During my master in nursing for attaching with my thesis, I prepared an information booklet on KMC which I will share with you

1. INFORMATION BOOKLET ON KANGAROO MOTHER CARE
FOR LOW BIRTH WEIGHT BABIES
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PREPARED BY:
Ms. Sunita Thakur
Master of nursing student
Rajkumari Amrit Kaur College of Nursing
Lajpat nagar, New Delhi

2. TABLE OF CONTENT
S. NO. CONTENTS PAGE NO.
1 Acknowledgement
2 Preface
3 Objectives
4 Introduction
5 Historical back ground of kangaroo mother care
6 What is kangaroo mother care?
7 Benefits of kangaroo mother care
8 Component of kangaroo mother care
9 Prerequisite for kangaroo mother care
10 Eligibility criteria for kangaroo mother care
11 Preparing for kangaroo mother care
12 Kangaroo mother care procedure
13 Time of initiation
14 Duration of kangaroo mother care
15 Kangaroo mother care during sleep and rest
16 From hospital to home
17 When should kangaroo mother care be discontinued?
18 Record keeping
19 Post discharge follow-up
20 Implementation of kangaroo mother care in the unit
21. Conclusion

3. ACKNOWLEDGEMENT
I , Ms. Sunita Thakur, Master of Nursing final year student greatly acknowledge expert guidance
of respected Madam, Mrs. O. K. Kathuria, guest faculty and Mrs. Sunita Patney senior lecturer
Rajkumari Amrit Kaur College of Nursing, New Delhi, for their continued, enthusiastic and
valuable direction in developing this information booklet.
I also greatly acknowledge the WHO, KMC India network, AIIMS, National Neonatology
Forum as a source of content and picture for preparation of this booklet.
I would also like to thank the teaching faculty of RAK College of Nursing, New Delhi. They
provided the timely support, encouragement and comprehensive and valuable comments on
different aspects of this booklet.
For any queries and/or suggestion regarding this information booklet please contact: ---
Ms. Sunita Thakur
Master of Nursing Student
Rajkumari Amrit Kaur
College Of Nursing,
Lajpat Nagar, New Delhi

4. PREFACE
“Children are the wealth of tomorrow. Take care of them if you
wish to have a strong India, ever ready to meet various challenges”
– Pandit Jawaharlal Nehru
This information booklet on kangaroo mother care for low birth weight babies is a
humble attempt to educate the nursing personnel and increase their competency and efficiency so
that, they can provide better quality KMC to LBW babies. This information booklet has been
developed taking into consideration the important roles which nursing personnel play during the
care of LBW babies in their recovery.
It has been proven by many researches related to KMC that it is very effective, simple,
low cost method for caring LBW babies. It helps in decreasing morbidity and mortality of LBW
babies especially where good care for such babies is scarce. Problems like this exists more in the
developing countries like India where such care is rarely available. The nurse‟s expertise in the
initiation of KMC is important to enable them to practice it for saving of life of LBW babies.
Nursing personnel are working in variety of settings i.e. obstetrics, pediatric, homes or
in the community and contribute in decreasing the morbidity and mortality of the LBW babies .It
is necessary that every nursing personnel gains knowledge and skill in implementing kangaroo
mother care. I have made an attempt to compile the important information regarding KMC in this
booklet. This booklet is a small effort to increase the knowledge and improve the skill of nursing
personnel. I hope that this information booklet will be helpful to all the nursing personnel and
they will utilize this knowledge while providing KMC for LBW babies.

5. OBJECTIVES
GENERAL OBJECTIVES:
After going through this information booklet you will be able to improve your knowledge and
practice about kangaroo mother care.
SPECIFIC OBJECTIVES:
After going through this booklet you will be able to:
 Describe the concept of Kangaroo Mother Care.
 Enumerate benefits of kangaroo mother care.
 Enlist components of kangaroo mother care.
 Discuss pre-requisites of kangaroo mother care.
 Identify the eligibility criteria for kangaroo mother care.
 Describe preparation for kangaroo mother care.
 Explain procedure of kangaroo mother care.
 Discuss time of initiation and duration of kangaroo mother care.
 Explain discharge and follow up of kangaroo mother care.
 Describe implementation of kangaroo mother care in the unit.

6. INTRODUCTION
Each year about 20 million low birth weight babies are born worldwide. In India every 4th
baby born is low birth weight, which imposes a heavy burden on healthcare and social systems.
Medical care of low birth weight infants is complex, demands an expensive infrastructure and
highly skilled staff, and is often a very disruptive experience for families. LBW babies in poorly
resourced settings often end up in understaffed and ill equipped neonatal care units, which may
be turned into potentially deadly traps by a range of factors, for example, malfunctioning
incubators, broken monitors, overcrowding, nosocomial infections, etc resulting in number of
complications and also mortality of these babies.
Kangaroo Mother Care is a promising method which has the potential to solve these
problems as it does not need expensive and sophisticated equipment, and is simple enough to be
applied almost everywhere. It is a powerful, easy-to-use method to promote the health and well-
being of infants born premature and low birth weight. Despite of so many advantages, it is still
not a widely practiced method especially in India. So it is essential that it should be promoted
and implemented by nursing personnel on a wider scale in developed and developing countries.
HISTORICAL BACKGROUND OF K M C
Kangaroo mother care was first suggested in 1978 by Dr Edgar Rey in Bogotá, Colombia.
KMC was started in response to overcrowding and insufficient resources in neonatal intensive
care units associated with high morbidity and mortality among low-birth weight infants. The
term KMC is derived from practice similarities to marsupial care giving, i.e., the premature
infant are kept warm in the maternal pouch and close to the breasts for unlimited feeding.
WHAT IS KANGAROO MOTHER CARE?
“A form of parental care giving where the newborn low birth weight is intermittently nursed
skin-to-skin in a vertical position between the mother‟s breasts or against the father‟s chest for a
non-specific period of time.”
(Kenner & Lott, 2003)

7. According to W.H.O. The low birth
weight babies are the newborn babies
weighing less than 2500 gm at birth are
classified as low birth weight (LBW)
irrespective of the periods of gestation. Any
neonate born before 37 weeks (<259 days)
of pregnancy irrespective of the birth weight
is classified as Preterm baby.
So, Kangaroo Mother Care is a special way of caring of low birth weight babies.
KMC satisfies all five senses of the baby. In KMC, the baby is continuously kept in skin-to-skin
contact by the mother and breastfed exclusively to the utmost extent. The baby feels warmth of
mother through skin-to-skin contact (touch), she listens to mother‟s voice & heart beat (hearing),
sucks on breast (taste), has eye contact with mother (vision) and smells mother‟s odor
(olfaction). It fosters their health and well being by promoting effective thermal control,
breastfeeding, infection prevention and bonding.
BENEFITS OF KMC
For parents:
 Enhanced attachment and bonding.
 Increased milk volume, increased rates and duration of breastfeeding.
 Feeling of confidence, competence, satisfaction and empowerment regarding baby care.
 Decreased separation anxiety of parents.
 Parent‟s participation and acceptance increases.
 Cost effective care.
For low birth weight baby:
 Normalizes temperature, heart rate and respiratory rate.
 Decrease in apnea.
 Breast milk is readily available and accessible.
 Increased weight gain.
 Normalized infant growth and development of premature infants.
 Enhanced mother-infant bonding.
 Less crying and distress.

8.  Restful sleep.
 Less nosocomial infection.
 Less time in incubators.
 KMC satisfies baby‟s five senses.
 Reduced risk of sudden infant death.
 KMC useful in transferring the LBW babies to higher centre.
 Improved health status and survival.
 Earlier discharge.
 Decreased readmission.
For institutions:
 Shorter hospital stay.
 Decreased overcrowding.
 No need of additional staff.
 Reduced use of advanced health care technology only used in addition to KMC.
 Increased survival of premature and LBW babies.
 More parental involvement, with greater opportunities for teaching and assessing.
 Fewer readmissions in the hospital.
For the community:
 Less morbidity and mortality of LBW babies.
 Decreased use of financial resources
 Promotion of total family health.
 Decreased health care cost.
COMPONENTS OF KANGAROO MOTHER CARE
A. SKIN-TO-SKIN CONTACT: Early,
continuous and prolonged skin-to-skin
contact between the mother and her baby is
the basic component of KMC. The infant is
placed on her mother's chest between the
breasts.

9. B. EXCLUSIVE BREASTFEEDING: The baby on KMC is breastfed exclusively. Skin-to-
skin contact promotes lactation and facilitates the feeding interaction.
PRE-REQUISITES OF KMC
1. SUPPORTING MOTHER IN HOSPITAL AND AT HOME
A mother cannot successfully provide KMC all alone. She would require counseling
along with supervision from care-providers, and assistance and cooperation from her family
members.
2. POST-DISCHARGE FOLLOW UP
KMC is continued at home after early discharge from the hospital. A regular follow up
and access to health providers for solving problems is crucial to ensure safe and successful KMC
at home.
ELIGIBILITY CRITERIA
Eligibility criteria for baby
All stable LBW babies are eligible for KMC. It can also be given to babies who are on
intravenous fluids, tube feeding or oxygen but are otherwise stable. Very sick babies needing
special care should be cared under radiant warmer initially and KMC should be started after they
become stable. Some guidelines for practicing KMC include:
I. Birth weight >1800 gm: These babies are generally stable at birth. Therefore, in most of them
KMC can be initiated soon after birth.
II. Birth weight 1200-1799 gm: Many babies of this group have significant problems in
neonatal period. It might take a few days before KMC can be initiated. If such a baby is born in a
place where neonatal care services are inadequate, the baby should be transferred to a proper
facility after initial stabilization and appropriate management, by keeping the baby in continuous
skin-to skin contact with the mother / family member during transport.
III. Birth weight <1200 gm: Frequently, these babies develop serious prematurity-related
morbidity often starting soon after birth. It may take days to weeks before baby's condition
allows initiation of KMC.

10. Eligibility criteria for mother
All mothers can provide KMC, irrespective
of age, parity, education, culture and
religion. The following points must be taken
into consideration:
 WILLINGNESS: The mother must be willing and realize the benefits of KMC.
Healthcare providers should motivate her to learn and undertake KMC.
 GENERAL HEALTH AND NUTRITION: The mother should be free from serious
illness, take adequate diet and supplements recommended by her physician.
 HYGIENE: The mother should maintain good hygiene: daily bath/sponge, change of
clothes, hand washing, short and clean finger nails.
 FAMILY SUPPORT: Apart from supporting the mother, family members should also
be encouraged to provide KMC when mother wishes to take rest or deal with
conventional responsibilities of household chores.
 COMMUNITY SUPPORT: Community awareness about the benefits should be
created. This is particularly important when there are social, economic or family
constraints.
PREPARING FOR KMC
 COUNSELING
When baby is ready for KMC, arrange a
time that is convenient to the mother and her
baby. The first few sessions are important
and require extended interaction.
Demonstrate to her the KMC procedure in
caring, gentle manner and with patience.
Answer her queries and allay her anxieties. Encourage her to bring her mother/mother in law,
husband or any other member of the family. It helps in building positive attitude of the family

11. and ensuring family support to the mother which is particularly crucial for post-discharge home-
based KMC. It is helpful that the mother starting KMC interacts with someone already practicing
KMC for her baby.
 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 or
shawl. Suitable apparel that can retain the
baby for extended period of time can be
adapted locally.
 BABY'S CLOTHING
Baby is dressed with cap, socks, nappy, and
front-open sleeveless shirt or 'jhabala'.

12.  PLACE FOR PROVIDING KMC
KMC is feasible everywhere, because it is
not based on equipments. So it can be
provided in the:
 Nursery.
 Post-natal ward.
 Home settings.
KANGAROO MOTHER CARE PROCEDURE
 KANGAROO POSITIONING
 The baby should be placed between
the mother's breasts in an upright
position.
 The head should be turned to one
side and in a slightly extended
position.
This slightly extended head position
keeps the airway open and allows eye
to eye contact between the mother
and her baby.
 The hips should be flexed and abducted in a "frog" position; the arms
should also be flexed.
 Baby's abdomen should be at the level of the mother's epigastrium.
Mother‟s breathing stimulates the baby, thus reducing the occurrence of
apnea.
 Support the baby in bottom with a sling/binder. (Special binders or carrying pouches are
also commercially available and can be helpful.)

13.  MONITORING
Babies receiving KMC should be monitored carefully especially during the initial stages.
Nursing staff should ensure that baby's:
 Neck is not too flexed or to extended
 Breathing is normal and regular
 Feet and hands are warm
 Baby is upright between mother‟s
breasts
 Airway is clear
 Color is pink
 Baby is maintaining temperature
Mother should be involved in observing the
baby during KMC so that she herself can
continue monitoring at home.
 FEEDING
The mother should be explained how to breastfeed while the baby is in KMC position.
Holding the baby near the breast stimulates milk production. She may express milk while the
baby is still in KMC position.
 PRIVACY
KMC unavoidably requires some exposure on the part of the mother. This can make her
nervous and could be de-motivating. The staff must respect mother's sensitivities in this regard
and ensure culturally acceptable privacy standards in the nursery and in the wards where KMC is
practiced.

14. 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). KMC can
be provided while the baby is being fed via orogastric tube or on oxygen therapy. Once the baby
begins to recover, family members should be motivated to practice KMC.
DURATION OF KMC
 Skin-to-skin contact should start gradually in the nursery, with a smooth transition from
conventional care to continuous KMC.
 Sessions that last less than one hour should be avoided because frequent handling may be
stressful for the baby.
 The length of skin-to-skin contacts should be gradually increased up to 24 hours a day,
interrupted only for changing diapers, especially where no other means of thermal control
are available.
 It may not be possible for mother to provide KMC for prolonged period in the beginning.
Encourage her to increase the duration each time. The aim should be to provide KMC as
long as possible.
KMC DURING SLEEP AND REST
A comfortable chair with adjustable back
may be useful to provide KMC during sleep
and rest. In the KMC ward or at home, the
mother can sleep with the baby in kangaroo
position in a reclined or semi recumbent
position, about 15 -30 degrees above the
ground.

15. When mother is not available, other family
members such as grandmother, father or
other relatives can provide Kangaroo
Mother Care.
FROM HOSPITAL TO HOME
Standard criteria to be made to transfer the
baby from nursery to the post natal ward
which should be as follows:-
 Stable baby
 Gaining weight
 Mother confident to look after the
baby
DISCHARGE CRITERIA
The standard policy of the unit for discharge from the hospital should be followed. Generally
the following criteria are accepted at most centers:
• Baby's general health is good with no evidence of infection
• Feeding well and receiving exclusively or predominantly breast milk.
• Gaining weight (at least 15-20 gm/kg/day for at least three days)
• Maintaining body temperature satisfactorily for at least three consecutive days in room
temperature.
• The mother and family members are confident to take care of the baby in KMC and should
be asked to come for follow-up visits regularly.
These criteria are usually met by the time baby weighs around 1500gm. The home
environment is also very important for the successful outcome of KMC. The mother should go

16. back to a warm, smoke-free home. She should have support for everyday household tasks.
WHEN SHOULD KMC BE DISCONTINUED?
When the mother and baby are comfortable, KMC is continued for as long as possible, at
the institution & then at home. Often this is desirable until the baby's gestation reaches term or
the weight is around 2500 g. The baby starts wriggling to show discomfort, pull limbs out, cries
and fusses every time the mother tries to initiate skin to skin contact. This is the time to wean the
baby from KMC. Mothers can provide skin to skin contact occasionally after giving the baby a
bath and during cold nights.
RECORD KEEPING
Adequate record keeping is important for babies, especially LBW babies receiving KMC
accurate record keeping help in programme evaluation. The records kept are as follows:
 Date when KMC began.
 Age of baby when KMC was started.
 Weight of baby when KMC was started.
 Condition of the baby.
 Feeding method for the baby.
 Duration and frequency of skin to skin contact.
 Daily weight gain by the baby.
 The drugs received by baby.
 Any complications.
 Information about admission and discharge of the mother.
POST-DISCHARGE FOLLOW UP
Close follow up is a fundamental pre-requisite of KMC practice. It is important that each
unit should formulate its own policy of follow up.
In general, a baby is followed once or twice a week till 37-40 weeks of gestation or till the
bay reaches 2.5-3 kg of weight. (Smaller the baby at discharge, the earlier and more frequent
follow-up visits should be made). Thereafter, a follow up once in 2-4 weeks may be enough till 3
months of post-conceptional age.

17. Later, the baby should be seen at an interval of 1-2 months during first year of life.
The baby should gain adequate weight i.e.15-20 gm/kg/day up to 40 weeks of post-conceptional
age and 10 gm/kg/ day subsequently. More frequent visits should be made if the baby is not
growing well or if his condition demands.
IMPLEMENTATION OF KANGAROO MOTHER CARE IN THE UNIT
The implementation of KMC depends on the following:
1. The staff„s acceptance of KMC.
2. Adopting a KMC policy.
3. Writing KMC guidelines.
4. Training and promoting the staff to use KMC.
5. Teaching mothers to give KMC.
6. Establishing facilities or requirements for KMC.
7. Managing ambulatory KMC.
1. STAFF„S ACCEPTANCE OF KMC:
Health care workers, managers, policy
makers and funders need to be convinced
that KMC offers better, more cost effective
care. All the staff must be encouraged and
trained to help mothers provide kangaroo
mother care to their LBW babies.
2. ADOPTING A KANGAROO MOTHER CARE POLICY: The KMC policy is a written
statement which commits to implement and promote benefits of KMC. It does not have to be a
long and complicated document. The KMC policy must be displayed for staff and parents to see
so, that they are oriented and follow it easily.
3. WRITING KANGAROO MOTHER CARE GUIDELINES: KMC guidelines explain how
KMC is to be implemented. Formal written protocols are needed in the guidelines. Copies of the
guidelines must be freely available in hospitals and clinics where KMC is practiced.
There are no fixed rules for KMC. Each hospital and clinic has their own preferences, while each
mother has her own likes and dislikes about KMC. However, it is important that the principles
and guidelines are followed to maintain that standard care is given and received. In order that

18. KMC succeeds, the whole staff must support the idea and play a role in writing the KMC policy
and guidelines.
4. TRAINING AND PROMOTING THE STAFF TO PRACTICE KMC: All members of
the staff, including nurses, doctors and administrators need to promote the KMC. Training of all
involved personnel must take place at regular intervals so that they can provide physical,
emotional and educational support to the mother and the family. Every mother/ father/ babies
grandparents/ general public should know about KMC and should be educated by nursing
personnel to support KMC both in hospital and at home.
5. TEACHING MOTHERS TO GIVE
KMC: Many mothers have never heard
about KMC and are afraid to give KMC,
especially to LBW babies. From the start of
antenatal care, KMC should be included as
an important part of educating pregnant
women.
Often mothers feel that their LBW infants will receive better care in an incubator which is a
wrong idea. The method, advantages and implications of KMC should be discussed with the
mother as soon as a low birth weight infant is born. Planned teaching programme, educational
material such as information booklet, pamphlets, posters, and video films on KMC in local
language should be available to the mothers, families and community.
6. ESTABLISHING FACILITIES OR
REQUIREMENTS FOR KMC: No
special equipments are needed to give
kangaroo mother care. If possible, reclining
chairs in the nursery and postnatal wards,
and beds with adjustable back rest should be
arranged. Mother can provide KMC sitting
on an ordinary chair or in a semi-reclining
posture on a bed with the help of pillows.

19. 7. MANAGING AMBULATORY KMC:
The word ambulatory means to “walk
around”. Ambulatory KMC usually refers to
the KMC which is given after the infant has
been discharged to home from the hospital
or clinic.
The mothers can give home (or ambulatory) KMC throughout the day. Most work in the house
can be done while giving KMC.
Mothers can give KMC while walking around in or near their homes. Ambulatory KMC can
also be given when attending the clinic, visiting friends, on the bus or going shopping.
Once Kangaroo Mother Care is
implemented, nurses and other staff
appreciate KMC because of health benefits
to the babies, the satisfaction of the mothers
and decrease the workload of staff.
Practicing of the KMC does not require
extra staff in ward compared to incubator
care.
CONCLUSION
Conventional neonatal care of LBW babies is expensive and needs both trained personnel and
permanent logistic support. In developing countries like, financial and human resources for
neonatal care are limited and hospital ward for LBW babies are often over crowded. In this
situation only ray of hope is the kangaroo mother care and the nurses have a major role to play to
initiate and motivate mothers to practice kangaroo mother care as they conduct deliveries in
various health settings and function as independent practitioners or as members of health team.
So KMC is definitely humane, simple and feasible method of care that is important to be
practiced and encouraged by the nurses for the care of LBW babies.