Kangaroo Care

[twinkletoes53]

we implemented kangaroo care, also called skin-to-skin holding in our nicu a couple of years ago. i am interested in the experences other units havd had with skin-to-skin holding. we allow intubated, stable babies to be held , with an attending md order.

what feedback have you gotten from other staff members and families in your units? are there any negative impacts of this type of holding that you have noticed? one of our drawbacks seem to be an increase in the number of inadvertent extubations when babies are transferred or held. newer nurses are also less comfortable with assisting parents with skin-to-skin holding. we are doing extensive staff education to address these issues. is there a time limit ordered for how long a baby may be held?

also, what products are available to assist with comfortable holding of infants by their parents? we have researched chairs that recline, but are limited by space constraints in our nicu. we are a 68 bed level iii unit.

thank you

[prmenrs, RN]

I did a forum search w/the term "kangaroo care", and here are the results: https://allnurses.com/forums/search.php?searchid=2845796

and got this website from a Google search: http://www.prematurity.org/baby/kangaroo.html

If you have gliders, position mom as comf as possible in one, after baby is placed w/her, use a nursing stool for her feet. (I'll edit to add what I mean--the ottoman is too cumbersome.) Add small pillows and/or a nearby place to put some water. She's gonna be there for a while, so make sure she gets a potty break.

The environment needs to quiet and not in main traffic areas. Watch baby for avoidance cues---yawning, hiccups, finger splays, mottling, "salutes" and the like. Encourage mom NOT to try to make eye contact--too stimulating.

[Imafloat, BSN, RN]

We allow skin to skin also. I am very uncomfortable getting the babies out for skin to skin, I am very slow and the parents staring makes me more nervous. If a baby goes out to Kangaroo, the parents have to hold for at least an hour. I have noticed that a downfall is that some parent's don't realize the seriousness of their babies condition if they are allowed to kanagaroo.

[Mags4711, RN]

We allow skin to skin also. I am very uncomfortable getting the babies out for skin to skin, I am very slow and the parents staring makes me more nervous. If a baby goes out to Kangaroo, the parents have to hold for at least an hour.

WeeBabyRN, I know it's scary the first few times you get a baby out. I found if I get all of my lines in position first and get everything set with mom or dad first, then I seem speedier in getting them up. We will usually disconnect them from the vent and inline suction before we move them over to the waiting parent, and in that cast, you can't be very slow. If the baby doesn't like being disconnected or has a high PEEP, then it goes a bit slower .

We encourage kangarooing, stable babies without umbi lines can kangaroo daily. They must be held for an absolute minimum of one hour, we prefer at least 90 mins. They go back when they start exhibiting signs they are getting stressed with their situation (as listed above by Prmenrs). I've had parents kangaroo for four hours. We have recliners and use the nursing stools that Prmenrs posted the picture of. If a parent decides to recline, then they get completely into position before the RT (in the case of an intubated baby) and I place the baby on their chest, and they stay reclined while we put the baby back when the session is over. We clip the vent tubing to the parents' gown or shirt in two places and check on the position of the baby and parent frequently (but quietly) to make sure they are not moving too much. We discourage talking at all during the kangaroo time, the whole point is for it to be very peaceful and I've seen babies get very upset if the parent speaks. I don't know if it is the reverberation or what, but many don't seem to like it. Also when most people talk, they have a tendency to move their arms or hands to express themsleves, it's an unconscious thing and then, whoops! There goes the ETT.

All of these things (parent in place first, clipping tubing in two places, checking on them frequently, discouraging talking) have helped decrease our unplanned extubations during kangarooing

I have noticed that a downfall is that some parent's don't realize the seriousness of their babies condition if they are allowed to kanagaroo.

I'm confused by this comment. This statement implies to me that your unit does not kangaroo unless the baby is really really sick? Or are you saying that you've found that when a parent is allowed to hold/kangaroo they have trouble grasping the fact their baby is a sick infant in an ICU and can still get very ill and possibly die. If the latter is the case, I kind of get what you are saying. It's like trying to tell a parent that just because the baby (possibly a 25 weeker) is here doesn't mean it is fine to hold and touch and stroke and give them a bottle right away. But I've found that if you educate the parents correctly about the concepts behind kangaroo care and it's benefits for ill babies, generally they don't seem to have unrealistic expectations. There are always those exceptions who think that no matter what or how sick the baby is, they should be able to hold.

[Imafloat, BSN, RN]

WeeBabyRN, I know it's scary the first few times you get a baby out. I found if I get all of my lines in position first and get everything set with mom or dad first, then I seem speedier in getting them up. We will usually disconnect them from the vent and inline suction before we move them over to the waiting parent, and in that cast, you can't be very slow. If the baby doesn't like being disconnected or has a high PEEP, then it goes a bit slower .

We encourage kangarooing, stable babies without umbi lines can kangaroo daily. They must be held for an absolute minimum of one hour, we prefer at least 90 mins. They go back when they start exhibiting signs they are getting stressed with their situation (as listed above by Prmenrs). I've had parents kangaroo for four hours. We have recliners and use the nursing stools that Prmenrs posted the picture of. If a parent decides to recline, then they get completely into position before the RT (in the case of an intubated baby) and I place the baby on their chest, and they stay reclined while we put the baby back when the session is over. We clip the vent tubing to the parents' gown or shirt in two places and check on the position of the baby and parent frequently (but quietly) to make sure they are not moving too much. We discourage talking at all during the kangaroo time, the whole point is for it to be very peaceful and I've seen babies get very upset if the parent speaks. I don't know if it is the reverberation or what, but many don't seem to like it. Also when most people talk, they have a tendency to move their arms or hands to express themsleves, it's an unconscious thing and then, whoops! There goes the ETT.

All of these things (parent in place first, clipping tubing in two places, checking on them frequently, discouraging talking) have helped decrease our unplanned extubations during kangarooing

I'm confused by this comment. This statement implies to me that your unit does not kangaroo unless the baby is really really sick? Or are you saying that you've found that when a parent is allowed to hold/kangaroo they have trouble grasping the fact their baby is a sick infant in an ICU and can still get very ill and possibly die. If the latter is the case, I kind of get what you are saying. It's like trying to tell a parent that just because the baby (possibly a 25 weeker) is here doesn't mean it is fine to hold and touch and stroke and give them a bottle right away. But I've found that if you educate the parents correctly about the concepts behind kangaroo care and it's benefits for ill babies, generally they don't seem to have unrealistic expectations. There are always those exceptions who think that no matter what or how sick the baby is, they should be able to hold.

Our unit allows kangaroo care for all babies. I meant the latter. It isn't all parents, just a couple of families so far. I think I will do a little more research on this. I never realized that parents talking would disturb the babies. We have a baby who was born at 23+4 days who is now about 27-28 weeks and it takes him a long time to get settled in his bed after skin to skin contact. I talked to my preceptor about this and she told me that the mom lightly rubbing the infant may be bothering him because his nerve endings aren't mature. We suggested to the mom that she hold his bottom and his head gently yet firm so that he could feel secure. I never realized the talking might bother him too, the mom will have conversations with whomever is sitting at the bedside while she kangaroos.

I have so much to learn, I love reading the postings here.

[Mags4711, RN]

If mom and dad are together, it is fine for them to whisper a few words to one another, but carrying on a conversation with someone else is usually disturbing to the tiny ones. As they get bigger, it is usually not an issue and chatting is fine.

Of note, dads can and should kangaroo as well. Some dads worry about their chest hair and that it would bother the baby. On the contrary, some babies love it.

Perhaps one of the most important points to hammer home to parents is one you've already brought up:no stroking! This is not a time to play with your baby, this is a time to be quiet and still and bond.

You and your preceptors are correct, in premature infants the nerve endings are also immature and some research has said they believe the stroking of a premature infant can feel to them like tickling does to us. Other research has said it is very uncomfortable for them. (I'd like to know how they determine these things, but...)

You are on the right track, do some research and just take a deep breath every time before you lift a baby to a parent, you'll be fine! :icon_hug:

P.S. I love reading the postings here, too! :)

[prmenrs, RN]

I have to say that, once parents start doing this, they LOVE it! Especially after the baby is @ the "grower-feeder" stage. I remember one dad who would walk into the nursery stripping off his shirt, biggg grin on his face, and plunked himself down in the glider. As time went by, he'd get the baby out himself, changing the diaper, even asking the nurse if he should take a temp! OK, a little more than I wanted to see, but can't argue w/the enthusiasm--or the obvious bond.

Another couple would get 2 gliders and a screen, get their babies (twins) changed and wrapped and sit there, one baby/parent (they even traded babies periodically). They'd be there for hours! Breastfeeding was gradually and naturally introduced as each baby initiated it themselves.

Kangaroo care can be really wonderful.

[NPinWCH]

The childrens hospital out here uses those fold up zero gravity chairs in the NICU for Kangarooing. They support up to 300#, can be wiped down easily and since they fold up they are easy to store and don't take up much room when not in use.

[Elvish, BSN, DNP, RN, NP]

Once my moms (daddies too) get to kangaroo, they usually come back to their room with an ear-to-ear grin. After that, I don't see them in their room much anymore. So I second your statement, prmenrs.:)

[Mags4711, RN]

The childrens hospital out here uses those fold up zero gravity chairs in the NICU for Kangarooing. They support up to 300#, can be wiped down easily and since they fold up they are easy to store and don't take up much room when not in use.

That sounds like a great idea! Storage is a huge issue for us, our space is very limited and all the recliners we have around clutters things up. Unfortunately quite a few of our parents would be too heavy for this... But great idea for the ones who aren't!

[prmenrs, RN]

I think it's important to make the parents as comfortable as possible. Their arms should be supported; pillows and footstools can help. They're gonna be there for an hour or more. If they're uncomfortable, that tension is communicated to the baby, it's just a negative experience.

Kangaroo care is such a good thing for both parent and baby. Whatever can be done to facilitate should be done. JMHO.