nasal cannula) can often receive KMC with careful monitoring.

Contraindications

KMC may be contraindicated or requires special consideration in the following situations:

Extremely unstable or critically ill infant
Mechanical ventilation for acute illness
Presence of chest drains
Immediately after major procedures
Inotrope infusions/hemodynamic instability
Umbilical lines (relative contraindication – requires careful positioning)

Step-by-Step Implementation Procedure

Assessment & Preparation

Assess infant’s clinical status and stability
Evaluate mother’s readiness and provide education about KMC
Arrange for a private, comfortable space with a reclining chair
Ensure ambient temperature is around 22-24°C (71-75°F)
Have extra blankets, pillows for support, and a KMC wrap if available

Preparing the Mother/Caregiver

Ask the mother to remove jewelry and wear a front-opening garment
Ensure the mother has emptied her bladder
Have the mother sit comfortably in a chair with support for her back
Wash hands thoroughly and instruct the mother to do the same
Advise the mother that session should last at least 60 minutes (ideally)

Preparing the Infant

Dress the infant in only a diaper, hat, and possibly socks
Check that all tubes and lines are secure
Monitor the infant’s vital signs before transfer
Consider timing around feeding schedule when possible

Transfer & Positioning

Transfer the infant safely to the mother’s chest with assistance as needed
Position the infant vertically between the mother’s breasts
Turn the infant’s head to one side, slightly extended to maintain airway
Place the infant’s legs and arms in a “frog-like” flexed position
Ensure the infant’s chest and abdomen are in direct contact with the mother’s skin

Proper positioning for KMC showing vertical placement

Securing the Infant

Use a kangaroo wrap, tube top, stretchy wrap, or adapted clothing to secure the infant
Ensure the wrap is tight enough to hold the infant securely but not restrict breathing
The wrap should support the baby’s back while keeping face, chest, and arms free
Cover the infant’s back with a blanket for additional warmth if needed

Monitoring During KMC

Monitor vital signs per unit protocol (typically every 30 minutes initially)
Observe for signs of distress, temperature instability, or apnea
Check infant position regularly to ensure airway remains unobstructed
Document start and end times, vital signs, and infant’s tolerance

Ending the KMC Session

Aim for sessions of at least 60 minutes (ideally longer)
Transfer the infant back to the incubator/cot using a two-person technique if needed
Reassess infant’s status after return to the incubator/cot
Provide feedback to the mother about the session
Document the session details in medical records

Practical Considerations for Nursing Care

Duration & Frequency

Minimum duration: 60 minutes per session (to minimize stress from frequent transfers)
Optimal duration: As long as possible, ideally several hours per session
Frequency: Daily, ideally multiple times per day
Continuous KMC (20+ hours/day) provides maximum benefits
Intermittent KMC (a few hours per day) still provides significant benefits

Managing Equipment & Procedures

CPAP/Oxygen: Can be maintained during KMC with careful positioning
IV Lines: Secure and position to prevent dislodgement, have extra tubing available
Feeding Tubes: Can remain in place during KMC
Monitoring: Use portable monitors when available
Routine Procedures: Schedule around KMC sessions when possible

Common Challenges & Solutions

Challenge	Nursing Solutions
Maternal anxiety or lack of confidence	Provide demonstration and hands-on guidance Start with shorter sessions and gradually increase duration Share success stories from other mothers Stay present during initial sessions to provide support
Maternal comfort issues	Ensure proper seating with adequate back support Provide pillows for arm and back support Recommend comfortable clothing (front-opening) Ensure privacy through screens or private rooms
Infant instability during transfer	Use two-person transfer technique Minimize handling by transferring in a single smooth motion Allow infant to stabilize before and after transfers Monitor vital signs closely during transfer
Equipment management (tubes, lines, monitors)	Secure all lines and tubes prior to transfer Use extension tubing if needed Check tube placement after positioning Have extra supplies available for reconnection if needed
Staff resistance or lack of knowledge	Provide evidence-based education about KMC benefits Create clear protocols and guidelines Designate KMC champions on each shift Include KMC in routine care planning

Discharge Planning & Home KMC

Readiness for Discharge with KMC

The infant may be considered for early discharge with continued KMC at home if:

Weight is >1500g (in some settings >1200g)
Gaining weight consistently (at least 15g/kg/day for 3 consecutive days)
Maintaining temperature in KMC position (36.5°C – 37.5°C)
Feeding well (breastfeeding or alternative method)
Mother is confident and demonstrates ability to provide KMC
No significant medical issues requiring hospitalization
Follow-up care is arranged

Nursing Education for Home KMC

Pre-Discharge Education Checklist

KMC Technique

Proper positioning and securing techniques
Duration (as continuous as possible)
Transferring baby safely in and out of position
Adapting KMC for sleeping and daily activities
KMC by other family members (fathers, grandparents)

Monitoring at Home

Daily weight checks using appropriate scale
Signs of illness requiring medical attention
Temperature monitoring techniques
Feeding assessment (adequate intake signs)
Tracking diaper count (minimum 6-8 wet diapers/day)

The “HOME-KMC” Mnemonic for Warning Signs

Teach parents to seek immediate care if they notice:

H Heat – Temperature instability (too high or too low)

O Oxygen – Breathing problems (fast, slow, pauses, blue color)

M Milk – Feeding problems (refusing feeds, vomiting)

E Energy – Lethargy or excessive irritability

K Kolor – Yellow skin (jaundice) or pale appearance

M Movement – Seizures or abnormal movements

C Crying – Excessive or high-pitched crying

Follow-up Schedule

First follow-up: 1-3 days after discharge
Subsequent follow-ups: Weekly until reaching term age (40 weeks corrected age)
After term age: Every 2-4 weeks until 3 months corrected age
Home visits by community health workers when available

Evidence Base & Research

Key Research Findings

2021 WHO-sponsored research found immediate KMC reduced mortality by 40% among infants weighing less than 2.0 kg.
Meta-analyses show KMC reduces risk of neonatal sepsis, hypothermia, and hypoglycemia.
KMC is associated with improved neurodevelopmental outcomes at 12-24 months.
Studies show improved breastfeeding rates and duration with KMC.
KMC has been shown to reduce maternal postpartum depression and anxiety.

Implementation Science & Nursing Role

Nurses play a crucial role in KMC implementation through:

Advocating for KMC as standard of care
Educating mothers, families, and other healthcare workers
Creating supportive environment (privacy, comfortable chairs)
Monitoring and documenting KMC sessions
Developing and implementing KMC protocols
Providing continuity of care from hospital to home

Concept Map: Kangaroo Mother Care

Concept map showing KMC benefits and implementation

Case Study

Clinical Scenario

“Baby Mia was born at 32 weeks gestation with a birth weight of 1650g. She is now 5 days old, has been weaned off CPAP to low-flow oxygen, and is receiving gavage feeds with mother’s expressed milk. The healthcare team is considering introducing KMC.”

Nursing Assessment

Vital signs stable for past 24 hours
Temperature maintaining in incubator at 32°C
Tolerating gavage feeds well
Mother visits daily but expresses anxiety about touching Mia
Low-flow oxygen at 0.5L/min

Nursing Plan

Educate mother about KMC benefits and procedure
Start with 60-minute session when mother is available
Ensure oxygen tubing has sufficient length
Prepare comfortable chair with privacy screen
Monitor vital signs before, during, and after KMC
Document infant’s tolerance and maternal response

Outcome

After initial anxiety, Mia’s mother gained confidence with daily KMC sessions. By day 10, Mia was weaned off oxygen, showing improved weight gain and initiating breastfeeding attempts. KMC sessions extended to 3-4 hours daily. Mia was discharged at 35 weeks corrected age (1950g) with home KMC.

Clinical Pearls for Nursing Practice

Start Early

Initiate KMC as soon as the infant is clinically stable, even if still requiring some medical support. Early initiation is associated with better outcomes.

Duration Matters

Longer is better. Aim for sessions of at least 60 minutes, preferably several hours. Benefits increase with increased duration and frequency.

Transfer Technique

Perfect your transfer technique to minimize stress. Use a two-person transfer method for fragile or unstable infants, moving in one smooth motion.

Position Matters

The true kangaroo position is vertical (upright), with the baby’s head turned to one side, slightly extended. This position optimizes breathing and prevents reflux.

Pain Management

KMC is an effective non-pharmacological pain management strategy. Consider using during minor painful procedures (heel pricks, injections).

Family-Centered Approach

Include fathers and other family members in providing KMC. This promotes family bonding and provides relief for the mother.

References

World Health Organization. (2003). Kangaroo mother care: a practical guide. https://www.who.int/publications/i/item/9241590351

WHO. (2021). Kangaroo mother care started immediately after birth critical for saving lives, new research shows. https://www.who.int/news/item/26-05-2021-kangaroo-mother-care-started-immediately-after-birth-critical-for-saving-lives-new-research-shows

Chan, G. J., Valsangkar, B., Kajeepeta, S., Boundy, E. O., & Wall, S. (2016). What is kangaroo mother care? Systematic review of the literature. Journal of Global Health, 6(1), 010701. https://pmc.ncbi.nlm.nih.gov/articles/PMC4871067/

Conde-Agudelo, A., & Díaz-Rossello, J. L. (2016). Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews, (8). https://doi.org/10.1002/14651858.CD002771.pub4

Ruiz, J. G., Charpak, N., et al. (2017). Kangaroo Mother Care 20 years later: connecting infants and families. Early Human Development, 126, 58-60.

Campbell-Yeo, M., Disher, T., Benoit, B., & Johnston, C. (2015). Understanding kangaroo care and its benefits to preterm infants. Pediatric Health, Medicine and Therapeutics, 6, 15-32. https://pmc.ncbi.nlm.nih.gov/articles/PMC5683265/