Kangaroo Mother Care

Bogotá, 1978

A Cochrane review reports that Edgar Rey proposed and developed kangaroo mother care in 1978 at the Instituto Materno Infantil in Bogotá, Colombia, as an alternative to conventional care for low-birth-weight infants. According to the review, the practice was first conceived to address a lack of incubators, high rates of hospital-acquired infection and infant abandonment at that hospital.

The same review gives the original definition as skin-to-skin contact between a mother and her newborn, frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital. The sources reviewed for this page do not provide a wider scholarly history of how the practice spread, so this section is limited to the origin stated in the review.

Trials and guideline milestones

The 2016 Cochrane review included 21 randomized trials, and 19 of them started kangaroo mother care after infants had been stabilized with conventional care. A multicountry trial published in 2021 then tested starting it immediately after birth. Its authors described the guidance in force at the time as starting short, intermittent kangaroo mother care once an infant begins to stabilize and continuous care once fully stable.

The World Health Organization (WHO) published its guideline on care of the preterm or low-birth-weight infant on 15 November 2022. The American Academy of Pediatrics (AAP) states that WHO launched the recommendations on World Prematurity Day, 17 November 2022. WHO's 2025 clinical practice guide now lists starting kangaroo mother care as soon as possible after birth as its first recommendation.

Routine skin-to-skin contact after birth

A separate line of research concerns skin-to-skin contact for healthy newborns. The Cochrane review of this practice first appeared in 2003 and was updated in 2025 to include 69 trials. The 2025 update states that WHO and UNICEF recommend immediate, continuous, uninterrupted skin-to-skin contact after birth.

The WHO definition

WHO's 2025 clinical practice guide defines kangaroo mother care as care of a preterm or low-birth-weight newborn in prolonged skin-to-skin contact, as close as possible to 24 hours a day and at least eight hours a day, started as soon as possible after birth, with exclusive breast milk feeding. When it begins in a health facility, an additional feature is timely discharge from intensive or special care to a lower level of care, with continued skin-to-skin contact and close monitoring.

Kangaroo mother care and routine skin-to-skin contact

The guide states that prolonged, sustained contact combined with exclusive breast milk feeding is what distinguishes kangaroo mother care from the routine skin-to-skin contact that WHO recommends for all newborns in the first hour after birth. It also reports terminology changes: "KMC position" replaces "kangaroo position", the term "skin-to-skin care" is no longer used because it can refer to any contact regardless of duration, and "KMC" is not used for contact provided by additional caregivers, to emphasize the mother's central role.

Usage in the research literature is broader. The Cochrane reviews treat kangaroo mother care as the intervention for low-birth-weight infants, describe it as continuous or intermittent, and use "skin-to-skin contact" for the separate practice studied in healthy newborns. Readers comparing studies should check which definition each one used.

What the sources describe

WHO's glossary describes the KMC position as the newborn lying in direct skin-to-skin contact on the chest of the mother or an additional caregiver, with a binder or garment holding the newborn in place. WHO states that contact should continue beyond the first hour, throughout the hospital stay and at home after discharge, until the newborn reaches term age or wriggles out of the position. The mother is the primary caregiver, but an additional caregiver such as the father can provide skin-to-skin contact. This page gives no instructions: WHO's guide says it is not a standalone training and that skills are built through hands-on training in facilities.

Settings and timing

Practice varies. The Cochrane review found 16 trials of intermittent and five of continuous kangaroo mother care, and most began after stabilization. WHO now states that it can start as soon as possible after birth even if the newborn is clinically unstable, unless the newborn is hemodynamically compromised or unable to breathe unaided, and that it can start in a facility or at home. A trial in Haryana, India, tested supporting mothers to provide community-initiated kangaroo mother care at home.

Related Machipedia pages

Kangaroo mother care is a member of the family of pages named Parenting Approaches, although it differs from many approaches there in having guideline status from WHO. Breastfeeding has its own Machipedia page, and WHO includes exclusive breast milk feeding in the definition. Babywearing and Attachment Parenting are separate pages; the sources reviewed here present kangaroo mother care as a clinical newborn-care practice and do not compare it with those approaches. WHO names midwives among the health workers its guide addresses, and Midwifery has its own page.

Benefits listed by WHO

WHO's guide lists benefits for newborns that include lower neonatal mortality, less hypothermia, fewer severe infections, longer exclusive breastfeeding, better weight gain and shorter hospital stays. For mothers and families it lists closer bonding, lower maternal anxiety and depression, and reduced postpartum hemorrhage. It also lists longer-term benefits such as improved brain development, citing its own reference list; this page did not independently check those references.

The 2016 Cochrane review found no significant difference in psychomotor development at 12 months of corrected age, with low-quality evidence, and reported some measures of mother-infant attachment and home environment as improved.

Aims for health systems

WHO states that providing kangaroo mother care in a facility costs less than conventional newborn care and describes it as supporting parent participation in care. The Cochrane authors, by contrast, said more information on the costs of care was needed.

Cochrane review for low-birth-weight infants

The 2016 Cochrane review of 21 trials (3,042 infants) compared kangaroo mother care with conventional neonatal care. At discharge or 40 to 41 weeks' postmenstrual age, it was associated with lower mortality (risk ratio 0.60, 95% confidence interval 0.39 to 0.92), less sepsis (0.35) and less hypothermia (0.28), with moderate-quality evidence. At latest follow-up, mortality was lower (0.67, 0.48 to 0.95) and exclusive breastfeeding at discharge was higher (1.16).

The authors concluded the evidence supports its use as an alternative to conventional care, mainly in resource-limited settings. They called for more information on early continuous use in unstabilized infants, long-term neurodevelopment and costs.

Immediate and community-initiated trials

An open-label trial in five hospitals in Ghana, India, Malawi, Nigeria and Tanzania randomized 3,211 infants weighing 1.0 to under 1.8 kg to immediate kangaroo mother care or to incubator or warmer care until stable. Neonatal death occurred in 12.0% versus 15.7% (relative risk 0.75, 95% CI 0.64 to 0.89). Death within 72 hours was 4.6% versus 5.8%, not statistically significant. The monitoring board stopped enrollment early; hypothermia and suspected sepsis results were not adjusted for multiplicity.

An equity analysis reports that a trial of 8,402 low-birth-weight babies in Haryana, India, found community-initiated kangaroo mother care lowered mortality to 180 days by 25% (hazard ratio 0.75). The primary trial report was not opened for this page.

Skin-to-skin contact in healthy newborns

The 2025 Cochrane update (69 trials, 7,290 mother-infant pairs) found that immediate or early skin-to-skin contact probably increases exclusive breastfeeding to one month (risk ratio 1.36, moderate certainty). Maternal outcomes were inconclusive, and no trial met every high-quality criterion. It covers healthy term and late preterm infants and is not evidence about kangaroo mother care for small newborns.

Sudden unexpected postnatal collapse

A 2024 nursing review describes sudden unexpected postnatal collapse as cardiorespiratory collapse in a healthy newborn and states that its most common cause is poor positioning during skin-to-skin contact or breastfeeding when no professional or attentive caregiver is observing. A Dutch survey of 59 of 70 perinatal centers found at least one case in 35 (59%); about half had protocols, and most lacked recent insights. Neither source gives an incidence figure.

A Spanish study that monitored 254 healthy term newborns for two hours after birth found at least one oxygen or heart-rate event in 66.5%, more often with mothers aged 35 or older, first births, higher body mass index or night births. These events are not collapse, and the infants were not small newborns.

Suitability, positioning and monitoring

WHO's guide states that the practice is suitable even for newborns needing non-invasive respiratory support and monitoring, but not for those who are hemodynamically unstable or cannot breathe unaided, and that some major malformations may make the position unfeasible. It describes a slightly extended neck to keep the airway open and removed older "fetal" wording because a flexed head is unsafe. Maternal contraindications named include uncontrolled epilepsy and contagious skin infection, in which case another caregiver can provide contact.

WHO notes limited evidence for newborns under 28 weeks or 1,000 g. The immediate-KMC trial assessed death as its only serious adverse event, and the 2025 skin-to-skin review urges that instances of harm be recorded. Decisions about a particular newborn belong to the newborn's clinical team.

Training for health workers

The AAP lists a free course, "Immediate Kangaroo Mother Care for Preterm and Low Birthweight Babies", available in English, Spanish and French since July 2025, and promotes minimal separation of mothers and newborns. WHO's guide is aimed at doctors, nurses, midwives and other staff. The sources reviewed describe no register or credential specific to kangaroo mother care.