Preterm birth complications are the leading cause of death among children under five worldwide, according to WHO. Many of these babies could survive with simple, low-cost care. One of the most effective is kangaroo mother care (KMC): continuous skin-to-skin contact between the baby and the mother (or another carer), combined with exclusive breastfeeding. WHO’s 2022 recommendations call for KMC to start immediately after birth for babies under 2.0 kg, rather than waiting until they are stable.
Why it works
- Keeps the baby warm: hypothermia is a major killer of small babies.
- Supports breastfeeding and milk supply.
- Stabilises breathing, heart rate and blood sugar.
- Reduces infections, including sepsis.
- Promotes bonding and reduces maternal anxiety.
A large WHO-led trial published in 2021 found that starting KMC immediately after birth, before stabilisation, reduced deaths among babies weighing 1.0–1.8 kg by about a quarter compared with conventional care.
How to position the baby
- Dress the baby in a nappy, hat and socks only.
- Place the baby upright on the mother’s bare chest, between the breasts, in a “frog” position with hips flexed and legs out.
- Turn the head to one side, slightly extended, so the airway is open and the face is visible.
- Secure the baby with a wrap or binder that supports the baby up to the ears, firm enough that the baby won’t slip when the mother stands, but not tight around the abdomen.
- Cover both with a blanket or the mother’s clothing.
The mother can sleep semi-reclined with the baby in position. Fathers, grandmothers and other family members can take turns when the mother needs a break.
Feeding
- Support exclusive breastfeeding, with feeds every 2–3 hours.
- Babies too small or weak to suck may need expressed breast milk by cup, spoon, paladai or nasogastric tube.
- Teach mothers to hand express early and often to build supply.
Monitoring
- Temperature (axillary): aim for 36.5–37.5°C.
- Breathing: rate, pauses (apnoea), chest indrawing.
- Colour, feeding, activity, and signs of infection.
- Weight daily or as per protocol.
- Jaundice: see our neonatal jaundice guide.
Teach mothers the danger signs: difficulty breathing or long pauses, cold body or fever, poor feeding, unusual sleepiness, convulsions, or a change in colour. They should alert a nurse immediately.
Supporting the mother
- Many mothers are anxious about holding a tiny baby. Demonstrate, reassure and stay nearby at first.
- Make sure the mother has food, water, rest, privacy, and access to a toilet and shower.
- Involve the family to share the care.
- Look out for postnatal depression.
Building a KMC unit
KMC can be practised in neonatal units, postnatal wards and dedicated KMC rooms with beds or reclining chairs for mothers. WHO now promotes “mother-newborn couplet care”, where mothers stay with their small or sick babies rather than being separated. Nurses and midwives are often the drivers of setting up KMC in their facilities: it needs commitment more than equipment.
Discharge and follow-up
Babies can usually go home when they are feeding well, gaining weight, keeping warm in KMC, and the mother is confident. Continue KMC at home until the baby is around term or no longer tolerates it, with close follow-up for weight, feeding, immunisations and danger signs.
Related: Newborn resuscitation · Hypoglycaemia
Based on WHO recommendations for care of the preterm or low-birth-weight infant (2022) and the WHO immediate KMC trial (New England Journal of Medicine, 2021). Educational content: follow your local newborn care protocols.