Must-Have Tips for a Smoother Kangaroo Care Experience in the NICU

March 27, 2021

I'm katie, OTD, OTR/L, NTMTC, CNT & founder of blooming littles

Guess who has the greatest influence on a baby's NICU stay? It's YOU! Let's get you the tools, info, and resources needed to create positive NICU experiences, one interaction at a time.

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One of the most recommended bonding activities in the NICU is kangaroo care. Kangaroo care means your naked baby (diaper only) is placed upright on mom or dad’s chest for holding skin-to-skin. It’s also called “skin-to-skin holding”.

Even though there is SO MUCH beauty in skin-to-skin holding between a parent and their baby, sometimes the kangaroo care experience doesn’t go as everyone hopes. 

Let’s talk about some things you can do to create a smooth kangaroo care experience for you and your baby.

You’ve got this!

It’s easy to get discouraged if things don’t go as planned.

There are a lot of reasons why babies in the NICU have difficulty tolerating the transfer for skin-to-skin holding. And it’s not because of you! There are some other things we can change that may help.

If you and your baby have a difficult skin-to-skin experience, give yourself a break and try again when you’re ready.

To set everyone up for success, including you…here are some tips!

1. Communicate timing with your baby’s nurse

Sometimes a negative experience in the NICU simply comes down to poor communication. 

A nurse not communicating their preference to do kangaroo care at a certain time.

Not communicating with the bedside nurse when you’re planning to be there to see your baby.

Not knowing the expectations.

Parents, if you know you want to do kangaroo care (skin-to-skin holding), let your baby’s nurse know ahead of time, as soon as you arrive for your visit. That way the nurse can plan their assessment structure and timing around supporting you for the transition to skin-to-skin.

If the nurse has already snuggled your baby back up in their positioning equipment, and then you mention that you would like to hold your baby for skin-to-skin, it can feel frustrating. 

Communicating ahead of time will help create a positive timeline of events for everyone.

Plus, your sweet baby can be prepared and ready for the interaction.

2. Learn the expectations

Similar to communicating effectively with one another, comes knowing and understanding the expectations around holding your baby skin-to-skin. I hate that so often the dos and don’ts of the NICU feel like rules to parents, making them feel more like a bystander than mom and dad.

Hopefully, knowing why we create certain guidelines around holding in the NICU will help bridge that gap, so you can make the absolute best choices for your baby. 

Here are some general expectations you may encounter during your NICU stay:

Plan to hold your baby for at least 60 minutes.

Why do we recommend 60 minutes at least? 

60 minutes is the average sleep cycle of a baby. The goal is to support your baby during holding for an entire sleep cycle, before they’re transitioned back to bed and sleep is interrupted. Note that I said at least 60 minutes. If you’re available to hold your baby longer and your baby is showing positive cues and responses, keep on holding! Skin-to-skin with mom and dad is one of the safest places for babies.

Turn your phone on silent or use headphones.

If you spend time scrolling on your phone during kangaroo care, make sure your phone is on silent (or you’re using headphones). Noisy phone calls, conversations, videos, or text messages add extra sensory stimulation. That extra input is more for your baby to process while they’re out of bed. Supporting their environment is one of the best ways to support coping skills.

Try not to rock in your chair.

This one is a really hard one for parents, it’s a natural instinct for us to rock when we hold our babies. Rocking is a type of vestibular input, and we typically won’t recommend additional vestibular input for babies in the NICU until close to their due date. Gentle rocking before then is OK for some babies, but always watch your baby’s cues. An easy trick to keep you from rocking is to pop the legs out on your recliner, so there isn’t even a temptation.

I have to do this myself, holding babies just makes you want to rock them.

3. Prepare yourself

There is a little bit of planning that is required for a successful kangaroo care experience. It’s important that you feel comfortable when you’re holding your baby.

If you know you’re going to be holding your baby skin-to-skin, get yourself comfortable first. 

Some things you can do to prepare yourself include:

  • wearing a shirt that buttons down the front or zips up so your baby can be placed more easily on your chest.
  • using the restroom before, so your bladder is empty, and you don’t end up having to go to the bathroom while you’re holding your baby,
  • avoid putting on any perfumes or lotions. Babies in the NICU can be sensitive to scents. Your bare skin is the absolute best thing for your baby.
  • gathering the things you want near you, like water, snacks, and/or your phone.
  • bringing the chair near your baby’s bedspace and be sure you have any pillows or positioning supports set up.

4. Pump before you start

Coordinate your skin-to-skin care timing with your pump schedule. If you’re pumping every three hours, pump right before you’re going to get your baby up for skin-to-skin holding.

Skin-to-skin is an amazing tool to increase your milk supply, so you may feel your breasts getting full during holding. A hormone called “oxytocin” is released when your body is feeling allllll the feels bonding with your baby. It also stimulates milk production. 

By pumping RIGHT before, you can hold your babies for a full 2 1/2 to 3 hours before needing to put them back and pump again.

5. Create a calming environment

Chaotic environments do not promote calm and relaxing experiences.

Focus on creating a calming vibe for you and your baby while you’re holding. There are some supportive things you can do to help them maintain medical stability and self-regulation

Here are just a few ways you can create a calm environment during skin-to-skin:

  • Dim the lights.
  • Close the door or put up privacy screens.
  • Avoid strong smelling perfume. 
  • Keep your baby’s eyes covered if lights are bright.
  • Wear an open front shirt, so you don’t have to fit your baby down your shirt.
  • Keep conversations quiet.

6. Prevent exposure to the cool air

If your baby is in an incubator, they’re staying toasty warm. It’s important to protect your baby from the cool air they’re exposed to when they transfer out of bed. Their bodies are working hard to hold their own temperature without the help of their incubator.

Once your baby is on your chest, your skin actually warms up and cools down in relation to your baby’s body temperature. Isn’t that amazing?! 

To prevent exposure to cool air, keep a blanket over your baby’s back to keep them warm during the transfer and while on your chest. Plus, get baby on mom as quickly as possible by using a standing transfer.

Interested in learning a little more about “cold stress”? You can check out this post I did on reasons your baby may not be tolerating kangaroo care.

There are so many developmental benefits of kangaroo care for both mom and baby. 

But, in the NICU, skin-to-skin holding doesn’t look like you envisioned. There are wires and tubes, and fragile babies, and beeping…thinking through extra ways you can create a comforting experience can help ease anxiety and help you feel relaxed as you enjoy your baby. 

If holding your baby skin-to-skin doesn’t evoke strong bonding emotions, you’re not alone. I’ve worked with many parents who said they didn’t feel that tingly, magical bond during kangaroo care. They chose to prioritize it, because they knew it was good for their baby.

Whatever you’re feeling, you are the best parent for your baby!

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