Skin-to-Skin Care in the NICU

By Dr. Namrata Todurkar

Skin-to-skin care (SSC), also known as Kangaroo Mother Care (KMC), is defined as the diaper-clad upright holding of the infant on the chest, providing maximum skin-to-skin contact between the baby and parent. This method was first introduced in Colombia as a way to care for premature babies when incubators were scarce. It is a safe, low-cost intervention with multiple proven benefits. Parents can provide SSC for as long and as often as they are able and willing to do so. The Neonatal Intensive Care Unit (NICU) can be overwhelming for both babies and parents. SSC helps reduce stress and provides comfort, improving the baby’s development and the parent-baby bond. This blog will discuss the development of baby’s sensory system, benefits of SSC, how to prepare for SSC and when not to do SCC.

During SSC, the baby is positioned:

• Upright on the parent’s chest, baby’s face is not covered by the wrap, baby’s neck is straight

• Arms and legs flexed like a frog

• There is maximum skin contact

This technique is safe for both full-term and premature babies and can be done for as long as the parents are able. The World Health Organisation (WHO) recommends initiating SSC in premature and low-birth weight infants as soon as possible after birth, then prolonging contact for at least 8 hours per day or as long as possible (up to 24 hours) per day. Even short periods up to 1 hour per session has shown to increase the duration of breastfeeding. Providing SSC gives parents the opportunity for positive interaction with their infants, even when they require intensive care.

How a Baby’s Senses Develop:

In the past, people believed that premature babies couldn’t feel touch or pain. Now we know that even in the womb, babies have developing nervous system and respond to sensory experiences. There is emerging evidence that early visual and vocal contact with parents, facilitated during SSC, promotes the development of infant attachment, attunement, and even language. Early experiences shape how the brain develops. The more a baby uses a sense, the stronger it becomes. This is why skin-to-skin care, gentle touch, and familiar voices are so important for preterm babies. Here’s when different senses start working:

🖐 Touch (8-28 weeks):

• 8 weeks: Reacts when lips are touched.

• 12-15 weeks: Grasps the umbilical cord and sucks thumb.

• 25 weeks: Responds to touch and pain begins.

⚖️ Balance & Movement (21-30 weeks):

• 21 weeks: The vestibular system (balance) begins functioning.

• 30 weeks: Full startle (Moro) response is present in preterm babies.

👃 Smell & Taste (8-31 weeks):

• 8-10 weeks: Chemosensory system (smell and taste) starts developing.

• 28-29 weeks: Begins to recognise different odours.

• 31 weeks: Responds to maternal scent.

👂 Hearing (18-40 weeks):

• 18-19 weeks: Begins to hear sounds.

• 28-30 weeks: Begins processing sounds.

• 32-34 weeks: Recognises mother’s voice and familiar voices.

👀 Vision (24-38 weeks):

• 24 weeks: The eyes undergo significant growth.

• 32-34 weeks: The pupil constriction reflex becomes active.

When your baby is held in Kangaroo Care they can hear your heartbeat and voice, feel your breathing and smell and feel your skin. Having your baby close to you skin-to-skin is comforting for your baby.

Benefits of Skin-to-Skin Care:

✔️ Improves breastfeeding – Baby naturally explores and latches onto the breast. Babies are more likely to have early breastfeeding behaviours and breastfeed for longer. Ask your nurse about your baby’s feeding cues.

✔️ Reduces infant mortality – Increases survival rates for preterm babies.

✔️ Regulates breathing and heart rate – Helps keep vital signs stable.

✔️ Boosts immunity – Preterm infants who receive SSC are colonised with their mothers ’bacteria, which help regulate the infant gut bacteria and decrease colonisation by disease causing bacteria.

✔️ Eases pain – Acts as natural pain relief during medical procedures.

✔️ Calms stress – Helps both baby and parent feel relaxed.

✔️ Supports brain development – Encourages learning and memory.

✔️ Improves sleep – Infants who receive SSC have more mature sleep organisation, better sleep cycling

✔️ Strengthens parent-baby bond – Releases bonding hormones like oxytocin.

✔️ Cost-effective – Reduces the need for expensive medical care.

How to Prepare for Skin-to-Skin Care:

• Talk to your baby’s healthcare team to plan your Kangaroo Care time. You may need help with the transfer depending on the needs of your baby.

• Practice with a doll to get comfortable with the position.

• Wear clean, front-opening clothes for easy access.

• Please avoid wearing strong perfumes and lotions and smoking before you do Kangaroo Care

• Eat, drink, and use the restroom beforehand.

• Plan for at least 2 hours to allow enough bonding time.

• Coordinate with baby’s care (like after weighing or diaper changes).

• Keep conversations quiet and dim the lights if possible.

• Express milk before, during, or after you practice Kangaroo Care with your baby

• Know how to ask for help if needed.

Safe sleep in the hospital while in Kangaroo Care: It is normal for you to become sleepy or want to rest during Kangaroo Care. If you feel yourself falling asleep, recline in a chair (do not lay flat), keep your baby secure in the wrap and in a safe position while on a monitor. Let your baby’s nurse know you might fall asleep.

When not to do skin-to-skin care: The presence of an abdominal wall or neural tube defect, postoperative instability, and significant instability associated with handling.

Summary:

Skin-to-skin care is a simple, natural, and powerful way to help premature and full-term babies thrive. It strengthens the parent-baby bond, reduces stress, and supports development—all while being safe and low-cost. Early and continuous SSC has lasting effects on baby’s brain development while in the NICU, once home, and throughout their life. In almost all medically complex situations, the benefits of SSC outweigh the risks.

References:

Foundational toolkit for family centred developmental care

Canadian Paediatric Society position statement on skin-to-skin care for term and preterm infants.

Perinatal Service BC Kangaroo care information for parents

Dr. Namrata Todurkar, MBBS, MD (Pediatrics), DNB (Pediatrics). Fellowship in Neonatology from National Neonatology Forum India. Fellow in Neonatal-Perinatal Medicine at the University of British Columbia. Areas of interest: Neonatal nutrition, Fluid and Electrolyte Management, Inborn Errors, Neurodevelopmental follow-up of preterm infants. Dr. Todurkar is a volunteer blogger at CPBF.