The Kangaroo Care or Skin-on-Skin

---

The Kangaroo Care offers skin-to-skin contact between parent and baby. This practice was developed in Bogotá in 1978 to overcome the lack of material resources, such as incubators, and to try to reverse the high rates of neonatal infection and mortality. It was explicitly intended for underweight babies, whose parents carried them around the clock in a pouch, like a marsupial, which served as a natural incubator. Today, this proven method is used worldwide.

In the case of a full-term birth, if the baby does not require any specific monitoring, skin-to-skin contact can be performed within minutes of birth. However, in the case of a premature birth, the baby usually needs to be transferred rapidly to the neonatal unit. Even in these conditions, skin-to-skin contact is encouraged as soon as possible when the baby's condition allows, and the parent is available.

The Kangaroo Care offers babies positive experiences like those they had in the womb. He can hear familiar sounds again, such as the beating of a heart and the sounds of digestion coming from the intestines. When the mother uses the Kangaroo Care, the baby can smell the familiar scents of her skin and mother's milk. When the father picks up the baby using the Kangaroo Care, the baby recognizes his deeper voice, which passes more easily through the uterine walls. He can also exercise his grasping reflex and comfort himself by clutching his chest hair, even if this makes Dad cringe!

This intimate contact has many advantages for both the baby and the parents:

• Promotes parent-child bonding
• Makes breast-feeding easier
• It increases the feeling of parental ability

For premature newborns, it contributes to greater physiological stability, i.e. thermoregulation, improved oxygenation and ventilation, weight gain and pain control.

Prior to the method

• Prepare the environment, if possible: Reduce exposure to light (bedside lamp, sunlight, nearby phototherapy, etc.) and noise ("silent" voices and alarms when possible, etc.).
• Prepare the parent: Tell the parent to wash their hands and ensure the skin on their chest is clean and fragrance-free. The parent should remove jewelry to promote optimal contact and protect the baby's fragile skin. Tell the parent to remove his or her clothes and put on a hospital gown. They can also keep their clothes on and bare their breasts only when the baby is placed against them. Mothers should remove their bras. As for fathers, they should avoid shaving their chest hair (the baby may cling to it for security). If the baby is wearing pyjamas, remove them while verbally announcing that you are about to touch him (if he can tolerate this auditory stimulation, of course) so as not to cause a startle. The baby should wear only a diaper.

During the method

• There are two options to transfer the baby to the parent: 1) the nurse transfers the baby from the fetal position to the parent, who is already seated. 2) the parent takes the baby from the incubator or bed.
• The parent sits in an armchair, rocking chair or, ideally, a weightless chair (if available). A 60-degree reclining chair is recommended so the baby is snuggled up against the parent.
• Place the baby’s head on its side, slightly tilted forward or in a neutral position to facilitate breathing. Cover the baby with a blanket, a hospital gown, or the parent's clothes. The baby’s physiological (fetal) positioning should always be favoured during the method, even with full-term babies.
• Due to the immaturity of their nervous system, premature babies may have delayed reactions after the transfer and show signs of stress. If the baby does not show signs of stress, the parent can add stimulation, such as talking to him in a soft, calm voice. If he tolerates this initial stimulation well, the parent can sing him a lullaby or cuddle him. It is important to introduce one stimulus at a time and check that it is well tolerated.
• The Kangaroo Care generally lasts a minimum of 60 minutes so that the baby reaches the deep sleep phase. The sleep cycle of a baby of this age lasts an average of 50 to 60 minutes, and this sleep phase - the deep sleep phase - is the last. It enables the baby to recover, grow, and assimilate what he has experienced during the day, among other things. For healthy full-term babies, the duration of skin-to-skin contact can vary according to various objectives (regulating the baby's temperature, soothing him, allowing the mother to rest, etc.).
• It is not recommended that parents fall asleep in a chair with their baby unless they use a safe positioning and baby-carrying tool to prevent falls, such as the kangaroo tube.

After the method

• Take the time to tell your baby that the Kangaroo Care is over (if he can tolerate it).
• Be sure to practice calming methods for the next few minutes to let the baby settle down and gently fall asleep.
• Remove your hands gradually so that the baby still feels contact as he relaxes and falls asleep.