Kangaroo Care (Skin-to-Skin) in the NICU: Benefits and How It Works

What kangaroo care is

Kangaroo care is simple: your baby, wearing just a diaper, rests on your bare chest, tummy to you, with a blanket over their back. March of Dimes and the American Academy of Pediatrics (AAP) both describe it this way, and many NICUs simply call it “skin-to-skin.”

According to the AAP’s HealthyChildren.org, the practice was developed in South America as a way to keep premature babies warm. Mothers held their diapered babies skin-to-skin under their clothing for warmth and breastfeeding. The name stuck because it looks a lot like a kangaroo carrying her joey in a pouch.

What the research says

The World Health Organization’s 2022 recommendations

In November 2022, the World Health Organization (WHO) released new guidelines for the care of babies born preterm (before 37 weeks) or with low birthweight (under 2.5 kg, about 5.5 pounds). The headline change: skin-to-skin contact with a caregiver, which WHO calls kangaroo mother care, should start immediately after birth, without an initial period in an incubator.

WHO said research showed that starting kangaroo mother care right after birth “saves many more lives, reduces infections and hypothermia, and improves feeding.” Those guidelines were written for health systems around the world. How and when they’re put into practice for a particular baby depends on that baby’s condition and on the hospital, so your NICU team is still the one who decides when your baby can be held.

What the AAP and March of Dimes say

HealthyChildren.org lists these benefits of skin-to-skin care for babies: warmth, a steadier heartbeat and breathing, more time in deep sleep and quiet alert states, less crying, more weight gain, and better breastfeeding. It notes these benefits show up “even when kangaroo care happens for only a few minutes each day.”

March of Dimes uses careful wording: kangaroo care may help babies stay warm, keep their heart and breathing regular, gain weight, sleep more deeply, and cry less. For parents, it says kangaroo care may reduce stress, help you feel close to your baby, build your confidence in caring for them, and increase breast milk production.

That last point matters if you’re pumping. Holding your baby skin-to-skin is one of the things March of Dimes suggests for building your supply. Our guide to pumping breast milk for a NICU baby has more on that.

How a first hold usually works with lines and tubes

Seeing your baby surrounded by wires, IV lines, and maybe a breathing tube can make holding them feel impossible. It often isn’t. March of Dimes says you can do kangaroo care “even if they’re connected to NICU equipment,” and Joe DiMaggio Children’s Hospital tells parents that even a baby with many tubes and wires can often be held skin-to-skin throughout the NICU stay. (If the alphabet soup of equipment is new to you, our NICU glossary can help.)

Every unit has its own routine, but a first hold often goes something like this:

• You plan a time with your nurse. Joe DiMaggio Children’s asks parents to tell the nurse when they plan to arrive so the team can work kangaroo care around the baby’s schedule.
• You get comfortable first. HealthyChildren.org suggests a comfortable chair, such as a rocking chair, and says screens can be set up around you for privacy.
• The team moves your baby to you. At the University of Rochester’s Golisano Children’s Hospital, parents do a sitting or standing transfer with help from the baby’s nurse, respiratory therapist, and/or provider. For a baby on a breathing tube, Joe DiMaggio Children’s says two staff members do the move, one holding the baby and one keeping the tube secure.
• Your baby settles in upright on your chest, tummy against you, with a blanket or gown wrapped around you both.
• You stay put and let staff handle changes. Joe DiMaggio Children’s asks parents to keep the call light within reach and not to reposition the baby or put them back to bed without a staff member.

How long? March of Dimes says research shows at least one hour is best, but you can keep going as long as you and your baby are comfortable. Joe DiMaggio Children’s and Montreal Children’s Hospital also suggest planning for at least an hour. On days when that isn’t possible, remember what the AAP said: even a few minutes count.

One firm safety rule: stay awake. March of Dimes, Cleveland Clinic, and Joe DiMaggio Children’s all say so. Cleveland Clinic suggests skipping skin-to-skin when you’re very tired.

If you want to know what the alarms and numbers on the monitor mean while you hold, see what to expect in the NICU.

What to wear and how to prepare

• A top that opens in front. HealthyChildren.org and Cleveland Clinic both recommend clothing that opens down the front. Cleveland Clinic says to take off your bra if you wear one.
• Shower and skip the scent. Joe DiMaggio Children’s asks parents to shower beforehand, wear clean clothes, and not smoke or wear heavy perfume or scented lotion before a session. It also asks you to check your chest for rashes or open wounds.
• Stay home if you’re sick. Joe DiMaggio Children’s asks parents not to come to the NICU with a fever, if they feel unwell, or after being exposed to something contagious. Call the nurse instead.
• Your baby wears very little. Usually just a diaper. Cleveland Clinic says sometimes a hat and socks too, and March of Dimes says to put a blanket over your baby’s back for warmth.
• Something to read. March of Dimes encourages reading to your baby in the NICU. They won’t understand the words, but they recognize your voice. A quiet book can be a lovely part of a long hold.

Partners can do it too

Kangaroo care isn’t just for moms. HealthyChildren.org says plainly that “both parents can participate in skin-to-skin care,” and Montreal Children’s Hospital says moms and dads can both do it. Cleveland Clinic notes that most of the research has focused on mothers, but fathers, other family members, and trained volunteers can provide kangaroo care too.

If you’re recovering from a hard birth, or you’re stretched thin between the NICU and home, a partner’s skin-to-skin time is a real way to share the load. It’s also a way for them to feel like a parent, not a visitor. The NICU is hard on both of you; our guide to NICU parent mental health is written for both of you.

Ask your nurse when your baby is ready

There’s no single start date. March of Dimes says some babies can start soon after birth and some need to wait, so ask your baby’s providers when to start and how often. Montreal Children’s Hospital puts it simply: most families can do kangaroo care, but every medical situation in the NICU is different, so ask your nurse whether your baby is a good candidate yet.

Some situations may mean waiting. Joe DiMaggio Children’s, for example, lists a sudden change in a baby’s condition within the past 24 hours, or a chest tube, as reasons it may not be recommended, with exceptions decided case by case by the physician.

If you can’t hold your baby yet

Waiting is hard. You can still touch your baby. March of Dimes describes a “hand hug” (also called a containment hold): one hand resting very lightly on your baby’s head, the other on their tummy or gently cupping their feet. Its advice is to hold still rather than stroke. Reading aloud at the bedside is another way to be close while you wait.

Questions to ask your nurse

• Is my baby ready for skin-to-skin? If not, what are we waiting for?
• What time of day works best for a hold, and how long can we plan for?
• Can my partner do skin-to-skin too?
• What should I wear, and does the unit have a gown or wrap I can use?
• Can I help with hand hugs or mouth care in the meantime?

Want to make those long holds a little more comfortable for a mom you love? Our NICU care package ideas include practical picks, and you can find more local support on our Treasure Valley NICU resources page. Every basket we deliver is made possible by people who donate.