Breastfeeding

11

Feeding of Healthy NewbornFeeding of Healthy Newborn

22

SKIN TO SKIN CONTACTSKIN TO SKIN CONTACT

33

SSC position for babySSC position for baby

• SSC positions build on the Tummy to MummySSC positions build on the Tummy to Mummyposition.position.• Full SSC position entails the baby lying on topFull SSC position entails the baby lying on topof the mother:of the mother:FacingFacingCloseCloseTouchingTouching• Mother does not have to hold the baby.Mother does not have to hold the baby.Gravity maintains baby positionGravity maintains baby position

44

Full SSC PositionFull SSC Position

• Baby’s chest is in close contact withBaby’s chest is in close contact with

mum’s body Contour.mum’s body Contour.

• Unrestricted access to breastUnrestricted access to breast

55

Advantages offered by Advantages offered by the Breast Crawlthe Breast Crawl

• Warmth Warmth

• Comfort Comfort

• Metabolic adaptation Metabolic adaptation

• Quality of attachmentQuality of attachment

66

WarmthWarmth

• Prevents hypothermiaPrevents hypothermia

77

ComfortComfort

• The infants in the cot cried for a The infants in the cot cried for a significantly longer time than the significantly longer time than the babies in Breast Crawl position babies in Breast Crawl position during all observation periods.during all observation periods.

88

Metabolic adaptationMetabolic adaptation

• Babies kept in the Breast Crawl position Babies kept in the Breast Crawl position had higher 90 minute blood sugar levels had higher 90 minute blood sugar levels and more rapid recovery from transient and more rapid recovery from transient acidosis at birth, as compared to babies acidosis at birth, as compared to babies separated and kept in a cot next to the separated and kept in a cot next to the mother (Christensson et al, 1992). mother (Christensson et al, 1992).

99

For the MotherFor the Mother

Expulsion of placenta and Expulsion of placenta and reduction of postpartum reduction of postpartum haemorrhagehaemorrhage

1010

The effects ofThe effects ofOxytocinOxytocin

• CalmCalm

• Lower heart rateLower heart rate

• Higher pain thresholdHigher pain threshold

• Higher social interactionHigher social interaction

• Less anxiousLess anxious

• SoporificSoporific

1111

Advantages for Both: Advantages for Both: BondingBonding

• A mother's feeling of love for the baby may not necessarily A mother's feeling of love for the baby may not necessarily begin with birth or instantaneously with the first contact. begin with birth or instantaneously with the first contact. During the Breast Crawl, while resting skin to skin and During the Breast Crawl, while resting skin to skin and gazing eye to eye, they begin to learn about each other on gazing eye to eye, they begin to learn about each other on many different planes. many different planes.

• For the mother, the first few minutes and hours after birth For the mother, the first few minutes and hours after birth are a time when she is uniquely open, emotionally, to are a time when she is uniquely open, emotionally, to respond to her baby and to begin the new relationship. respond to her baby and to begin the new relationship. Suckling enhances the closeness and new bond between Suckling enhances the closeness and new bond between mother and baby. Mother and baby appear to be carefully mother and baby. Mother and baby appear to be carefully adapted for these first moments together adapted for these first moments together

1212

Finally.Finally.SSC works for every other mammal onSSC works for every other mammal onthe planet.. Why should we be any different?the planet.. Why should we be any different?

1313

• http://breastcrawl.org/video.htmhttp://breastcrawl.org/video.htm

1414

Benefits of breast milk to the Benefits of breast milk to the babybaby

• Breast milk and human colostrum are Breast milk and human colostrum are made for babies and is the best first foodmade for babies and is the best first food

• Easily digested and well absorbedEasily digested and well absorbed

• Contains essential amino acids Contains essential amino acids

• Rich in polyunsaturated essential fatty Rich in polyunsaturated essential fatty acidsacids

• Better bioavailability of iron and calciumBetter bioavailability of iron and calcium

1515

Benefits of breast milk Benefits of breast milk (contd.)(contd.)

• Protects against infectionProtects against infection

• Prevents allergiesPrevents allergies

• Better intelligence Better intelligence

• Promotes emotional bondingPromotes emotional bonding

• Less heart disease, diabetes and Less heart disease, diabetes and lymphoma lymphoma

1616

1. Mother infected

4. Antibody to mother’s infection secreted in milk to protect baby

2. WBC in mother’s body make antibodies to protect mother

3. Some WBCs go to breast and make antibodies there

Protection against infectionProtection against infection

1717

Benefits to motherBenefits to mother

• Helps in involution of uterusHelps in involution of uterus

• Delays pregnancyDelays pregnancy

• Decreases mother’s workload, Decreases mother’s workload, saves time and energysaves time and energy

• Lowers risk of breast and ovarian Lowers risk of breast and ovarian cancercancer

• Helps regain figure faster Helps regain figure faster

1818

Benefits to familyBenefits to family

• Contributes to child survivalContributes to child survival

• Saves moneySaves money

• Promotes family planningPromotes family planning

• Environment friendlyEnvironment friendly

1919

Anatomy of breastAnatomy of breastMyoepithelial cells

Epithelial cells

ducts

Lactiferous sinus

Areola

Montgomery gland

AlveoliSupporting tissue and fat

Nipple

2020

Physiology of lactation Physiology of lactation

• Hormonal secretions in the motherHormonal secretions in the mother

– Prolactin helps in production of milkProlactin helps in production of milk

– Oxytocin causes ejection of milkOxytocin causes ejection of milk

• Reflexes in the baby – rooting, Reflexes in the baby – rooting,

sucking & swallowing sucking & swallowing

2121

Prolactin productionProlactin production

Enhanced byEnhanced by

• How early the baby is put to the How early the baby is put to the breastbreast

• How often and how long baby feeds How often and how long baby feeds at breastat breast

• How well the baby is attached to the How well the baby is attached to the breast breast

2222

Prolactin reflexProlactin reflex

Hindered byHindered by

• Delayed initiation of breastfeedsDelayed initiation of breastfeeds

• Prelacteal feedsPrelacteal feeds

• Making the baby wait for feedsMaking the baby wait for feeds

• Dummies, pacifiers, bottlesDummies, pacifiers, bottles

• Certain medication given to mothersCertain medication given to mothers

• Painful breast conditions Painful breast conditions

2323

Enhancing factors Hindering factors

Emptying of breast

Sucking

Expression of milk

Night feeds

Bottle feeding,Incorrect positioning,

Painful breast

Sensory impulse from nipple

Prolactin in blood

Prolactin “milk secretion” Prolactin “milk secretion” reflexreflex

2424

Baby sucking

Sensory impulse from nipple to brain

Oxytocin contracts myoepithelial cells

Oxytocin “milk ejection” reflexOxytocin “milk ejection” reflex

2525

•Thinks lovingly of baby

•Sound of the baby

•Sight of the baby

•CONFIDENCE

•Worry

•Stress

•Pain

•Doubt

Stimulated by Inhibited by

Oxytocin reflexOxytocin reflex

2626

Mother learns to position baby

Baby learns to take breast

Rooting reflex

Swallowing reflex

Sucking reflex

Feeding reflexes in the babyFeeding reflexes in the baby

2727

Composition of preterm and full Composition of preterm and full term milk (g/dl)term milk (g/dl)

3.5

1.0

7.0

Fat

Protein

Lactose

3.5

2.0

6.0

Full Term Preterm

2828

How breast milk composition varies

Colostrum Foremilk Hindmilk

Fat

Protein

Lactose

2929

For successful breastfeedingFor successful breastfeeding

• A willing and motivated motherA willing and motivated mother

• An active and sucking newbornAn active and sucking newborn

• A motivator who can bring both mother A motivator who can bring both mother

and newborn together ( health and newborn together ( health

professional or relative )professional or relative )

3030

Successful breastfeedingSuccessful breastfeeding

• Have a written breastfeeding policyHave a written breastfeeding policy

• Motivate mother from antenatal periodMotivate mother from antenatal period

• Put to breast within 30 minutes of birthPut to breast within 30 minutes of birth

• Promote rooming -in of mother and babyPromote rooming -in of mother and baby

• Promote frequent breastfeedingPromote frequent breastfeeding

3131

Successful breastfeeding Successful breastfeeding (contd.)(contd.)

• Don’t give prelacteal feedsDon’t give prelacteal feeds

• Don’t use bottle to feedDon’t use bottle to feed

• Support mother in breastfeeding the babySupport mother in breastfeeding the baby

• Arrange mother craft classes in health facilitiesArrange mother craft classes in health facilities

• Treat breastfeeding problems earlyTreat breastfeeding problems early

• Exclusive breastfeeding till 6 monthsExclusive breastfeeding till 6 months

• Addition of home-based semisolids after 6 monthsAddition of home-based semisolids after 6 months

3232

Position of baby in relation to Position of baby in relation to the motherthe mother1.1. The baby’s whole body should face the The baby’s whole body should face the

mother and be close to hermother and be close to her

2.2. The baby’s head and neck should be The baby’s head and neck should be supported, in a straight line with his supported, in a straight line with his body, to face the breastbody, to face the breast

3.3. Baby’s abdomen should touch mother’s Baby’s abdomen should touch mother’s abdomen, to be as close as possible to abdomen, to be as close as possible to his motherhis mother

3333

Signs that a baby is attached Signs that a baby is attached well at the breast well at the breast

1.1. The baby’s mouth is wide openThe baby’s mouth is wide open

2.2. The baby’s chin touches the The baby’s chin touches the breastbreast

3.3. The baby’s lower lip is curled The baby’s lower lip is curled outwardoutward

4.4. Usually the lower portion of the Usually the lower portion of the areola is not visibleareola is not visible

3434

Signs that a baby is attached well at Signs that a baby is attached well at the breast the breast

baby’s mouth is wide openlower lip is curled outward

lower portion of the areola is not visible

chin touches the breast

3535

Treatment of inverted Treatment of inverted nipplenippleTreatment should begin Treatment should begin

after birthafter birth

• Syringe suction methodSyringe suction method

• Manually stretch and roll Manually stretch and roll the nipple between the the nipple between the thumb and finger several thumb and finger several times a daytimes a day

• Teach the mother to Teach the mother to grasp the breast tissue grasp the breast tissue so that areola forms a so that areola forms a teat, and allows the baby teat, and allows the baby to feedto feed

3636

Treatment of inverted nipple by syringe Treatment of inverted nipple by syringe methodmethod

STEP 1

STEP 3

STEP 2

Cut along this line with blade

Mother gently pulls the plunger

Insert the plunger from cut end

Use 10 or 20cc syringe

Before the feeds 5-8 times a day

3737

Sore nippleSore nipple

CausesCauses• Incorrect attachment : Nipple sucklingIncorrect attachment : Nipple suckling

• Frequent use of soap and waterFrequent use of soap and water

• Candida (fungal) infectionCandida (fungal) infection

Treatment Treatment • Continue breastfeeding and correct Continue breastfeeding and correct

the position & attachment the position & attachment

• Apply hind milk to the nipple after a Apply hind milk to the nipple after a breastfeed breastfeed

• Expose the nipple to air between Expose the nipple to air between feedsfeeds

3838

Breast engorgement Breast engorgement CausesCauses

• Delayed and infrequent Delayed and infrequent

breastfeedsbreastfeeds

• Incorrect latching of the babyIncorrect latching of the baby

Treatment Treatment

• Give analgesics to relieve painGive analgesics to relieve pain

• Apply warm packs locallyApply warm packs locally

• Gently express milk prior to feedGently express milk prior to feed

• Put the baby frequently to the Put the baby frequently to the

breastbreast

3939

Causes of “Not enough Causes of “Not enough milk”milk”

• Not breastfeeding often enoughNot breastfeeding often enough• Too short or hurried breastfeedingToo short or hurried breastfeeding• Night feeds stopped earlyNight feeds stopped early• Poor suckling positionPoor suckling position• Poor oxytocin reflex (anxiety, lack Poor oxytocin reflex (anxiety, lack

of confidence)of confidence)• Engorgement or mastitisEngorgement or mastitis

4040

Management of “Not enough Management of “Not enough milk”milk”•Put baby to breast frequentlyPut baby to breast frequently•Baby to be correctly attached to Baby to be correctly attached to

breastbreast•Build mother’s confidenceBuild mother’s confidence•Use galactogogues judiciously Use galactogogues judiciously

Adequate weight gain and urine frequency 5-6 Adequate weight gain and urine frequency 5-6 times a day are reliable signs of enough milk times a day are reliable signs of enough milk intake intake

4141

Expressed breast milkExpressed breast milkIndicationsIndications

• Sick mother, local breast problems Sick mother, local breast problems

• Preterm / sick babyPreterm / sick baby

• Working motherWorking mother

StorageStorage

• Clean wide-mouthed container with Clean wide-mouthed container with tight lidtight lid

• At room temperature 8-10 hrsAt room temperature 8-10 hrs

• Refrigerator – 24 hours, Freezer - 20° C Refrigerator – 24 hours, Freezer - 20° C – for 3 months – for 3 months

4242

Ten steps to successful Ten steps to successful breastfeeding breastfeeding

Every facility providing maternity services Every facility providing maternity services and care for newborn infants shouldand care for newborn infants should

1.1. Have a written breastfeeding policy that is Have a written breastfeeding policy that is

routinely communicated to all health care routinely communicated to all health care

staffstaff

2.2. Train all health care staff in skills necessary Train all health care staff in skills necessary

to implement this policyto implement this policy

3.3. Inform all pregnant women about the Inform all pregnant women about the

benefits and management of breastfeeding benefits and management of breastfeeding

4343


(contd….)(contd….) 4.4. Help mothers initiate breastfeeding within half Help mothers initiate breastfeeding within half

hour of birthhour of birth

5.5. Show mothers how to breastfeed, and how to Show mothers how to breastfeed, and how to

maintain lactation even if they are separated maintain lactation even if they are separated

from their infantsfrom their infants

6.6. Give no food or drink, unless medically Give no food or drink, unless medically

indicatedindicated

7.7. Practice rooming-in : allow mothers and infants Practice rooming-in : allow mothers and infants

to remain together 24 hrs a dayto remain together 24 hrs a day

4444

8.8. Encourage breastfeeding on Encourage breastfeeding on demanddemand

9.9. Give no artificial teats or pacifiers Give no artificial teats or pacifiers (also called dummies or soothers) (also called dummies or soothers) to breastfeeding infantsto breastfeeding infants

10.10.Foster the establishment of Foster the establishment of breastfeeding support groups and breastfeeding support groups and refer mothers to them on refer mothers to them on discharge from the hospital.discharge from the hospital.


(contd….)(contd….)

4545

4646

FeedingFeeding

•The World Health Organization (WHO) recommends that

all babies be exclusively breastfed for six months

•Semi-solids can be introduced after six months, and baby

can continue to have breast milk for two years and beyond to

enjoy the maximum protection breast-feeding can provide.

4747

Strategy for SuccessfulStrategy for Successful BreastfeedingBreastfeeding

At the delivery suite: first breastfeed within 1 hour after birth unless medically contraindicated

Post-natal Ward:

Mothers who have had a Caesarean delivery can breastfeed lying down with help from the nursing staff

Once you are able to sit up, you can breastfeed using the football hold, which is nursing the baby in a side lying position supported by your arm.

Rooming-in: Having your baby together with you after delivery helps to build the mother-child bonding process.

4848


Frequency of feed:

√Newborns should be breastfed whenever they show signs of hunger, for example rooting reflex or increased alertness.√ at least 8 to 12 breastfeeds per day. √The frequent breastfeeds help to stimulate the milk production

4949


Helpful tips to Mums:

√ Prepare your nipple, if retracted start pulling it outwards antenatally√Your baby should be well positioned, correctly latched on and suckling well when on the breast√A baby who is sleepy on the breast needs to be coaxed to suckle√Ensure you are drinking adequately, >3 lit /day√Have adequate rest, are not stressed or distracted or in pain√Observe your baby's suckling cues. Your baby may take 15 to 20 minutes to finish a feed from the first breast before offering the second breast•Breastfeeding is not always easy and sometimes, a lot of patience and perseverance is required as mothers may find that breastfeeding is a totally new learning experience

5050

How do you know if your How do you know if your baby is getting enough?baby is getting enough?

Observe the following: √Baby passes light yellow urine at least 6 to 8 times in 24 hours.√The frequency of your baby’s bowel movement may vary a lot. On the average, 3 or more bowel movements per day indicates that your baby’s milk intake is sufficient.√Your baby is generally alert, contented and gaining weight.(There is some weight loss in the first few days of life. Your baby should gain back the birth weight by 7 to 14 days of life and should then gain weight weekly.)

5151

Working And BreastfeedingWorking And Breastfeeding

√Introduce a bottle of expressed milk to your baby about 2 weeks prior to your commencement of work as some babies may take some time to get √used to feeding from the bottle.√Breastfeed your baby before going to work and when you return home.√Express your milk regularly or at least once while at work.√Store the expressed milk in the fridge or freezer.√Use an ice-filled cooler box to keep the breast milk cool during transportation

5252

Label the name, date and time of expression of breast milk

Storage of expressed breast milk

5353

Storage of expressed breast milk

√Freshly expressed breast milk kept in the general compartment of

the fridge at a temperature of 4 degrees Celsius should be used within 48 hours.

√Breast milk kept in the freezer which has a separate door, should be used within 3 months.

5454

Thawing of frozen expressed breast milk

A bottle of frozen expressed breast milk can be thawed in the fridge by placing it in a cup filled with water at room temperature

(Indicate the date and time that the milk is taken out from the freezer and placed in the general compartment of the fridge. Use this milk in 24 hours.)

5555

Warming up of expressed breast milk

√For immediate use, you can thaw a bottle of frozen or chilled expressed milk by placing it in a mug of warm water√Test the temperature of the milk before feeding√Discard any unused remainder√Do not boil or microwave the milk.

5656

Goals of BreastfeedingGoals of Breastfeeding

Mothers should Mothers should be given every be given every support tosupport to exclusively breastfeed their exclusively breastfeed their infants from birth to 6 months of age, infants from birth to 6 months of age,

start complementary foods at 6 start complementary foods at 6 months while continuing to breastfeed months while continuing to breastfeed

till 2 years and beyond …till 2 years and beyond …

5757

Breastfeeding GoalsBreastfeeding Goals

About 2000 mothers surveyedAbout 2000 mothers surveyed

•95% initiated breastfeeding95% initiated breastfeeding

•21% at 6 months21% at 6 months

Exclusive breastfeedingExclusive breastfeeding

•14% at 2 months14% at 2 months

•1% at 6 months1% at 6 monthsHealth Promotion Board Survey Singapore 2001

5858

Benefits of BreastfeedingBenefits of Breastfeeding

• Infectious diseasesInfectious diseases

• Long term health outcomesLong term health outcomes

• NeurodevelopmentNeurodevelopment

• Maternal health benefitsMaternal health benefits

• Community benefitsCommunity benefits

Breastfeeding and the use of human milk. Breastfeeding and the use of human milk. Pediatrics.Pediatrics. 2005;115:496–506 2005;115:496–506

5959

Health OutcomesHealth Outcomes

INFANTSINFANTSReduced risk of Reduced risk of • Acute otitis mediaAcute otitis media• Nonspecific gastroenteritisNonspecific gastroenteritis• Severe lower respiratory Severe lower respiratory

tract infectionstract infections• Atopic dermatitisAtopic dermatitis• AsthmaAsthma• ObesityObesity• Type 1 and 2 diabetesType 1 and 2 diabetes• Childhood leukemiaChildhood leukemia• SIDSSIDS• Necrotising enterocolitisNecrotising enterocolitis

WOMENWOMEN

Reduced risk ofReduced risk of

• type 2 diabetes by 12% for type 2 diabetes by 12% for each year of breastfeedingeach year of breastfeeding

• ovarian cancer by 21 %ovarian cancer by 21 %

• breast cancer 28 % in breast cancer 28 % in those whose lifetime those whose lifetime duration of breastfeeding duration of breastfeeding was 12 months or longer was 12 months or longer

6060

Practical Aspects of Practical Aspects of BreastfeedingBreastfeeding

6161

Mother’s positionMother’s position

Any comfortable position

6262

Baby’s Position Baby’s Position

Baby held close to mother’s Baby held close to mother’s bodybody

• Infant faces breast with Infant faces breast with head and body in straight linehead and body in straight line

• Upper lip opposite nippleUpper lip opposite nipple• Baby can reach breast easilyBaby can reach breast easily• Move baby to breast, Move baby to breast,

not breast to babynot breast to baby

6363

Preparing for LatchPreparing for Latch

Ensure correct position of Ensure correct position of babybaby

• Stimulate rooting reflex Stimulate rooting reflex with nipplewith nipple

• Wait for baby to open Wait for baby to open mouth widemouth wide

• Baby’s bottom lip touches Baby’s bottom lip touches base of areolabase of areola

• Help baby take sufficient Help baby take sufficient areola into mouthareola into mouth

Insert video Clip

6464

Correct Latch - CLAMSCorrect Latch - CLAMS

• CChin touching lip hin touching lip

• Bottom Bottom LLip curling back ip curling back

• More More AAreola visible above reola visible above

top lip than below lower lipstop lip than below lower lips

• MMouth wide open with big outh wide open with big

mouthful of breastmouthful of breast

• SSucking pattern change ucking pattern change

from short sucks to long from short sucks to long

deep sucks with pausesdeep sucks with pauses

6565

Assessing Adequacy of Breastfeeding: 3rd Assessing Adequacy of Breastfeeding: 3rd day of life day of life babybaby

• Weight loss less than 7%, Regain Weight loss less than 7%, Regain birth weight by day 10 -14birth weight by day 10 -14

• Urine 3 - 4 times/day Urine 3 - 4 times/day

• Stools 3 – 4 times/dayStools 3 – 4 times/day

• Stools yellow-green by 3rd-4th dayStools yellow-green by 3rd-4th day

http://en.wikipedia.org/wiki/Image:Meconium.jpg

6666

Assessing Adequacy of Assessing Adequacy of Breastfeeding: 3rd day of life Breastfeeding: 3rd day of life MotherMother

•Respond appropriately to early infant Respond appropriately to early infant feeding cues and feeding cues and feeding 8 – 12 times in feeding 8 – 12 times in 24 hours24 hours

•Comfortable positioning and effective Comfortable positioning and effective latchlatch

•Recognise signs of effective Recognise signs of effective breastfeedingbreastfeeding

• Identify available breastfeeding Identify available breastfeeding resources and helpresources and help

6767

Fully Breastfed Babies in First Fully Breastfed Babies in First WeekWeek

Day of lifeDay of life Wet diapers in 24 Wet diapers in 24 hourhour

Stools in 24 hoursStools in 24 hours

First 24 First 24 hourshours

11 1 meconium1 meconium

Day 2Day 2 22 2 meconium2 meconium

Day 3Day 3 33 Stool colour changeStool colour change

Day 4Day 4 4, light yellow4, light yellow Transitional stoolsTransitional stools

Day 5Day 5 5, colourless5, colourless 3 - 4 yellow stools3 - 4 yellow stools

Day 6+Day 6+ 6+,colourless6+,colourless 4+ stools, freq and colour 4+ stools, freq and colour variesvaries

6868

6969

7070

Formula FeedingFormula Feeding

• Goal standard for nutrition is the exclusively Goal standard for nutrition is the exclusively breast fed infant breast fed infant

• Wide range of commercial formulas, mainly Wide range of commercial formulas, mainly cows milk basedcows milk based

7171

Formula Feeding in InfancyFormula Feeding in Infancy

• Caloric requirements 80 –120 kcal/kg/day Caloric requirements 80 –120 kcal/kg/day

• Standard formula: 20 kcal/30 ml or 0.67 kcal/ml Standard formula: 20 kcal/30 ml or 0.67 kcal/ml

• Therefore, infant requires 120 – 180 ml/kg/day Therefore, infant requires 120 – 180 ml/kg/day of formulaof formula

• Feeding on demand, generally 2 – 5 hourly, with Feeding on demand, generally 2 – 5 hourly, with varying volumesvarying volumes

7272

Human versus Bovine milk: Human versus Bovine milk: ProteinProtein

• Higher protein content in bovine milkHigher protein content in bovine milk• Whey – Casein ratioWhey – Casein ratio

•Human milk 70% whey and 30% caseinHuman milk 70% whey and 30% casein•Bovine milk 18% whey and 92% caseinBovine milk 18% whey and 92% casein Whey protein is digested more easily and Whey protein is digested more easily and

promotes more rapid gastric emptyingpromotes more rapid gastric emptying• Whey protein Whey protein

– Human: Human: -lactalbumin, lactoferrin, -lactalbumin, lactoferrin, lysozyme and secretory Ig A lysozyme and secretory Ig A

– Bovine Bovine -lactoglobulin (? Cow milk protein -lactoglobulin (? Cow milk protein allergy)allergy)

7373

Human versus Bovine milk: Human versus Bovine milk: LipidLipid• Human milk has variable fat components with Human milk has variable fat components with

changes during day, among women and within changes during day, among women and within one feedone feed

• Formulas mimic human milk fat content by Formulas mimic human milk fat content by addingadding– CarnitineCarnitine– Higher Medium chain FA to increase absorptionHigher Medium chain FA to increase absorption– Essential fatty acids linoleic and linolenic acidEssential fatty acids linoleic and linolenic acid– Arachidonic acid (AA) and Docosahexaenoic Arachidonic acid (AA) and Docosahexaenoic

acid(DHA)acid(DHA)

•LC-PUFA are phospholipids in brain, retina LC-PUFA are phospholipids in brain, retina and rbc membranesand rbc membranes

7474

Human versus Bovine milk: Human versus Bovine milk: CarbohydrateCarbohydrate• Human milk has high lactose (90-Human milk has high lactose (90-

95%) and oligosaccharides (10-5%)95%) and oligosaccharides (10-5%)

• Softer stool consistency and non-Softer stool consistency and non-pathogenic bacterial fecal flora pathogenic bacterial fecal flora

• Oligosaccharides are natural Oligosaccharides are natural prebiotics, Lactobacillus and prebiotics, Lactobacillus and Bifidobacterium spp are natural Bifidobacterium spp are natural probioticsprobiotics

7575

Special formulasSpecial formulas

• Preterm formulasPreterm formulas– Higher caloric content (24kcal/30ml)Higher caloric content (24kcal/30ml)– Higher protein, lipidsHigher protein, lipids– Higher minerals ( Ca, Phosphate)Higher minerals ( Ca, Phosphate)

• Formulas for cows milk allergyFormulas for cows milk allergy– Extensively hydrolysed milkExtensively hydrolysed milk

• Lactose intoleranceLactose intolerance– Soy formulaSoy formula– Lactose free cows milk formulaLactose free cows milk formula

7676

Complementary Feeding of Complementary Feeding of the Breastfed Babythe Breastfed Baby

• Start weaning about 6 months (WHO guidelines)Start weaning about 6 months (WHO guidelines)

• Nutritional basisNutritional basis– Need for additional minerals e.g. sodium, iron, Need for additional minerals e.g. sodium, iron,

zinczinc– Caloric dense semi-solidsCaloric dense semi-solids– Not as supplement to breast milk, Not as supplement to breast milk, as complementas complement

• Developmental basisDevelopmental basis– Refusal of solids if introduced too lateRefusal of solids if introduced too late– Baby is developmentally ready Baby is developmentally ready

•Adequate head/neck/trunk controlAdequate head/neck/trunk control

•Loss of tongue thrust reflexLoss of tongue thrust reflex

7777

Kangaroo CareKangaroo Care

7878

Kangaroo CareKangaroo Care

Kangaroo Care (KC) is skin-to-skinKangaroo Care (KC) is skin-to-skin

placement of a diaper clad infantplacement of a diaper clad infant

against the chest of another against the chest of another humanhuman

being (usually mother, father)being (usually mother, father)

7979

What is Kangaroo Mother What is Kangaroo Mother Care??Care??

Definition:Definition: • early, continuous and prolonged skin-to-skin early, continuous and prolonged skin-to-skin

contact between the mother and the baby contact between the mother and the baby • A universally available and biologically sound A universally available and biologically sound

method of care for all newborns, but in particular method of care for all newborns, but in particular for premature babies, with three components ...for premature babies, with three components ...

• 1. Skin-to-skin Contact1. Skin-to-skin Contact2. Exclusive breastfeeding2. Exclusive breastfeeding3 .Support to the mother infant dyad. 3 .Support to the mother infant dyad.

8080

Kangaroo CareKangaroo Care- Mother and Father- Mother and Father

8181

Why the title "Kangaroo Why the title "Kangaroo Mother Care"?Mother Care"?

Mother kangaroo is a mammal (just like us), and feeds its baby milk like we do (or like we should!) from a nipple inside its pouch.

The pouch covers the baby with skin, and this not only protects the very immature baby, but also provides it with a total environment which is essential for development.

This includes warmth, food, comfort, stimulation, protection.

The baby is CARRIED for all this time, without interruption !

8282

At Manama (where birth skin-to-skin At Manama (where birth skin-to-skin contact started), phototherapy was contact started), phototherapy was

also donealso done..The box has lights shining on the baby, and mother!The height of the box can be adjusted using the pegs on the side, to get optimal temperature and exposure., the round side holes allowed for inspection. Sheets in summer, and blankets in winter, covered all the sides. Mother's head can extend beyond the top side cover, or be inside, in which case her eyes are covered !!! This picture is posed ... only 3 out of 126 skin-to-skin babies ever developed jaundice. This box was used mainly to treat the fullterm babies that developed jaundice, and could be used without mother present.

8383

HistoryHistorySr Agneta Jurisoo studied what little literature was available on KMC Sr Agneta Jurisoo studied what little literature was available on KMC during 1987. The following year she and Dr Bergman arrived at a during 1987. The following year she and Dr Bergman arrived at a small mission hospital in Zimbabwe, where premature births were small mission hospital in Zimbabwe, where premature births were common. There were no incubators, poor transport over great common. There were no incubators, poor transport over great distances, and overloaded referral centres: only one of ten premature distances, and overloaded referral centres: only one of ten premature babies survived. babies survived.

In the absence of incubators, they started a care plan in which the In the absence of incubators, they started a care plan in which the mother became the incubator. Instead of waiting for the baby to mother became the incubator. Instead of waiting for the baby to “stabilise”, the mother was used to stabilise premature infants “stabilise”, the mother was used to stabilise premature infants immediately after birth. It was immediately clear this was highly immediately after birth. It was immediately clear this was highly effective, no matter how small or how premature, stabilisation took a effective, no matter how small or how premature, stabilisation took a mere six hours. With this care, now five of ten very low birth weight mere six hours. With this care, now five of ten very low birth weight babies survived. babies survived.

This work has been published:This work has been published:The "kangaroo-method" for treating low birth weight babies in a The "kangaroo-method" for treating low birth weight babies in a developing country.developing country.

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HistoryHistory• • 19791979 - Dr Rey and Martinez started program in - Dr Rey and Martinez started program in

Bogota, Colombia, in response to shortage of Bogota, Colombia, in response to shortage of incubators and severe hospital infections.incubators and severe hospital infections.

• • 19831983 - UNICEF brought attention to program - UNICEF brought attention to program Spanish!Spanish!

• • 19851985 - Number of visits from USA, UK and - Number of visits from USA, UK and Scandinavia, first English report published in The Scandinavia, first English report published in The Lancet by Whitelaw and Sleath, May 1985.Lancet by Whitelaw and Sleath, May 1985.

• • 1986 onwards1986 onwards - Research in Europe and USA. - Research in Europe and USA. Implementation widespread in Scandinavia and Implementation widespread in Scandinavia and Germany. Early implementation in Mozambique Germany. Early implementation in Mozambique and other African countries.and other African countries.

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HistoryHistory19911991 - First review of research published by Gene Cranston Anderson. - First review of research published by Gene Cranston Anderson.

19961996 - First International Workshop, Trieste, Italy, hosted by Adreano - First International Workshop, Trieste, Italy, hosted by Adreano Cattaneo and team. Noted over thirty different terms used, agreed to Cattaneo and team. Noted over thirty different terms used, agreed to use KMC (Kangaroo Mother Care), defining the program of skin-to-skin use KMC (Kangaroo Mother Care), defining the program of skin-to-skin contact, breastfeeding and early discharge. The term “K C” refers only contact, breastfeeding and early discharge. The term “K C” refers only to intervention “intrahospital maternal-infant skin-to-skin contact”.to intervention “intrahospital maternal-infant skin-to-skin contact”.

19981998 - First International Conference on Kangaroo Care, Baltimore, - First International Conference on Kangaroo Care, Baltimore, Maryland, USA, arranged by Susan Ludington-HoeMaryland, USA, arranged by Susan Ludington-Hoe

19981998 - Second International Workshop, Bogota, Colombia, arranged by - Second International Workshop, Bogota, Colombia, arranged by Nathalie Charpak and team; focus on research and implementationNathalie Charpak and team; focus on research and implementation

20002000 - Third International Workshop, Yogyakarta, Indonesia. - Third International Workshop, Yogyakarta, Indonesia.

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OUTLINEOUTLINE

I. Definition & History of Kangaroo CareI. Definition & History of Kangaroo Care

II. Physical & Psychological responsesII. Physical & Psychological responses

III. Intubated infantsIII. Intubated infants

IV. Applying K.C.IV. Applying K.C.

V. Kangaroo Care and LactationV. Kangaroo Care and Lactation

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APPLYING KANGAROOAPPLYING KANGAROO

Normal NewbornNormal Newborn

• Temp stabilizerTemp stabilizer

• Slow respiratory Slow respiratory raterate

• Early breastfeedingEarly breastfeeding

• Early attachmentEarly attachment

• processprocess

• Less cryingLess crying

NICUNICU

• Thermal regulationThermal regulation

• Less A’s & B’sLess A’s & B’s

• Weight gainWeight gain

• BondingBonding

• Parent involvementParent involvement

• with care of babywith care of baby

• Earlier dischargeEarlier discharge

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Physical & PsychologicalPhysical & PsychologicalResponses fromResponses from

Skin To Skin ContactSkin To Skin ContactInfantInfant

&&MaternalMaternal

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Benefits of KC for InfantsBenefits of KC for Infants

Early Postpartum PeriodEarly Postpartum Period• Cry 10 times less and for shorter periods thanCry 10 times less and for shorter periods thaninfants in cotsinfants in cots• Less distress cryingLess distress crying• More flexor & few extensor muscle movementsMore flexor & few extensor muscle movements• Greater physiologic stability, less crying, & fewerGreater physiologic stability, less crying, & fewergrimaces during painful procedures (ex. Injections)grimaces during painful procedures (ex. Injections)• Better attachment to mothersBetter attachment to mothers

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RESPIRATORY RATERESPIRATORY RATE

• Stabilizes a preemie’s breathing rate 35-50 per Stabilizes a preemie’s breathing rate 35-50 per minuteminute

• Depth of each breath becomes more evenDepth of each breath becomes more even• Apnea decreases fourfold or is absentApnea decreases fourfold or is absent during KCduring KC• Length of apnea episode diminishesLength of apnea episode diminishes• Periodic breathing is significantlyPeriodic breathing is significantly decreased with normal breathing takingdecreased with normal breathing taking over.over.

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THERMAL REGULATIONTHERMAL REGULATION

• Neutral thermal zone Neutral thermal zone - the temperature- the temperature

range at which a baby has minimal oxygenrange at which a baby has minimal oxygen

needs.needs.

• Baby’s temp rises quickly in the first 10Baby’s temp rises quickly in the first 10

minutes and then stabilizes to minutes and then stabilizes to their neutraltheir neutral

thermal zone thermal zone for the remainder of for the remainder of K.C.sessionK.C.session

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OXYGENATIONOXYGENATION

• Increased oxygenation with increased Increased oxygenation with increased blood flow through the vessels the blood flow through the vessels the oxygenation is increased.oxygenation is increased.

• Tools to assess is clinical assessment Tools to assess is clinical assessment of babyof baby

• Transcutaneous pressure of oxygenTranscutaneous pressure of oxygen

(TCPO2), pulse oximeter , carbon (TCPO2), pulse oximeter , carbon dioxide monitor or blood gases.dioxide monitor or blood gases.

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INFANT RESPONSEINFANT RESPONSECARDIACCARDIAC

• CARDIAC STABILITY - blood flow is steady CARDIAC STABILITY - blood flow is steady and sustained to the brain with oxygen and sustained to the brain with oxygen when there is less variability of heart ratewhen there is less variability of heart rate

• Babies with episodes of bradycardia Babies with episodes of bradycardia may may not have not have bradycardia with Kangaroo Carebradycardia with Kangaroo Care

• K.C. improves post-extubation K.C. improves post-extubation cardiorespiratory parameters after open cardiorespiratory parameters after open heart surgery continuedheart surgery continued

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INFANT RESPONSESINFANT RESPONSES

• Increased regular sleepIncreased regular sleep• Increase states of alertnessIncrease states of alertness• Self-regulatory feeding: relax & feed,Self-regulatory feeding: relax & feed,frequently repeat pattern, this aids infrequently repeat pattern, this aids insustained blood glucose levelssustained blood glucose levels• Early opportunity to learn suckling andEarly opportunity to learn suckling andbreathing coordinationbreathing coordinationThis can save calories thus better weight This can save calories thus better weight

gaingain• Reduces pain score with painful procedureReduces pain score with painful procedure

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Long Term Benefits of KC for Long Term Benefits of KC for Infants- 1 yearInfants- 1 year

• Fewer infections at 6 & 12Fewer infections at 6 & 12monthsmonths• Less fussy/crying and more alert statesLess fussy/crying and more alert states• Infant in cribs cried 10 timesInfant in cribs cried 10 timesmore frequently than KC infantsmore frequently than KC infants• Smiles more often at 3 monthsSmiles more often at 3 months• Ahead in social, linguistic, fine/gross motor Ahead in social, linguistic, fine/gross motor

indices at 1 yearindices at 1 year

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Long Term Benefits of KC for Long Term Benefits of KC for Infants- 3 yearInfants- 3 year

• Earlier urinary continenceEarlier urinary continence

• Earlier stubbornnessEarlier stubbornness

• In free play mothers & children were In free play mothers & children were smiling & laughing moresmiling & laughing more

• Mothers more encouraging & instructingMothers more encouraging & instructing

towards childrentowards children

Ref; (de Chateau & Weiberg, 1977a, 1977b, Ref; (de Chateau & Weiberg, 1977a, 1977b, 1984)1984)

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Full Term StudiesFull Term Studies

• Breastfeeding Difficulties - 2003 Anderson & ChiuBreastfeeding Difficulties - 2003 Anderson & Chiu Found 30 -90 minutes of KC before anticipated feeding Found 30 -90 minutes of KC before anticipated feeding

increased latch-on Increased mothers perception of getting increased latch-on Increased mothers perception of getting enough display of cues associated with breastfeedingenough display of cues associated with breastfeeding

Thermal Regulation - Chiu et.al, 2005 and Durand et al, 1997Thermal Regulation - Chiu et.al, 2005 and Durand et al, 1997• Infants breastfed in the KC position stay warm and are Infants breastfed in the KC position stay warm and are

warmer that those breastfed while swaddled or in a cot warmer that those breastfed while swaddled or in a cot (bed).(bed).

• Exclusive Breastfeeding - Mikiel-Kostryra et al. 2002Exclusive Breastfeeding - Mikiel-Kostryra et al. 2002• KC promotes exclusive BF >20 minutes of KC is significant KC promotes exclusive BF >20 minutes of KC is significant

predictor of exclusive BF duration, the more KC they have, predictor of exclusive BF duration, the more KC they have, the longer the mother will exclusive BF.the longer the mother will exclusive BF.

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FAMILIES WHO BENEFITFAMILIES WHO BENEFITFROM KANGAROO CAREFROM KANGAROO CARE

• All families benefit from Kangaroo CareAll families benefit from Kangaroo Care

• Fathers & Support PersonsFathers & Support Persons

• Teen ParentsTeen Parents

• Adoptive FamiliesAdoptive Families

• Substance Abuse MothersSubstance Abuse Mothers

• GrandparentsGrandparents

• SiblingsSiblings

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FAMILY CENTERED CAREFAMILY CENTERED CARE

• Earlier and increased bonding with motherEarlier and increased bonding with mother

• Earlier parental involvement with care ofEarlier parental involvement with care of

the babythe baby

• Parents become more “in tune” withParents become more “in tune” with

their baby’s cues and responsestheir baby’s cues and responses

• Increase in parents readiness to careIncrease in parents readiness to care

for infantfor infant

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KANGAROO CARE ANDKANGAROO CARE ANDLACTATION BENEFITSLACTATION BENEFITS

• Skin to skin promotes hormone responseSkin to skin promotes hormone responsein mother to trigger increased milkin mother to trigger increased milkproductionproduction• Milk Ejection Reflex (MER) frequentlyMilk Ejection Reflex (MER) frequentlyoccurs in Kangaroo Careoccurs in Kangaroo Care• Babies will find their way to the breast forBabies will find their way to the breast fora little “licking and loving”a little “licking and loving”• Nuzzling at the breast progressing on toNuzzling at the breast progressing on tobreastfeedingbreastfeeding

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MATERNAL RESPONSESMATERNAL RESPONSES

• Bonding to baby - aids in attachmentBonding to baby - aids in attachmentprocess for neonates that can already beprocess for neonates that can already bedifficult to bond with.difficult to bond with.• Increased sense of comfort with parenting Increased sense of comfort with parenting

and caring for their baby at discharge.and caring for their baby at discharge.• Strongly identify with their infants and feltStrongly identify with their infants and feltconfidence in meeting their infants needsconfidence in meeting their infants needs• Reduces incidence of post partum Reduces incidence of post partum

depression (PPD)depression (PPD)

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MATERNAL RESPONSESMATERNAL RESPONSES

• Milk production - increased prolactinMilk production - increased prolactin

levels with skin to skinlevels with skin to skin

• Milk ejection reflex (MER) - LetdownMilk ejection reflex (MER) - Letdown

Increased oxytocin levelsIncreased oxytocin levels

• Mother more relaxed and confidentMother more relaxed and confident

• Lactation longevityLactation longevity

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Benefits of Kangaroo CareBenefits of Kangaroo Carefor Mothersfor Mothers

• Enhanced maternal-infant attachment & Enhanced maternal-infant attachment & bondingbonding

• Increased maternal self confidenceIncreased maternal self confidence

• Increased maternal affectionate behaviorIncreased maternal affectionate behavior

• Enhanced relaxationEnhanced relaxation

• Experience less anxietyExperience less anxiety

• Less breast engorgementLess breast engorgement

• More rapid involution (uterus returning to More rapid involution (uterus returning to pre-pregnant size)pre-pregnant size)

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Benefits of kangaroo care to Benefits of kangaroo care to institutionsinstitutions

• Shorter hospital stay Advanced healthcare technology only used in Shorter hospital stay Advanced healthcare technology only used in addition to Kangaroo care addition to Kangaroo care

• More parental involvement with greater opportunities for teaching More parental involvement with greater opportunities for teaching and assessing and assessing

• Better use of resources Better use of resources • Less morbidity and mortality especially in developing countries Less morbidity and mortality especially in developing countries • Opportunities for teaching and during pregnancy and follow up in Opportunities for teaching and during pregnancy and follow up in

preparation of postnatal implementation preparation of postnatal implementation • Less drain on financial resources Less drain on financial resources • Promotion of total family health Benefits of Kangaroo care to Promotion of total family health Benefits of Kangaroo care to

community community

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KANGAROO CAREKANGAROO CAREAND THE DYING BABYAND THE DYING BABY

• For some families it can be comforting toFor some families it can be comforting to

hold their baby until death occurs.hold their baby until death occurs.

• This can provide the family with a sense ofThis can provide the family with a sense of

comfort and bonding that may not havecomfort and bonding that may not have

been established due to the baby’s critical been established due to the baby’s critical status.status.

• Assists in the grieving process for theAssists in the grieving process for the

family.family.

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• Unstable babiesUnstable babies

• Baby at risk for IVHBaby at risk for IVH

• Baby with immature skinBaby with immature skin

• Baby on vasopressor drugsBaby on vasopressor drugs

• Babies with arterial lines Babies with arterial lines

• Prolonged or severe apnoeaProlonged or severe apnoea

• Indwelling chest tubesIndwelling chest tubes

• UAC,UVC or peripheral arterial linesUAC,UVC or peripheral arterial lines

• Severely jaundiced babiesSeverely jaundiced babies

Which babies are not able toKangaroo care

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Eligibility criteria: BabyEligibility criteria: Baby

• Birth weight >1800 gm: Birth weight >1800 gm:

Start at birthStart at birth

• Birth weight 1200-1799 gm: Birth weight 1200-1799 gm:

Hemodynamically stable Hemodynamically stable

• Birth weight <1200 gm: Birth weight <1200 gm:

Hemodynamically stableHemodynamically stable

• Hemodynamic stability is a MUSTHemodynamic stability is a MUST

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Preparing for KMCPreparing for KMC

CounselingCounseling• Demonstrate procedureDemonstrate procedure• Ensure family supportEnsure family support• KMC support groupKMC support groupMother’s clothingMother’s clothing• Front-open, light dress as per the local cultureFront-open, light dress as per the local cultureBaby’s clothingBaby’s clothingCap, socks, nappy and front-open sleeveless shirt or Cap, socks, nappy and front-open sleeveless shirt or

‘jhabala’‘jhabala’

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Kangaroo care :ActionKangaroo care :Action

• Discuss with parent. Some may Discuss with parent. Some may feel reluctant or embarrassedfeel reluctant or embarrassed

• if so, consider kangaroo care if so, consider kangaroo care with both dressed/ still providing with both dressed/ still providing skin to skin at the chest and skin to skin at the chest and baby’s cheek areas.baby’s cheek areas.

• Document parental decision.Document parental decision.

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• Training Training

Nurses, physicians and other staffNurses, physicians and other staff

• Educational material: Information sheets, Educational material: Information sheets, posters and video films on KMCposters and video films on KMC

• Furniture Furniture

Semi-reclining easy chairs Semi-reclining easy chairs

Beds with adjustable back restBeds with adjustable back rest

Requirements for KMC Requirements for KMC implementationimplementation

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How to do Kangaroo CareHow to do Kangaroo Care

• EquipmentEquipment

• Prepare the environment, quiet, softPrepare the environment, quiet, soft

lighting and relaxed.lighting and relaxed.

• Comfortable chair, preferably withComfortable chair, preferably with

arms, foot stool if desired.arms, foot stool if desired.

• Screens (optional)Screens (optional)

• Parent in opening shirt, Mother braParent in opening shirt, Mother bra

lessless..

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How to do Kangaroo CareHow to do Kangaroo Care

• Baby needs a nappy on and a Baby needs a nappy on and a hathat

(optional)(optional)

• Blanket for baby.Blanket for baby.

• Provide cool drink for parent.Provide cool drink for parent.

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KMC procedure: Kangaroo KMC procedure: Kangaroo positioningpositioning

• Place baby between the mother’s breasts in Place baby between the mother’s breasts in an upright positionan upright position

• Head turned to one side and slightly Head turned to one side and slightly extendedextended

• Hips flexed and abducted in a “frog” Hips flexed and abducted in a “frog” position; arms flexedposition; arms flexed

• Baby’s abdomen at mother’s epigastriumBaby’s abdomen at mother’s epigastrium

• Support baby’s bottomSupport baby’s bottom

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Kangaroo Care : ActionKangaroo Care : Action

• Parent should support baby’s Parent should support baby’s buttocksbuttocks

and back with hands, tucking limbs intoand back with hands, tucking limbs into

flexion.flexion.

• Head and neck positioned to protectHead and neck positioned to protect

airway eg. not slumped, chin tucked soairway eg. not slumped, chin tucked so

that breathing is not compromised.that breathing is not compromised.

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• Provide and prepare equipment.Provide and prepare equipment.

• in addition face mask, oxygenin addition face mask, oxygen

and suction in case of accidentaland suction in case of accidental

extubation/collapse.extubation/collapse.

• Take and record vital signs of baby Take and record vital signs of baby and dress accordinglyand dress accordingly

• Seat parent and place baby ontoSeat parent and place baby onto

chest.chest.

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• Cover baby with Parents shirt andCover baby with Parents shirt andplace blanket over.place blanket over.• Consider reclining chair for extraConsider reclining chair for extracomfort or use of foot stool.comfort or use of foot stool.• Record vital signs after 15 minutesRecord vital signs after 15 minutes,,reposition ensuring parent and babyreposition ensuring parent and babycomfortablecomfortable• If stable continue with usualIf stable continue with usualobservationsobservations

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• Encourage parent to follow babiesEncourage parent to follow babies

cues, if asleep encourage parent tocues, if asleep encourage parent to

allow baby to sleep. allow baby to sleep.

• Allow interactions if baby becomes Allow interactions if baby becomes more alert encouraging eye contact, more alert encouraging eye contact, talking and suckling at breast.talking and suckling at breast.

• Remain available to offer support toRemain available to offer support to

familyfamily..

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• Feeding can take place duringFeeding can take place during

Kangaroo care.Kangaroo care.

• Kangaroo care should be for as Kangaroo care should be for as long as comfortable providing long as comfortable providing vital signs of baby are vital signs of baby are satisfactory fromsatisfactory from

20minutes to a few hours.20minutes to a few hours.

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Duration of Kangaroo Duration of Kangaroo Mother Care Mother Care

• Start KMC sessions in the nurseryStart KMC sessions in the nursery• Practice one hour sessions initiallyPractice one hour sessions initially• Transit from conventional care to Transit from conventional care to

longer KMClonger KMC• Transfer baby to post-natal ward and Transfer baby to post-natal ward and

continue KMCcontinue KMC• Increase duration up to 24 hours a dayIncrease duration up to 24 hours a day

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KMC during sleep and KMC during sleep and restingresting

RestingResting

• Reclining or semi-recumbent positionReclining or semi-recumbent position

• Adjustable bedAdjustable bed

• Several pillows on an ordinary bedSeveral pillows on an ordinary bed

• Easy reclining chairEasy reclining chair

SleepSleep

• Supporting garment restraint for babySupporting garment restraint for baby

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Discontinuation of KMC Discontinuation of KMC

• Term gestationTerm gestation• Weight ~ 2500 gmWeight ~ 2500 gm• Baby uncomfortableBaby uncomfortable• Wriggling outWriggling out• Pulls limbs outPulls limbs out• Cries and fussesCries and fusses• Mother can continue KMC after giving the Mother can continue KMC after giving the

baby a bath and during cold nightsbaby a bath and during cold nights

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National & InternationalNational & InternationalEndorsementsEndorsements

Kangaroo care has been endorsed asKangaroo care has been endorsed asthe standard of care by:the standard of care by:• American Academy of Pediatrics American Academy of Pediatrics

(AAP)(AAP)• Academy of Breastfeeding MedicineAcademy of Breastfeeding Medicine• World Health OrganizationWorld Health Organization• Neonatal Resuscitation ProgramNeonatal Resuscitation Program(American Heart Association & AAP)(American Heart Association & AAP)

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Universal KCUniversal KC

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ReferencesReferences

• Kangaroo care in full termKangaroo care in full termKMC_term_table.pdfKMC_term_table.pdf• Kangaroo Care in preterm Kangaroo Care in preterm KMC_table.pdfKMC_table.pdf• KMC practical guide KMC practical guide kmc_practical_guide.pdfkmc_practical_guide.pdf• KMC Manual KMC Manual KMC KMC ParticiPartici Manual_Complete.pdfManual_Complete.pdf• Guidelines for Infant Development inGuidelines for Infant Development inthe Newborn Nursery. Inga Warren 2001.the Newborn Nursery. Inga Warren 2001.Holding your baby close: KangarooHolding your baby close: Kangaroocare.care.• www.MarchofDimes.com/prematuritywww.MarchofDimes.com/prematurity• Overcoming Emotional Barriers toOvercoming Emotional Barriers to Kangaroo Care Step by Step guide.Kangaroo Care Step by Step guide.• Bliss in association with JNN. 2004Bliss in association with JNN. 2004 (www.Bliss.org.uk)(www.Bliss.org.uk)

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ReferencesReferences

• Bergman NJ, Linley LL, Fawcus SR. Randomized controlled Bergman NJ, Linley LL, Fawcus SR. Randomized controlled trial of maternal-infant skin-to-skin contact from birth trial of maternal-infant skin-to-skin contact from birth versus conventional incubator for physiological versus conventional incubator for physiological stabilization in 1200g to 2199g newborns. Acta Paediatr stabilization in 1200g to 2199g newborns. Acta Paediatr 2004; 93: 779-785. Stockholm. ISSN 0803-52532004; 93: 779-785. Stockholm. ISSN 0803-5253

• Kangaroo care compared to incubators in maintaining bodyKangaroo care compared to incubators in maintaining body warmth in preterm infants. Ludington-Hoe,S.M.,Nguyen, warmth in preterm infants. Ludington-Hoe,S.M.,Nguyen,

N.,N., Swinth,J.Y, Satyrshur,RD. Biol Res Nurs2(1):60-73. 2000.Swinth,J.Y, Satyrshur,RD. Biol Res Nurs2(1):60-73. 2000.• Infant Holding policies and practices in neonatal units.Infant Holding policies and practices in neonatal units. Neonatal network 21 (2):13-20.Franck, L.S.,Bernal,H., Neonatal network 21 (2):13-20.Franck, L.S.,Bernal,H.,

Gale,G 2002.Gale,G 2002.

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BibliographyBibliography

• Anderson G (1986)Kangaroo care forAnderson G (1986)Kangaroo care for

premature infants.American Journalpremature infants.American Journal

of Nursing July pg 807-809of Nursing July pg 807-809

• Gale G.,Franck L.,Lund (1993)Skin toGale G.,Franck L.,Lund (1993)Skin to

Skin (Kangaroo) Holding of theSkin (Kangaroo) Holding of the

intubated Premature Infant neonatalintubated Premature Infant neonatal

Network Vol 12 No 6 pg49-57Network Vol 12 No 6 pg49-57

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Kangaroo Position :Kangaroo Position :

• maternal infant skin-to-skin contactmaternal infant skin-to-skin contact

• between the baby front and the mother's chest. between the baby front and the mother's chest. The more skin-to-skin, the better.The more skin-to-skin, the better. For comfort a small nappy is fine, and for warmth For comfort a small nappy is fine, and for warmth a cap may be used. a cap may be used.

• should ideally start at birth, but is helpful at any should ideally start at birth, but is helpful at any time. time.

• It should ideally be continuous day and night, but It should ideally be continuous day and night, but even shorter periods are still helpful.even shorter periods are still helpful.

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Baby friendly hospital Baby friendly hospital initiativesinitiatives

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Health & Medicine

Breastfeeding