Kangaroo mother care

What it is

Kangaroo mother care was born in Colombia: Dr Edgar Rey Sanabria started it in 1978 at the Instituto Materno Infantil in Bogotá, using mothers as a heat source because incubators were scarce. It rests on continuous skin-to-skin contact (the kangaroo position), exclusive breastfeeding when possible, and early discharge home with strict outpatient follow-up. In 2022 WHO recommended starting it immediately after birth, without a first period in an incubator. It complements neonatal care; it does not replace it.

What it requires

• Three components: the kangaroo position, feeding based on breast milk, and early discharge with follow-up.
• The father or another relative can share the position with the mother.
• To sleep, the carrier stays semi-reclined.
• WHO excludes from immediate kangaroo care a baby who cannot breathe unaided after resuscitation, is in shock or is critically ill.

Components

• An elastic cloth wrap or support.
• The mother, the father or another trained caregiver.
• A newborn unit open to the family.
• An outpatient follow-up programme through the first year of corrected age.

How it is applied (and why)

1. Confirm that the baby is stable or eligible per the protocol — the method adapts to the baby's condition.
2. Explain the method to the mother and family and answer questions — the family will be the main caregiver.
3. Place the baby skin to skin, upright between the mother's breasts and under her clothes — so the baby gets the warmth of her skin.
4. Secure the wrap so the neck is neither bent nor overextended — keeps the airway from being blocked.
5. Watch colour, breathing, temperature and saturation at the start and during the position — confirms the baby tolerates it.
6. Support breastfeeding in the kangaroo position and avoid dummies — the position stimulates milk production.
7. Teach how to keep the position day and night and to sleep semi-reclined — continuity brings the benefit.
8. Record the hours in kangaroo position and book outpatient follow-up — this measures adherence.

In nursing practice

• When the kangaroo position is used in the delivery room, the nurse or paediatrician keeps supervision; it is not handed to the mother.
• In very fragile, newly stabilised babies it can be used intermittently, in periods of at least 2 hours.
• The baby shows that it no longer tolerates the position by sweating, scratching, crying or other clear signs of discomfort.
• WHO asks that the family and the baby be cared for as a unit and not separated.

Common mistakes

• Leaving the baby without a wrap: the neck can bend and cause apnoea.
• Interrupting the position often or for short periods.
• Thinking that kangaroo care replaces monitoring or the neonatal unit.
• Leaving the father or other caregivers out of the training.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: WHO advises immediate skin to skin care for survival of small and preterm babies (World Health Organization, 2022); Actualización de los Lineamientos Técnicos para la implementación de Programas Madre Canguro en Colombia, con énfasis en la nutrición del neonato prematuro o de bajo peso al nacer (Ministerio de Salud y Protección Social de Colombia, 2017).

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Representative model, for educational purposes only.