Neonatology Medical Staff
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FAQ Frequently Asked Questions

 

Information in this site should not be considered as medical advice. It has been compiled with the help of healthcare professionals in the area of Kangaroo Mother Care.

1. Is it necessary a special infrastructure to implement the KMC at the NICU?

Every change needs support from the right people, planning, education (parents AND healthcare team), the correct tools, and proper implementation to make it successful, and we can help you in one or every step of the way.

If doing Kangaroo Care in your unit is not bringing the expected results for any reason, more than likely it is because it is not done properly and we can help. From troubleshooting, answering a simple or complex question, to full implementation, we are equipped to support your efforts to assist your unit in providing evidence-based developmental care.

If we want the Unit to provide the best evidence-based developmental care for their babies, we must give parents the environment where they can hold their babies in Kangaroo Care.

A chair (hopefully comfortable) and a Kangaroo Zak is all they need to properly hold the babies in skin-to-skin. The Kangaroo Zak is ergonomically designed for the NICU, and provides support, all around containment, and boundaries to the baby during the skin to skin contact. It also gives privacy/coverage to the mother's breasts and allows for comfortable and hands-free holding for parents while sitting so they can kangaroo as long as possible.

All changes bring together some difficulty, but you know that the babies greatly benefit from the chest of the parents to heal, bond, grow, and develop.

2. Do I need additional staff to encourage the practice of skin to skin in my Unit?

No. You need to start small, by finding a couple of Kangaroo Care 'champions (nurses, therapists, lactation consultants, doctors, etc)', a couple of parents, and a couple of Kangaroo Zaks. That will encourage the practice and help the program get started. Once you see the results, you won't be able to help but providing that same treatment to all the babies and do full implementation.

At first it seem to be a lot of work but we can guide you through the process. We have a brochure that you can print for free and give to the parents so they can understand the basics of Kangaroo Care.

Very quickly KC will become routine in the Unit, and the picture of the parents watching their babies through the walls of an incubator will diminish. Parents need to know they are critical as caregivers for their baby. If they know and feel that they can make a difference, they keep going to the NICU and doing KC.

3. Does KMC replace the care of anyone or anything in the NICU?

No. Kangaroo Care does not replace but complements and humanizes the care of the neonate, and if practiced correctly, it makes your job easier.

Kangaroo Care helps the fragile baby grow, heal, develop, and integrate to the new family in this critical period and the Kangaroo Zak ensures its successful implementation. Guaranteed.

In places with limited resources, the KMC could be the only opportunity of survival. In more affluent Units where medical/technical/equipment resources exist, it is used as a complement of the neonatal care with excellent results and benefits for the baby, the family, the institution and the society at large.

Consider providing the "Perfect Bundle" to every baby in your NICU (2 Zakys and a Kangaroo Zak) to give a clear message to the parent that your NICU knows how important their presence is for the baby, and that your NICU provides only evidence-based developmental tools. The "Perfect Bundle" virtually eliminates the need for all positioners, bonding, soothing, and transitional items that are left on the baby's bed/incubator.

4. What is the difference between Kangaroo Care, Kangaroo Mother Care, Skin-to-Skin Contact, and Kangaroo Position?

They all refer to "the holding of a diaper clad infant bare chest - to bare chest, ventral surface-to ventral surface by mother, father, or other caregiver." (source: USIKC)

Generally, Kangaroo Care refers to intermittent sessions (some hours a day), as we do in the USA currently.

Kangaroo Mother Care refers to when it is practiced around the clock, like in Sweden. In Colombia some babies are discharged as early as when they weigh 1,200 grams only if the baby is in Kangaroo Mother Care (24/7). That is, anyone must be holding the baby on kangaroo position (mother, father, grandparent, neighbor, etc) around the clock and bringing the baby back for follow up visits regularly.

Skin-to-Skin Contact refers to either one. In practice, all terminology is used to mean the same thing.

Kangaroo Position is the basic component of the KMC and it has has been specifically described in the scientific literature. In the Manual published by the WHO in 2003, it is described as strict upright with legs and arms outstretched and head in lateral position in the mother’s breast, to allow maximum exposure of body surface area between the baby and the mother or whoever that holds him/her. The Kangaroo Zak allows this exact position safely and comfortably for both mom and baby.

5. For babies weighing less than 1000 grams, how do I keep the head upright during Kangaroo?

When the person holding the baby adopts a semiseat position and is using the Kangaroo Zak, the weight of the baby will keep him/her in a suitable position and the hypotonia won't be a problem. Of course, the position should periodically be supervised by the nurse. The use of the Kangaroo Zak makes it easier to keep proper position.

6. How long should a parent hold the baby in the NICU?

The Kangaroo Position (or skin to skin contact) should begin as soon as possible and must be continuous and ongoing.

"Best practice is Kangaroo Care as soon as possible, for as long as possible, and as ininterrupted as possible" - Nyqvist et at, 2010, May Carta Paediatrica.

Rule of thumb, parents should not kangaroo for less than one hour (one full sleep cycle of the baby). Anything less than one hour may be detrimental as the transfer is stressful for the baby.

Rule of thumb, parents should hold preemies on skin-to-skin for six (yes, six) months. The Kangaroo Zak is very effective for holding while doing light chores.

Many procedures are best done while in Kangaroo such as breastfeeding, pumping, blood transfussions, heel sicks, assessments, etc. Research shows the baby feel less pain while in the chest of the mother.

For this to happen, the NICU needs to make a commitment to provide the best possible environment for the parent and the baby (encourage parents to visit, provide education, etc). The Kangaroo Zak is a critical component for safety, comfort, and achieving results.

7. What if baby becomes unstable during holding and I need instant access to him?

Prior to the first session of skin-to-skin contact, the parent is instructed on the basics of Kangaroo Care. This will give everyone confidence and security while always being under the supervision of the NICU staff, and the parent will be able to know when the baby starts showing signs of instability.

In case of a complication everybody acts coordinated and the baby can stabilized again (on the parent's chest or coming back to the incubator/bed).

The Kangaroo Zak makes it very easy to access the baby, this is one of the reasons the Kangaroo Zak does not have straps. Either open the zipper of the Kangaroo Zak or lower the Kangaroo Zak to have immediate and full access to the baby.

8. What do I do if the parents are not able to come to the NICU and do KC?

Research suggests that the Zaky is the best maternal simulator device. If possible, ask the parents to scent the Zaky (by placing them behind the neck or on the chest for at least one hour) to leave with their baby.

The scent of mom helps the baby calm down, and the baby starts learning the scent of dad in the NICU.

If that is not possible either, then use the Zakys without the scent.

With or without the scent, they improve self-regulation and organization, and decrease apnea and bradycardia of prematurity.

9. What do I do if my NICU does not believe in KMC and/or does not let parents practice KMC with the baby under my care?

Each NICU has different rules depending on the staff working in them. First of all, it is important to know why it is not supported (lack of information/education, previous bad experience, limited resources, etc). If the NICU offers "evidence-based" developmental care, they should use the Kangaroo Care method to hold the babies (not swaddling), and the Zaky when the baby is not in KC.

Every NICU needs to start somewhere. This website is an important resource for healthcare providers and parents alike. It is important to show them successful experiences like Yamile Jackson's and to read documents about the hundreds of research findings and articles that speak about the benefits of KMC.

We can help you. Just tell us what you need, or we can help you find out what you need to have a successful KC implementation.

10. Why is it important to offer Kangaroo Care and the Kangaroo Zak?

Kangaroo Care is the new standard of care. As healthcare providers in the NICU, you are dedicated to meeting the needs of babies and caring for parents in this traumatic time.

Physiology and research provides overwhelming evidence that Kangaroo Mother Care is superior to any other environment for the baby and offers many benefits for babies, parents, and the NICU staff.

To achieve this, The Kangaroo Zak was made to contain the baby while giving comfort to the parent. It holds the baby without compression or pressure points, keeping him/her safely attached to the parent’s skin. The source of heat is natural and constant, and with additional benefits for the baby by being permanently stimulated for the heartbeat, breath sound and movement, voice and scent of the mother/father.

By enjoying all these stimuli, the baby easily reaches deep/quiet sleep. It is only in deep sleep when the baby grows, heals, and develops the brain. In many cases it makes the hospital stay less prolonged.

The mother of a fragile baby feels important in the healing of her baby, reduces her anxiety, and this in turn has a direct effect on the breast milk production.

Once the parents hold the baby in skin to skin contact using the Kangaroo Zak they become an important partner of the healthcare professionals in the NICU. This is important also because they will show more aptitudes and will be more confident for the later care of their baby at home.

11. Do I need additional staff to encourage the practice of skin to skin in my Unit?

No. You just need to educate the staff you have.

At first it seems to be a lot of work to teach mothers and watch them closely to ensure the stability of the baby, but in practice the parents become an important ally in providing the best possible care for the babies.

As parents understand the importance of their role, they become better caretakers of their babies while you support their emotional need in being a caregiver for their own baby.

12. For babies weighing less than 1000 grams, how do I keep the head upright during Kangaroo?

When the parent sits down and reclines, the weight of the baby and gravity will keep him/her in a suitable position and hypotonia won't be a problem. Of course, the baby's position should be checked regularly. Parents may use a hand-held mirror to check the baby's position.

13. What if the parent does not want to Kangaroo Care?

Kangaroo Care and its benefits are virtually unknown for parents. The leaders should be proactive in updating the policies of the NICU to reflect the use of Kangaroo Care as an evidence-based practice and keep the personal preference of the nurse to a minimum. Nurses and lactation consultants should be educated in KC so that they can give accurate information to the parents.

In our experience, parents that do not want to kangaroo is because they are afraid to hurt the baby and/or they don't know how important they are in the healing of their baby. If a nurse says to a parent "your baby develops his/her brain if you hold in kangaroo care," no parent is known to reject the practice.

While separation is common, it is abnormal and harmful, so consider Kangaroo Care as much as possible, when possible.

14. Can I use the Moby Wrap or the Boba Wrap to do Kangaroo Care in the NICU?

One that is asked a lot is the Moby Wrap, which is the same as the Boba Wrap - is that the product that you are considering?

The moby wrap is a strip of fabric of about 6 or 7 yards that is wrapped around the mother. Here is the website: http://www.mobywrap.com/t-instructions.aspx
The Boba Wrap is the same - here is the website: http://store.bobafamily.com/baby-wrap/

 

Here is the feedback from nurses that tried this long piece of fabric to do Kangaroo Care in the hospital

1- it is a baby carrier - both mother and baby are fully clothed.

2 - Parent must be standing up to wear it, and many mothers cannot stand up and wrap it alone.

3- Made to carry babies on their side, and this is not the correct Kangaro Position.

4- It is not easy to use in a hospital setting: There is a pretty long learning curve for mothers to do it alone- nurses have to spend time and make sure the wrap is not too tight or too loose.

5- it doesn't work very well with the medical equipment and leads, or with mothers that are recovering from a medical procedure.

6- instead of placing the baby first, positioning him well and secure him, the mother wears the moby wrap and then handle the baby a great deal to place him inside the wrap. This means too much stimulation for the convalescent infant.

7- Not an option in the NICU 3 due to all the leads and need to access the baby immediately to perform a variety of nursing interventions.

8- Because of the length of the product, the baby an have numerous creases of fabric on the back, and even some pressure points. It also has 3 layers of fabric that are not easy to access to do any nursing intervention, pump, or breast feed.

9- Once the mother wears the long fabric, it may not be easily adjusted.

 

On the other hand, our Kangaroo Zak is made for NICUs, for easy access, has no creases or pressure points, and provides a constant containment holding the best position so the experience is enhanced.
The zipper can be partially opened for breastfeeding/pumping, for easy emergency or routine access, and for giving the baby some room to "sniff and explore" if needed.