• Method of holding preterm and/or sick baby skin-to-skin in an upright position between mother’s breasts or against carer’s chest (fathers and siblings can also be kangaroo carers)
• Kangaroo care (KC) can be offered to parents of medically stable babies

Benefits of KC

• Inform parents about the benefits of KC (use ‘BLISS Skin-to-skin and Kangaroo Care’ information https://www.bliss.org.uk/parents/in-hospital/looking-after-your-baby-on-the-neonatal-unit/skin-to-skin-and-kangaroo-care or locally approved information leaflets):
  • helps promote physiological stability: regulates baby’s temperature, heart rate, breathing and oxygen saturation
    reduces incidence of apnoea and bradycardia 
  • increases time in quiet sleep
  • longer alert states and less crying
  • analgesic effect during painful procedures
  • promotes growth and earlier discharge
  • improves lactation and breastfeeding success – duration and exclusivity 
  • promotes parent–baby attachment and family-centred care
  • positive effect on parenting – reduces stress and depression, triggers healing process, increases confidence 
  • helps reduce risk of mortality among preterm and low-birth-weight babies

• Medically stable baby – including those on CPAP with a stable oxygen requirement
• Medically stable ventilated babies after discussion with MDT
• Ventilated babies receiving palliative care

• Umbilical lines in situ

Consider

• Baby’s condition and dependency
• Maintenance of neutral thermal environment and humidity
• Activity in the room – quiet, calm environment is preferable
• Support available from colleagues 

Ensure

• Access to oxygen and suction

• Ensure parents are aware that baby may be briefly unstable during transfer from/to incubator/cot 
• Suggest parents do not smoke immediately before KC time
• Choose a mutually convenient time for parents and baby
• Provide privacy for parents to prepare clothing – suggest parents wear a clean loose fitting, front fastening shirts
• Provide comfortable chair and foot rest if appropriate
• Offer a hand-held mirror – to enable parent to see baby’s face
• Advise parents to bring a drink and go to toilet before KC time

Nurse transfer

• Parent to sit slightly reclined in a comfortable chair. Ensure clothing open and ready to receive baby
• Contain baby’s limbs and move gently – use ‘snuggle up’ nest if appropriate
• Place baby on parent’s chest, prone with head to parent’s sternum
• Parent to support baby’s head and body with baby’s legs flexed
• Turn baby’s head to side to protect airway
• Use parent’s clothing and a wrap/blanket for warmth and support
• If appropriate, place hat on baby 

Parent transfer

• Parent to stand at side of incubator
• Place forearm gently under ‘snuggle up’ nest or sheet, cup baby’s head with other hand
• Gently lift baby from incubator and onto chest, resting baby’s head against sternum while supporting baby’s back and bottom with forearm
• Parent gently moves back to sit in chair, guided by nurse
• Nurse to check baby’s position as before

Duration of KC

• When baby settled, remove screens/curtains – be guided by parental preference
• Aim to provide KC for ≥1 hr
• Monitor baby’s position and vital signs 
• Babies may have nasogastric tube feeds during KC time
• Discontinue KC if:
  • baby shows signs of distress 
  • has a prolonged increase in oxygen requirement of 10–20% 
  • at parent’s request

Breast milk

• Encourage mother to express breast milk following KC time. See Breast milk expression guideline