1.
Kangaroo Mother Care
(KMC)
Mukesh Sah, MD
Post graduate Medical Intern

2.
Kangaroo Mother Care (KMC)
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3.
Background (1/2)
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• The global prevalence of low birth weight (LBW) is
15.5%, which amounts to about 20 million LBW infants
born each year (WHO, 2003).
• Among which, 96.5% occur in developing countries.

4.
Background (2/2)
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• Globally, low birth weight (LBW) contributes to
60% to 80% of all neonatal deaths.
• Preterm birth and small for gestational age is
the most common direct cause of newborn
mortality, is one of the reason for low birth
weight.
• Prematurity is the primary cause of newborn
death accounting to 31% (NENAP, 2016).

5.
What is Kangaroo Mother Care?
• Kangaroo Mother Care (KMC) is care
of newborn infants secured skin-to-skin
to the mother
• KMC is a powerful and easy to use
method to promote the health and well-
being of
o Low birth weight (LBW) - infants
with birth weight below 2500g
o Preterm infants – infants with
gestational age less than 37 weeks
o Full term infants
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6.
Reasons why KMC was implemented (1/2)
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• In 1979, while working in hospital of Bogota,
Colombia, Dr. Edgar Rey & Hector Martinez,
found out that:
• Large numbers of LBW & preterm infants were
delivered because of:
oPoor Antenatal Care attendance
oHigh incidence of toxaemia of pregnancy,
anaemia & infections
oShortage of staff & inadequate equipment

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Reasons why KMC was implemented (2/2)
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• High infection & mortality rate because of
overcrowding
• Large numbers of infants who were abandoned by
their mothers

8.
KMC Practice in Colombia
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• Maternal-infant skin-to-skin contact was
introduced to stable LBW infants surviving the
first few weeks of life
• Exclusive breastfeeding was encouraged
• As long as infants could feed and were gaining
weight, they were discharged, regardless of
weight

9.
• This practice resulted in:
o Improved outcome for LBW infants
o Decreased hospitalisation time
o Less overcrowding
o Less abandoned infants
o Improved staff morale
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10.
Scientific evidence showed
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“Incredible survival of Kangaroo
Babies hence KMC practiced in rest
of the of the world”

11.
Why is it called Kangaroo Mother Care?
• A newborn baby kangaroo (joey) is very immature at birth
and very small in size.
• The mother kangaroo’s pouch provides warmth, safety and
a constant supply of food (milk) to the joey.
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12.
Similar to kangaroo care giving the human infant is also
immature and especially the LBW infant benefits from
skin-to-skin care because it provides warmth, safety and
food.
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13.
Additionally…
• As incubators and radiant
warmer are expensive, require
skilled staff and reliable electric
power, many hospitals do not
have them or not enough.
• Babies born in hospitals who
need incubators or radiant
warmer to keep them warm
often have to share them.
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14.
• Sharing incubators is
risky because if one
baby becomes ill he can
easily pass the infection
to the other baby.
• KMC was developed
as a way to maintain
the normal body
temperature of low birth
weight and premature
babies born in hospitals
that do not have
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15.
Types of KMC
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1. Continuous KMC or full KMC
2. Partial or intermittent KMC

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Continuous KMC
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• When KMC is practiced ideally for 24 hour
except cleaning the diaper, or breast feeding.
• At least 18 hours is compulsory.
• KMC may discontinue for very short periods
when the mother has to bathe or attend to other
personal needs.
• It requires support from the family members,
including the husband.

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Partial or intermittent KMC
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• Less than 18 hours but it should not be less than 3
hours a day.
• The duration of
condition of the
mother.
intermittent
infant and
KMC depends
the availability
on the
of the

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Components of KMC
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• Continuous skin to skin contact between baby’s front
and mothers chest.
• Exclusive breastfeeding.

19.
1. Continuous skin to skin contact
between baby’s front and mothers
chest
• Place the baby between the mother’s breasts in
an upright position
• Continuous or intermittent
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20.
Eligibility Criteria for KMC: Baby
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• All stable low birth weight babies are eligible for KMC.
• Sick babies needing special care should be cared
under radiant warmer initially.
• KMC - started after the baby is hemodynamically
stable.
• HEMODYNAMICALLY STABLE: IS A MUST!!

21.
Guidelines for practicing KMC according
to weight
allows initiation of KMC.
• Birth weight >1800 g: These babies are
generally stable at birth. Therefore, in most of
them KMC can be initiated soon after birth.
• Birth weight 1200-1799 g: It might take a few
days for stabilization before KMC can be
initiated.
• Birth weight <1200 g: Frequently, these
babies develop serious prematurity-related
morbidities often starting soon after birth. It may
take days to weeks before baby's condition
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22.
Eligibility Criteria for KMC: Mother
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• Willingness
• General health and nutrition
• Hygiene
• Supportive family
• Supportive community

23.
2. Exclusive Breastfeeding
• The kangaroo position is ideal
for breastfeeding.
• The cloth that wraps around
the mother and baby is
loosened to breastfeed.
• Initially tube or cup feeding
before breastfeeding is
established.
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24.
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25.
Pre-requisites for KMC
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1. Support to the mother
2. Post discharge and follow up

26.
Support to the mother
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• Health care staff support in hospital
o Emotional support – The mother needs
encouragement if she is to give KMC
o Teaching mothers the skill to take care of
their LBW infants
o After discharge infants need regular follow-
up to check satisfactory weight gain at
clinics close to home
• Support from the family at home to help mother
take care of her infant and practice KMC at
home.

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Any family member can do it!
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28.
Early discharge and follow up
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The mother continues to practice KMC after the
infant is discharged.
Eligibility criteria for discharge:
• Baby’s general health is good and there is no
concurrent disease such as apnoea or infection
• Feeding well, and is exclusively or
predominantly breastfed

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• Follow-up visits ensured
• Gaining weight (at least 15g/kg/day for at least three
consecutive days)
• Temperature is stable in the KMC position
• Mother is confident
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30.
Benefits of KMC
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• To the baby
• To the mother
• To the hospital
• To the nation

31.
Benefits to the baby
best
• Baby kept warm 24 hours as mother is the
incubator
• Breathing becomes regular as it reduces apnoea
• Breastfeeding better and gains weight faster
• Infants are much less stressed and this provides
neurological protection to the infant
• Better organized sleep patterns
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32.
Benefits to the Mother
• Confidence in caring for her infant is boosted
• Improved bonding between mother and infant
due to the physical closeness between them
• Mothers are empowered to play an active role in
their infants care
• Mothers are enabled to become the primary care
giver of their infants
• Breastfeeding is promoted
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33.
Benefits to the Hospital
• Significant cost-savings as well as better
outcomes
o Less dependence on incubators
o Less nursing staff necessary
o Shorter hospital stay
• Improved morale & quality of care
• Better survival
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34.
Benefit to the Nation
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• KMC result in healthier and more intellectual babies
and thus adds to the nation wealth.
• Decrease neonatal mortality and morbidity.
• Simple and applicable everywhere and cost effective.

35.
Preparing for KMC (1/4)
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• Initiation of KMC
• Counselling
• When baby is ready arrange a time that is
convenient to the mother and baby
• Demonstrate her KMC procedure in a caring,
gentle manner with patients

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Preparing for KMC (2/4)
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• Answer her all her queries and allay her anxieties
• Allow her to bring other family members during this
time
o It helps in building positive attitude of the family and
ensuring family support to the mother which is
particularly crucial for post-discharge home-based
KMC.
o It is helpful if the mother starting KMC interacts with
someone who is already practicing KMC.

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Preparing for KMC (3/4)
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• Mother's clothing
KMC can be provided using any front-open, light dress
as per the local culture. KMC works well with blouse and
sari, gown.
• Baby’s clothing
Baby is dressed with cap, socks, nappy, and front open
sleeveless shirt, Bhoto in winter.

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Preparing for KMC (4/4)
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• Supporting garment
▶ To carry the baby in kangaroo position – KMC sling or
3.5 meter cloth that will allow the mother or the father
or the relatives to sleep with the baby in that position.

39.
Time of Initiation
• KMC can be started as soon as the baby is
stable.
• Babies with severe illnesses or requiring special
treatment should be managed according to the
unit protocol.
• Short KMC sessions can be initiated during
recovery with ongoing medical treatment (IV
fluids, Oxygen Therapy).
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40.
Procedure of KMC
privacy: Since it requires some
▶ Provide
exposure of mother culturally acceptable
privacy should be given in nursery, wards and
NICU.
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41.
Kangaroo Position (1/2)
• Baby should be placed between mother’s
breast in upright position.
• Head should be turned to one side in slightly
extended position. The slightly extended
head keeps the airway open and allows eye
to eye contact with mother.
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42.
Kangaroo Position (2/2)
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• Hips should be flexed and abducted in a “frog”
position and arms should also be flexed.
• Baby’s abdomen should be at the level of mother’s
epigastrium. Mother’s breathing stimulates the baby
thus reducing apnoea.
• Support the baby’s bottom with a sling/binder.

43.
Feeding
• Explain about breastfeeding while in KMC
• Can give express breast milk cup/spoon, orogastric
tube
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44.
Monitoring
• Important especially in early stage
• Make sure neck in slightly extended position
• Airway clear
• Regular breathing
• Pink in colour
• Temperature normal
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45.
Can the mother continue KMC during sleep
and resting?
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• The mother can sleep with baby in kangaroo
position in reclined or semi recumbent position
about 30 degrees from horizontal.
• This can be done with an adjustable bed or with
pillows on an ordinary bed.
• A comfortable chair with an adjustable back
may be used for resting during the day.

46.
When to stop KMC?
• Till baby finds it comfortable and cosy
• Once baby’s weight >2500gm and gestation >37
weeks
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47.
Post-Discharge Follow-up (1/2)
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• Close follow up is a fundamental pre-requisite
of KMC practice. Baby is followed once or
twice a week till 37-40 weeks of gestation or till
the baby reaches 2.5 – 3 kg of weight.
• Thereafter, a follow up once in 2 – 4 weeks
may be enough till 3 months of post-
conception age.
• Later, the baby should be seen at an interval of
1-2 months during first year of life.

48.
Post-Discharge Follow-up (2/2)
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• The baby should gain adequate weight (15-20
gm/kg/day up to 40 weeks of post-conception age and
10 gm/kg/ day subsequently).
• More frequent visits should be made if the baby is not
growing well or his condition demands.

49.
THANK YOU!!
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