Neonatology Medical Staff
Other Awards and Accolades
  • What is Kangaroo Care (KC)?

    The most effective and proven method for “cerebral protection" - The baby's brain is in your hands!more

  • Benefits for Babies and Parents

    Learn why this method is the preferred environment for babies in the NICU and newborns.more

  • Kangaroo Care Sessions

    What you and parents should know before, during, and after holding the baby on skin-to-skin.more

  • Complementing Kangaroo Care

    What if the parents are not available or if the baby is not ready for Kangaroo Care? more

Top ^
Kangaroo Care and Kangaroo Zak

What is Kangaroo Care (KC)?

Kangaroo Care, Skin-To-Skin Contact, and Kangaroo Mother Care are terms that relate to the holding of a diaper clad infant bare-chest to bare-chest, ventral-surface to ventral-surface by the mother, father, or others(Source: USIKC).

This method was invented in Bogota, Colombia, and consists of skin to skin contact between the adult and baby, from the time of birth (from the delivery room or intensive, intermediate or basic care,) the food based on breastfeeding, and the early discharge from the hospital. For effective, safer, more comfortable, and longer sessions, use the Kangaroo Zak™.

It is well known that while the attention of high–tech medical care is essential, babies have to endure the stress conditions from which they were supposed to be protected by the womb: noise, light, painful procedures and sleep and wakefulness cycles. All these noxious stimuli affect the development of the neurological system, which is still immature, unable to adequately respond to all this and become attacks that can leave short, medium and long term consequences.
Mother holding her twins skin-to-skin with the Kangaroo Zak, while scenting The Zakys to leave with the baby at the end of the session. (photo courtesy of the Institute of Neonatology of Serbia)

The Kangaroo Zak™ holds the position and the weight of the baby that has been given the green light to be in Kangaroo Care. It minimizes disruptions, provides proper containment and support leaving the parent's handsfree for resting safely or for other activities (thus holding for longer periods of time).

Parents need to be present in the NICU with their baby as soon as they can to provide an effective, more kinder and gentler environment in Kangaroo Care. They should hold as long as they can, no less than one hour which is the length of one full sleep cycle. Many sessions a day if necessary and with minimal interruptions, as recommended by The American Academy of Pediatrics, The Academy of Breast Feeding Medicine, UNICEF, the World Health Organization, the Neonatal Resuscitation Program, and the United States Institute of Kangaroo Care.

"Best Practice is Kangaroo Care as soon as possible, for as long as possible, and as uninterrupted as possible"
(Nyqvist et al., 2010, May Acta Paediatrica)

Kangaroo Position is best achieved and held with the Kangaroo Zak. The Kangaroo Zak holds the weight, proper posture and kangaroo position, prevents the baby from sliding and dislodging medical equipment, provides boundaries and containment without restraining movement. Made especially in NICUs and Post Partum:

Kangaroo Position (World Health Organization)Mother/adult: sitting up or reclined (never horizontal, or prone). On the torso, the adult only wears the Kangaroo Zak over the bare skin. May wear an open top (shirt, blouse, robe, gown, sweater) over the Kangaroo Zak if needed for comfort.

Infant: Infant is placed between the mother's bare breast, strictly vertical and in a prone position, with legs and arms flexed, head in midline and lateral position to allow maximum skin-to-skin exposure. The top of the baby's head is placed a couple of inches lower than the mother's neck. Once the infant is properly positioned, lift the Kangaroo Zak covering the baby up to the level of the learlobe. Make sure the baby's face is uncovered and the nose unobstructed.

Baby only wears diaper (no higher than the belly button) and a hat. Socks may be worn if the room is too cold.

Birth Kangaroo Care Position: During the first hour of life of a healthy or stable baby, when the baby is placed in birth KC position: strictly vertical between the breasts of the mother, and the eye level of the child is at the level of the mother's nipples to reduce the length of the "natural journey" to the first breastfeed.

Graphic by World Health Organization


Resting in Kangaroo Position:

Resting in KC (World Health Organization)

Parents should be able to rest while doing Kangaroo Care. According to the World Health Organization, the mother will best sleep with the baby in kangaroo position in a reclined or semi-recumbent position, about 15 degrees from horizontal. It has been observed that this position may decrease the risk of apnoea for the baby

Some parents prefer sleeping on their sides in a semi-reclined bed (the angle makes sleeping on the abdomen impossible), and if the baby is secured as described there will be no risk of smothering.

A comfortable chair with adjustable back may be useful for resting during the day.

Babies need to be secured to avoid accidental falls, and The Kangaroo Zak is ergonomically designed for this purpose.


Graphic by World Health Organization

Kangarooing with the Kangaroo ZakThe Kangaroo Zak comes in two adjustable sizes, and it is made not only to provide safety, but to hold the weight, provide proper posture/positioning of the parent and the baby, give boundaries and containment without restraining movement, facilitate instant access to the baby from the top, bottom, and sides for interventions/breastfeeding/assessments with minimum disruption. By parents holding hands-free, the kangaroo zak facilitates prolonged and effective kangaroo care session every time.


Top ^


Kangaroo Care and Kangaroo Zak

Benefits of Kangaroo Care

New Poster Presented at Graven's Conference (March 2013):

The Science Behind Kangaroo Care

By Yamile Jackson, PhD, PE, PMP and Barbara Weaver, CCRN

Download: JPG


PDF (208MB)
(80 in x 40 in)
Poster Science Behind KC

Benefits for the parents include:

  • Enhanced attachment and bonding (Tessier et al., 1998).
  • Resilience and feelings of confidence, competence, and satisfaction regarding baby care (Tessier et al., 1998; Conde Agudelo, Diaz Rossello, & Belizan, 2003; Kirsten, Bergman, & Hann, 2001).
  • Increased milk volume, doubled rates of successful breastfeeding and increased duration of breastfeeding (Mohrbacher & Stock, 2003).
  • Physiologically her breasts respond to her infant's thermal needs (Ludington-Hoe et al., 2006).
  • Profoundly beneficial for adoptive parents with critically ill preterm infant (Parker L, Anderson GC. , 2002).

Benefits for the babies include:

  • Kangaroo Care reduces neonatal mortality (Conde-Agudelo et al, 2011).
  • Less incidence and severity of infection (Charpak N, Ruiz-Pelaez JG, Figuero de Calume Z, Charpak Y., 1997).
  • Accelerated autonomic and neurobehavioral development (Feldman R, Eidelman, 2003).
  • Promotes self-regulation in premature infants: sleep wake cyclicity, arousal modulation, and sustained exploration (Feldman R, Weller A, Sirota L, Eidelman A., 2002).
  • Consistently high and stable oxygen saturation levels, lower airway resistance, fewer apnea episodes, and an increased percentage of quiet sleep (Ludington- Hoe, Ferreira, & Goldstein, 1998).
  • Stable temperature within normal thermal zone, heart rate, and respiratory rate (Ludington-Hoe et al., 2010).
  • Reduced crying associated with painful procedures (Kostandy R, Ludington-Hoe SM, 2008).
  • Breast milk is readily available and accessible, and strengthens the infant's immune system.
  • The maternal contact causes a calming effect with decreased stress and rapid quiescence (McCain, Ludington-Hoe, Swinth, & Hadeed, 2005; Charpak et el., 2005).
  • Reduced physiological and behavioral pain responses (Ludington-Hoe, Hosseini, & Torowicz, 2005).
  • Increased weight gain (Charpak, Ruiz-Pelaez, & Figueroa, 2005).
  • Enhanced attachment and bonding (Tessier et al., 1998).
  • Positive effects on infant's cognitive development (Feldman, Eidelman, Sirota, & Weller, 2002).
  • Less nosocomial infection, severe illness, or lower respiratory tract disease (Conde-Argudelo, et. al., 2003).
  • Restful sleep (Ludington-Hoe et al., 2006).
  • Earlier hospital discharge (London et al., 2006).
  • Possible reduced risk of sudden infant death syndrome (SIDS) (see
  • Normalized infant growth of premature infants (Charpak, Ruiz-Pelaez, & Figueroa, 2005).
  • May be a good intervention for colic (Ellett, Bleah, & Parris, 2002).
  • Possible positive effects in motor development of infants (Penalva & Schwartzman, 2006).
  • The critical stimuli to which the baby is exposed during KC are:
    Vestibular: the chest movement of the breathing of the parent, and walking if allowed
    Tactile: the skin and natural warmth of the parent on the bottom (chest), on the sides (breast of mother), and the back (Kangaroo Zak™)
    Olfactory: the scent of the parent and the maternal breast milk.
    Auditory: by the voices and heartbeat of the parent.
Top ^
Kangaroo Care and Kangaroo Zak

Kangaroo Care Sessions

To maximize the effectiveness of the Kangaroo Care sessions, parents and caregivers must have some basic knowledge.

Birth Kangaroo Care Competency Checklist by the USIKC (PDF)

Who can be kangarooed: If the baby is in condition to be moved or lifted to be weighed, s/he can be transfered to Kangaroo Care.

Time of holding: No less than one hour per session, and there is no maximum time - the more the better. Since a complete sleep cycle is one hour, it is NOT recommended that the babies are held on kangaroo if the parent cannot hold for at least that long (especially for small preemies as it may cause reverse effects). The stress of the transfer only is outweighed if the baby is held for at least one sleep cycle.

Rule of thumb: preemies are "Kangarooed" for 6 months and full-term babies within one minute from birth until the first feeding and as much as possible for 3 months.

Instructional Video about Skin-to-Skin Contact

from the Institute of Neonatology, Belgrade, Serbia,
(English subtitles) They use the Kangaroo Zak for both single and multiple babies kangarooing simultaneously.

They use the Kangaroo Zak and The Zakys as the standard of developmental care.

What parents should know before they hold their babies in KC:

  • Learn the benefits of Kangaroo Care and to distinguish signs of stability of the baby (to request a kangaroo session) and warning signs of instability (to stop the kangaroo session).
  • Learn the how to wear the Kangaroo Zak for standing and sitting transfer.
  • Learn that the Kangaroo Zak can be opened just enough to allow the baby to sniff and explore the mother's breasts, for breastfeeding/pumping, and numerous medical interventions while holding.
  • Know that they may do the transfer alone, but ONLY after the training and approval of a medical professional.
  • Learn basic monitor readings, and know what and when to communicate with the staff.
  • Wear the Kangaroo Zak without anything underneath (bra, shirt, etc.) and with the zippers to the side.  Over it, wear comfortable clothing that easily opens in the front or a hospital gown.
  • Remove jewelry that might come in contact with the baby.
  • Refrain from using powder, lotion or perfume on the chest before doing skin to skin care. The baby needs to feel the parent's natural scent.
  • Be free of any lesions or skin breakdown on the chest.
  • Take care of their own personal needs (food, fluids, restroom, etc.).
  • Bring a camera and ask the medical staff to take pictures and/or movies.  After all, it is an important time for them.
  • With the Kangaroo Zak parents kangaroo for long periods of time, so plan accordingly. Parents are encouraged to sleep (as the baby will help the parent relax and take an effective nap), read (for them or to their children), rest, work or do a craft or scrapbook, write a journal, bring a computer/tablet/phone and watch a movie (don't forget the headphones). This is also a great time to read the manuals, books, and other resources provided by the hospital.

To provide 24/7 developmentally supportive care, place The Zaky(s) behind the neck to scent it and warm it naturally while kangarooing. Leave it with the baby when the skin-to-skin session ends to continue to provide neurological development. Top ^

Kangaroo Care and Kangaroo Zak

Complementing Kangaroo Care with The Zakys

The Zaky

The benefits of providing the best possible environment/habitat for the baby do not have to stop with Kangaroo Care. Unfortunately, and for many reasons, parents are not available to Kangaroo, or the baby is not ready/stable for the session.

To provide evidence-based developmentally supportive care AROUND THE CLOCK, complement Kangaroo Care with The Zaky, which is the only ergonomic device that keeps the scent of the parents and simulates the shape, touch, feel, and warmth of the parents' hands when the baby is not held.

The results of an independent clinical research suggest that The Zakys significantly improve self-regulation and significantly decrease apnea and bradycardia of prematuirty, thus improving neurological development.

A pair of Zakys provide the best support to the physical, psychological (emotional), physiological, and neurological development of the baby, while effectively empowering parents to be involved and caring for their own babies in the NICU and then at home.

Parents place The Zaky behind the neck or on the chest for at least one hour to scent it and warm it naturally. Its universal size supports babies in every developmental stage, size, and medical condition. Leave it with the baby when the skin-to-skin session ends to continue to provide developmentally supportive care around the clock.

At Nurtured by Design, we work primarily in helping the baby self-regulate and achieve deep sleep because "only while in Deep Sleep babies develop touch, Motion, Position, Smell, Taste, Vision, Auditory, Emotion, Memory" [Graven & Browne, 2008]

Top ^