Kangaroo care (skin-to-skin care)
Kangaroo care, also known as skin-to-skin care, is an approach that involves holding an infant directly against a parent or caregiver's bare chest for extended periods, promoting bonding and healthy development. Originally developed in Bogotá, Colombia, in response to high infant mortality rates, particularly among premature babies, this method has shown significant benefits for both preterm and full-term infants. The baby is typically dressed only in a diaper, allowing for close physical contact that helps regulate breathing, body temperature, and heart rate while also reducing crying and fostering weight gain.
Kangaroo care encourages early and continuous skin-to-skin contact, ideally initiated within the first minute of life, which is crucial for successful breastfeeding and overall infant health. Research indicates that this practice can improve brain development, enhance maternal confidence, and lower healthcare costs compared to traditional incubator care. While its impact on survival rates is less pronounced in developed countries with more medical resources, the holistic benefits of kangaroo care continue to be recognized globally. The method remains a valuable practice for fostering the well-being of infants and strengthening the parent-child bond, regardless of the healthcare setting.
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Kangaroo care (skin-to-skin care)
Kangaroo care, also known as "skin-to-skin care," was developed as an approach to caring for premature babies, although it has been found to have benefits for full-term infants as well. The method involves the parent or caregiver holding the infant in direct skin-to-skin contact for as long as possible each day. The baby wears only a diaper (and, optionally, a hat) and is placed upright and prone against the parent’s or caregiver’s bare chest. The baby and parent are then covered with a blanket or wrap, enabling the baby to be properly supported while also providing protection from air drafts. In cold conditions, the parent can wear a garment that can be opened in the front, such as a kimono or button-down shirt, and then place a blanket over the baby’s back. The cozy bundling provides the infant with physiological stimulation that promotes bonding and healthy development.
Skin-to-skin care has been found to help regulate the infant’s breathing and body temperature, stabilize the infant’s heart rate, and help the infant cry less and gain more weight. It can also stimulate breast milk production in mothers and provide psychological comfort to parents. The snuggling of the baby against the parent’s body created an obvious parallel with the way a kangaroo carries its young inside its pouch, leading to the term "kangaroo care."
Background
The term "skin-to-skin contact" was first coined by M. E. Thomson in 1979 in reference to the importance of immediate postnatal contact in the promotion of successful breastfeeding. However, kangaroo care, also called "kangaroo mother care," originated in Bogotá, Colombia, in reaction to the city’s high rate of infant mortality—particularly among preterm infants—due to infections, respiratory issues, and a lack of caregivers and other resources in the late 1970s. For these reasons, Dr. Edgar Rey from the Universidad Nacional de Colombia, promoted a new method to ease the caregiver shortage and lack of resources. He proposed that new mothers have early and nearly continuous skin-to-skin contact with their preterm babies to help keep them warm and to promote breastfeeding on demand. As a result, the overcrowded incubator space and caregivers were freed, and researchers discovered that the infants who were held by their mothers for long periods of time throughout the day not only survived but fared as well or better than infants receiving conventional care.
Kangaroo care was found to be particularly beneficial for low-birth-weight (LBW) infants whose condition had stabilized after birth. Rey and his colleague Hector G. Martinez reported an increase in hospital survival among LBW infants from 30 to 70 percent in a 1983 paper describing kangaroo care; although these results were somewhat inflated due to the fact that Martinez and Rey did not include babies who had died within a few days following birth, there were a number of benefits of skin-to-skin care, including reductions in nosocomial (hospital-acquired) infections, a decline in infant abandonment rates, and earlier hospital discharge for mothers and infants. In the mid-1980s, the kangaroo method was made known to English-speaking health professionals due to its endorsement in the United Nations International Children’s Emergency Fund (UNICEF) report The State of the World’s Children 1984 and a 1985 article in the Lancet by Andrew Whitelaw and Katharine Sleath.
Overview
Kangaroo care involves placing the infant in skin-to-skin contact with the mother or another caregiver within one minute of birth, if possible, and keeping the baby there until after the first feeding. It is recommended that the baby’s head be dried immediately following childbirth and a hat placed on the newborn’s head before putting the baby on the mother’s chest. The measurements needed for birth metrics can be taken after the first feeding. For babies whose condition has stabilized following birth and who do not require life support services, physicians suggest maintaining the practice with minimal disruption as often as possible throughout the first few weeks of life. For premature babies, skin-to-skin care can be initiated as soon as the baby’s condition is stable, which may take hours, days, or even weeks following the birth. Some babies who require breathing machines, intravenous injections, and heart monitors can also be held skin to skin at intervals throughout the day with the help of trained hospital staff.
Early and continuous skin-to-skin contact is part of the innate parenting behavior of primates, and research indicates that close maternal contact is a key component for the healthy development of all mammals. Human infants are born particularly underdeveloped and helpless compared to other primates, likely due to human evolutionary adaptations for bipedalism that limited the width of the birth canal. Skin-to-skin contact helps to regulate an infant’s heart and respiratory rates, improve blood glucose levels, and stabilize body temperature. Increased time in which the baby is quietly alert or in deep sleep while being held skin-to-skin is considered to be another key advantage to the baby’s development and overall growth. The additional sleep and the temperature regulation that the baby gets by snuggling with the parent or caregiver helps to conserve energy and redirect vital calories toward increasing the baby’s weight and head circumference. Also, the stimulation the baby gets from hearing and feeling the adult’s breathing, heartbeat, movement, touch, and voice contribute to the baby’s development.
Kangaroo care also has been shown to have a positive impact on brain development, likely due to decreased stress levels in the infant and an increase in oxytocin in both the parent and infant. It also helps to diminish crying episodes, improve breastfeeding rates, and facilitate earlier hospital discharge. The advantages of kangaroo care to the parents are also significant and may include better bonding, greater confidence in the ability to care for the baby, and a stronger sense of control. An additional benefit for the health-care providers is the significantly lower cost of skin-to-skin care compared to conventional care using incubators.
In the early 1990s, the skin-to-skin care concept was promoted in North America for premature babies and was later suggested for full-term infants as well. While research into the benefits of kangaroo care has been conducted in several developed nations, implementation has been slow due to ready access to incubators and other life-saving medical technologies in high-income countries as well as a lack of education among parents and hospital staff of the method’s benefits. The effect of skin-to-skin care on the survival rates of premature infants is much more modest in developed countries, where shortages of resources such as incubators and trained hospital staff are less likely to occur compared to low-income countries with resource-limited health-care systems. However, the method confers many other positive benefits besides its effect on survival rates and therefore continues to be promoted for babies regardless of setting, birthweight, gestational age, and clinical resources.
Bibliography
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