Caring for Premature Infants With Kangaroo Care


Premature baby, alone with no sound of mother’s heartbeat or rhythmic breathing.


History of Kangaroo Care

Kangaroo care was invented in the late 1970s by Dr. Edgar Rey in Bogota Colombia as a response to the extremely high death rate of preterm babies at his impoverished hospital.

Rey’s NICU department did not have enough incubators for all of the preterm babies and few of them survived. Asking for money probably wouldn’t get him anywhere so he started thinking creatively.

He reasoned out a solution that would change the fate of preterm babies all across the world.

What are incubators for, he asked himself? To mimic a mother’s womb by offering the baby constant warmth, nourishment, and oxygen. Well, Rey thought, a mother herself could probably offer the same if not superior incubation. He may have not known exactly why this was true at the time, but indeed, it was true. The method was so successful that it spread to other third world nations and has since been studied extensively and even adopted by many developed nations.

Kangaroo Care Methods

Babies are placed skin to skin against a parent’s chest 24 hours a day (probably less in developed nations where incubators are available). The baby is kept upright to prevent reflux and apnea. They wear a hat and blanket on their backs. Those that need it will receive an IV and oxygen right on the mother’s chest. As soon as the baby is able to start sucking, it will nurse.

Conditions are said to be fair to return home if the baby is pink, can suck, and breath on its own. This generally happens much faster in kangaroo cared infants than in conventionally incubated infants. Sometimes preterm babies and their parents go home the next day.

Benefits of Kangaroo Care

  1. A woman’s breasts modulate temperature, responding to the thermal needs of the infant, giving the infant the exact temperature it needs to stay warm all the time. (This even works with twins! Each breast has the ability to maintain different temperatures.)
  2. Kangaroo care infants sleep more. Hence, they grow and develop faster. According to Dr. Ludington, author of Kangaroo Care: The Best You Can Do to Help Your Preterm Infant, babies sleep twenty to twenty-two hours per day in their last six weeks in the womb. In contrast, she says that NICU babies get about 2 hours of quality sleep per day.
  3. There is greater opportunity for breastfeeding and parent/child attachment in kangaroo cared infants.
  4. Mothers and fathers of preterm infants are better equipped to manage the care of their tiny baby and more confident in how to handle the challenges of caring for such a small person.
  5. The mother’s heart rate and breathing help to regulate a premature baby’s heart rate and breathing.

Holly Richardson said in an article entitled Kangaroo Care: Why Does It Work? published in Midwifery Today,

“Researchers have gained significant insight into what happens to an infant’s brain during kangaroo care. Any baby’s heart rate and respiratory rates can be plotted as a sort of artistic drawing. Because premature infants lack the ability to coordinate their breathing and heart rates, the rates “plot out” as chaotic. This means with increased demand on the cardiovascular system, as with crying or fussing, the system does not respond with a related increase in cardiac output. In other words, the baby’s respiratory rate may increase while crying, but the heart rate does not. As preemies mature, these rates become synchronized, or “coupled,” resulting in an orderly drawing when the rates are plotted together. The drawing no longer looks random.

In infants in kangaroo care, researchers found that coupling takes place after only ten minutes. This hardly seemed possible because it equaled four weeks of brain development in the “normal” preemie. As researchers studied brain wave patterns of infants in kangaroo care, they found two significant things. First, there was a doubling of alpha waves—the brain wave pattern associated with contentment and bliss. Second, they found that “delta brushes” were occurring. Delta brushes happen only when new synapses are being formed. So holding the infant skin-to-skin allows his or her brain to continue its work of developing neural synapses.”

Why Incubators Aren’t the Best Option

  1. Incubated babies are usually not warm enough and preemies must make heat with their own bodies and use their own calories to regulate temperature.This takes a lot of energy that they should be expending on brain development.
  2. Premature infants in incubators have high rates of irregular heart rates and sleep apnea.
  3. Premature infants are alone with no skin to skin contact most of the time. Dr. Ludington says that, “Separation is not biologically normal,” hence the irregularities in sleep, breathing, heart rate, and neural brain development.
  4. Babies receive an IV nutrition and hydration drip while in the incubator. While preterm infant formula is a different formulation than other infant formulas it still contains soy oil, carageenan, non-fat milk, and corn syrup solids.
  5. The liquid medications babies receive can contain sorbitol, ethanol, aspartame, flavorings, and food colorings. Sorbitol causes nausea and malabsorption.
  6. Potential infant drug addiction.
  7. Preterm infant can contain enough ethanol to get a baby drunk.

Is Preterm Labor Really So Bad?

All of this makes me wonder, do preterm babies suffer so many hardships such as cognitive difficulties later in life because they are preterm? Or is it because preterm infant care is not very good? Infants who don’t sleep enough, don’t absorb nutrients well, don’t feel safe, aren’t warm enough, and are subject to the chemicals in preterm infant drugs are not given the conditions necessary to develop properly.

How Early is Too Early for Preterm Home birth?

The choice to have a baby at home when it comes before 38 weeks gestation is a decision only the parents can make. Many midwives won’t deliver babies any earlier than 36 to 37 weeks, though some will attend an even earlier preterm birth.

The greatest risk for premature babies is respiratory problems, though when they are delivered vaginally, the risk decreases significantly. Midwives generally bring oxygen to births and if further support is needed, the baby can be transported to a hospital via ambulance, which can administer oxygen.

Most babies older than 28 weeks gestation have digestive tracts mature enough for milk feedings, however, they may not be mature enough to suck until 32 weeks gestation, making an IV absolutely necessary.

I think most of us are led to believe that preterm infants (before 38 weeks gestation) cannot survive outside of a hospital. This is often simply not the case and the use of kangaroo care around the world proves it. However, when a baby is at risk for complications, having a hospital nearby can be a life saver.

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  1. My water broke at 34 weeks and I had to deliver in the hospital despite my plans for a homebirth. My midwife came along as support which was great given the situation. Luckily my daughter was developed enough not to need additional care (she was 5 lbs 8 oz). I did have to get antibiotics and that whole deal which I hated. We both suffered from candida issues for almost a year afterword despite our best probiotics and diet. I wish we could have had our homebirth but in the end I was just so thankful we were both ok and to hold her in my arms. Speaking of kangaroo care – I think its wonderful for babies at any age. I literally held my daughter nonstop for months and months – even at night we’d fall asleep chest to chest. It was such a sweet time.
    Best wishes on your birth and new baby!

  2. My last child was born at 32 weeks via emergency c-section, and while that sounds like a recipe for disaster, it wasn’t.

    She’s now a healthy 5 foot 9 inch 12 year old with no issues AT ALL.

    I did provide breastmilk for her, but her very first meal was formula due to a nurse not reading the notes and going with what normally is the flow. I was so disappointed.

    However, I think the percentage of bad can be outweighed by the good we provide. The hugs, the food, the values – these are all things we can only do our best on, and every day is a new chance.

    Thanks for your blog, I love reading it. So insightful. Enjoy your pregnancy!

  3. Fortunately, I delivered my son full-term, and have not had to deal with NICU issues, but certainly believe that Kangaroo Care is what preemies need. My little A was born in a hospital. Home would have been nicer, but I was ill-informed at the time. My son left my side for 15 minutes while we were in the hospital, for a procedure which is the one thing I regret in his whole life. I know where your friends are coming from with the Staph infections.
    After leaving the hospital, I had vaginal pain which I thought was extreme for afterbirth, even without an epidural. A week later, by clitoral stitch site had swelled to the size of a golf ball and I could barely walk. The lancing hurt worse than giving birth, and I was put on antibiotic for 10 days. Those 10 days were terrible. I was unable to nurse, so had to rely on formula. Over a year later, I dread that those ten days had a negative affect on my baby.

    Hospitals are good, but also bad. I feel like my tear was due to the roughness of my midwife, as well as the infection which followed.

    • It’s definitely not unusual to come out of a hospital with an infection. That is so sad. I feel for you. I hope you were able to get able to get back to nursing at least.

      You know, there is good and bad no matter which way you go. If we didn’t have hospitals we’d be complaining about how dangerous home care is and since we do have hospitals we complain about those dangers.

      I guess in the end we do what we do based on our own experiences. My own have definitely led me to try and avoid hospitals and doctors.

  4. With all my babies I wore them near 24 hours a day, usually via a Moby or another carrier that keeps baby right next to me. I think it makes a lot more sense than medical intervention though I must admit I’ve never had a premature birth…I have 3 kiddos and each was born well after expected arrival. I hope your birth is a wonderful!!!

  5. I do not think your concerns about hospital and NICU care are off at all. But as the mother of a preterm baby (34 weeks – no known cause for it) who spent 4 weeks and 1 day in the NICU I can speak from experience.

    Most of the babies in the NICU for longer than a few weeks are in there for severe issues. Mine was there because he contracted an infection from the NICU (are we surprised? I’m not). However, while 24 hour kangaroo care was not an option, I was able to hold him, we did some kangaroo care (not as much as I would do now), and the NICU nurses supported breastfeeding. I would get calls in the middle of the night if they were down to their last bottle to let me know. I was welcome to be by his side 24/7. So, while I am highly critical of hospital care, I did have a relatively positive experience with the NICU nurses (the doctors were another story).

    On a happy note, my son exhibits no issues or delays. I am aware that we dodged a lot of bullets. He is bright, tall for his age, strong, and healthy as a horse. I think this is partly that he came when he was ready (more or less) and partly that I worked damn hard to establish a breastfeeding relationship, which continued until he was 27 months.

    When my second child was born (home birth in Wales) the NHS midwives said that homebirth at 37 weeks was fine, otherwise they’d want me at a hospital. My husband and I discussed the possibility of having an unassisted birth at 36 weeks, but wouldn’t risk it any earlier. Thankfully, the babe came at 38 weeks.

    Here’s hoping you don’t have to worry about any of this! May the babe keep cooking!

    • Thanks for adding your experience! How sad that he contracted an infection there in the hospital. I have known 3 people to get a staph infection at the hospital. One died, one still owes a million dollars due to treatment, and one had his arms and legs amputated. aye yaye yaye. But many people are saved in hospitals too…

      Many hospitals in the US are using kangaroo care in hospital and for a kiddo like your own, that would have been ideal, since obviously, he couldn’t come home. The cool thing about the research, though, is that many preterm infants can go home very quickly if kangaroo care is used. The practice should be taken more seriously. While many preterm babies need the hospital, most of them could be receiving kangaroo care simultaneously.

      Thank you for the well wishes and I’m glad to hear your child is well!

  6. So what do you do if you do have a preterm baby that does end up needing to stay in the NICU. I whole heartedly agree with everything you do regarding birth and now kangaroo care. I’d rather not be at the hospital all together, for birth or any kind of stay whatsoever. But, if baby needs to be in NICU, and they don’t “allow” you to hold your baby more than a little bit a day, what do you do? I think I might demand I hold the baby and they can bite me on what they “think is best.” But, just curious on what you recommend or think should be done in that situation. Thanks!
    I also wish you the best birth and that the baby stays in there until its birthday (hopefully near full term!)

    • That’s a good question and it extends far beyond infant care. When we go to hospitals we are kind of at their mercy, especially when it’s an emergency.

      • Not if you do it right. Call other local hospitals, find one you like. Then tell them you want to transfer there. You go in an ambulance. I got lucky and insurance did pay. I was told they wouldn’t. Now, taking him and walking…

  7. Peggy, this is a great post for people who may never have heard of kangaroo care. I was blessed enough with my daughter that she was full term and I was able to birth naturally (though at a hospital, which is my choice and preference) and get off to a good skin to skin start. I plan on doing the same for baby #2.

    Kangaroo care can also be great for parents adopting infants. Our good friends adopted twins last summer, born at 34 weeks, and Baby B was significantly smaller than her brother, only 2 lbs 4 oz. Their NICU nurses set both babes up with kangaroo care as soon as they could. While my friend’s body was not as responsive as a birth mom’s would be and she didn’t induce lactation, it did help her little girl grow well and get to the point she no longer needed a feeding tube, respirator, etc. And, although she hasn’t confided in me, I think it helped a great deal with forging a bond between her and her two new babes.

  8. My daughter was born at just shy of 29 weeks. For the first almost 2 weeks because she was so tiny we could touch her but not hold her. As soon as we were able to hold her the NICU encouraged us to do kangaroo care as much as possible. We were very lucky (I had/have wonderful docs) that other than being less than 3 pounds and contracting an infection at the hospital that she was “healthy”. Breastfeeding and kangaroo care helped her come home in less than 8 weeks. She gained weight quickly, passed all her tests and left much sooner than expected. A lot sooner than other babies that were in the NICU with no problems whose parents didn’t seem to do as much kangaroo care. Our princess is now 30 months and as rowdy as they come. I’m OK with that because while in the NICU we were able to see the good and the bad and we know we are fortunate!

  9. My son was born at exactly 34 weeks weighing 5 pounds 1 ounce. I was glad to be at the hospital, because I almost bled to death. I nearly passed out during the delivery and they had to give me medication to help stop my bleeding. He seemed perfectly healthy at first, other than his low birth weight. Being extremely exhausted and weak from the blood loss, they kept him in the nursery the first two nights so I could rest and brought him to me when it was time for him to eat. It was a good thing.

    Had he been in the room with me while I was sleeping, or – God forbid – they had let us take him home, he would have died. He had laryngopharyngeal reflux (LPR), a condition in which the two esophogeal sphincters are immature and allow stomach acid to rise up all the way into the back of his throat, cutting off his airway.

    We spent a month in NICU waiting for his esophagus to mature enough that he didn’t stop breathing. The NICU encouraged breastfeeding and kangaroo care, although I couldn’t hold him 24/7, as I was dealing with delivery-related medical issues of my own.

    He had to wear an apnea monitor for six months after he came home. Even lying upright on my chest, he would stop breathing and his heart rate would plummet. I was breastfeeding exclusively.

    A month after we brought him home, my milk dried up completely. I tried everything to get it back, but couldn’t. As I lost my milk, he became listless, pale, and started losing weight. It scared the life out of me, so I started him on formula without even a second thought. I couldn’t help it, and I don’t regret my decision.

    He perked right up and began to thrive. At 7-months old, he weighed 22 pounds and was 29 inches long (he’s 8 months-old now). He’s completely solid, not mushy at all. He is talking, crawling, and trying to stand up. He only cries if he is hungry or tired and he smiles the rest of the time.

    From my experience, it is not a complete disaster if your baby has to stay in NICU or is fed formula. I was really disappointed that I didn’t get to breast feed for longer than two months, and I felt horrible and angry that I had to put him on formula, but once I saw how much better he was doing on it, all that went away. He’s thriving. That’s all I care about. I nearly lost him twice (threatened miscarriage at 9 weeks). Now that he is eating solids, I can feed him all the healthy organic foods that he’ll eat. I’m just saying, it’s not the end of the world. Things happen, just do what you can.

  10. the girl in the yoga pants does have a point.

    i’m someone who felt the way you do about the medical system.
    my mother works for a hospital and has for the last 30+years.
    we spent much of my pregnancy arguing about the circumstances in which i desired to give birth because she knew of the dangers that could come about even in a seemingly normal birth.

    i wanted to have an unassisted home birth because i thought i could due to my extensive reading on the subject. how wrong i was.

    i did end up having a natural vaginal delivery at home with a midwife but i had a child who had gastroschisis (read: intestines on the outside of his body). not only that but i had been in labor for a day and a half, he was posterior and meconium stained. I hadn’t had much prenatal care because i was staunchly against western medicine but i definitely learned that integrative medicine is where it’s at. as much as the hospitals have a bad rap, they do a lot of amazing things for us humans.

    he was whisked to the children’s hospital to get taken care of.
    luckily i was fine and had no complications and with the exception of the gastroschisis, he was fine too. it could have been much worse.

    he’s fine now but he spent five weeks in the hospital. i did pump for five weeks and he does breastfeed currently but i had to let go of my fantasy for what the reality was.
    i needed to accept that life hands you what it does and that i needed to be thankful for the medical system that i had so easily condemned because they saved my baby from terrible complications.

    get yourself a doula or midwife or both who is educated on hospital procedures during delivery who can speak on your behalf when you’re in labor so you don’t feel bullied into doing something that isn’t medically necessary.

    like the girl in the yoga pants said, it’s not the end of the world, it’s just different and the most important part is to have a healthy baby. all the other stuff is just the details.

    • It’s good to hear that everything has worked out for your in the end.

      I have never said or thought that hospitals don’t have their place. Things go wrong in every aspect of our lives, childbirth included. That’s what hospitals are there for. But to instill fear into the mind of every mother based on what could go wrong is simply counter productive. For the real emergencies kangaroo care should be offered and encouraged in the hospital whenever possible, for all other cases women should be taught the method and sent home to take care of their baby as is the custom in other countries.

  11. My daughter was born at 27 weeks. I couldn’t hold her for the first week. She was intubated, but as soon as she was stable enough I held her as often as possible! The hospital we were at was fantastic. They encouraged Kangaroo Care. We had our own room and we kept it dark and quite. We also gave her baths. Those baths were amazing. The warm water was so soothing to her and her breathing always evened out and she slept really really well after. My baby is 5 years old now. Perfectly healthy & extremely bright. We are so thankful for here health despite being born so early. I would not have known about Kangaroo Care if the hospital hadn’t told me. I was in such a state of shock and completely unprepared for a preemie. It’s good to get the word out.

    • It is so great to hear of families who were educated about kangaroo care while in the hospital! With the widespread availability of incubators in developed nations, we are a bit slow to adopt the practice but the American Academy for Pediatrics does endorse the practice and many hospitals are incorporating it. Thanks for sharing!

  12. Love kangaroo care. A prime example of the beauty of the design of the human body.

    I actually have a question about your liver consumption. You may have dealt with this question elsewhere but I’ve been trying to dig up some decent, scientific, non-fear-mongering information on the issue of overdosing on Vit A as a result of eating liver while pregnant. I’m worried that my iron is low and eating liver seems to be a quick fix – what guidelines are you following for eating it?

  13. My first son also was born at 29 weeks. Water burst in the morning and he came flying out that night. I had just started my hypnobirthing classes and had met with a doula. I learned of kangaroo care at the hospital. It was their standard procedure. I was attached to a pump every 3 or 4 hours round the clock. So we had a freezer full of breast milk at the hospital and at home. The hospital was amazing in that it really encouraged kangaroo care and breast milk. Besides the stress of having a preemie in the NICU, kangaroo care was actually kind of stressful. I thought it was for me to bond with my child. But it can get loud and distracting in the NICU with monitors beeping, nurses talking, my own child’s monitor beeping when he got too warm on top of me. But in the end I realized it was more for him and not totally for me. Now he’s a boisterous 7 year old.

    I am grateful that the hospital was there although I had wanted that “perfect” birth. Now I really do think that biologically we are made to have our babies at a young age…. 20’s at the most. I was 35 with my first.

    Many blessings!

  14. even if baby isn’t premature yet needs a stay in the NICU its still very stressful for the parents and close family members to see them so vunerable.

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