Last week, news of a recent study trickled  across my newsfeed, touting the benefits of skin-to-skin contact with infants. That study, published online by the American Association of Pediatrics,  presented evidence in support of Kangaroo Mother Care (KMC), which is a method that involves infants being carried and held with prolonged skin-to-skin contact (S2S).

As is often the case, though, the mainstream media picked up the story and ran with it, touting the potential benefits of the practices, while making no mention of any risk. But there are risks – and I believe a parent needs to be aware before putting the practices into place.

Benefits & Caveats of Kangaroo Mother Care and Prolonged Skin-to-Skin Contact

The Kangaroo Mother Care concept was introduced in the the late ’70s in developing countries as an alternative solution to incubators, where access to them and more complex healthcare for infants was limited.

As a pediatrician, I agree that that KMC can be potentially beneficial, particularly for premature and low birth weight infants, and especially in hospitals and homes where newborns can’t get the same level of medical care as in developed nations. Even here in the United States I fully support and encourage the practice for higher-risk patients in those categories. Kanagroo Mother Care and Skin-to-Skin is also aligned with current trends and programs like the Baby-Friendy Hospital Initiative, that are designed to support mothers in early and successful breastfeeding practices in many American hospitals.

But the misinterpretation of this study by many of the articles you may have come across last week is a problem. As parents of newborns, you need to know that the reduced risk of death has really only been found in babies born with low birth weight. The majority of the other potential benefits do not apply to your healthy baby if they’ve been born at term, weighing more than about 4 pounds, 6 ounces (2000 grams, to be specific).  That’s not to say that Kangaroo Mother Care or skin-to-skin contact is a waste of time for these newborns, however.

When a mother spends time holding her newborn baby against her skin, there is good reason to believe that this can help improve breastfeeding success, and it’s a great way to help cement the connection between a mother and her child. But it must be pointed out that both of these outcomes can and generally do occur even if no KMC/S2S takes place. I stress, you are not a bad mother if you aren’t attached to your baby 24-7!

The Risks of Kangaroo Mother Care and Skin-to-Skin

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From that viewpoint alone, it sounds like there’s little concern for parents, and that this Kangaroo Mother Care and Skin-To-Skin practice can only help a child. However, when something is too good to be true, it usually is. There are risks. The media reports I saw had flawed conclusions, overlooking that these practices can put babies at risk of neurologic injury and even death. Given the conclusion of the report, it’s not surprising that this point was missed:
“KMC is protective against a wide variety of adverse neonatal outcomes and has not shown evidence of harm. This safe, low-cost intervention has the potential to prevent many complications associated with preterm birth and may also provide benefits to full-term newborns.” – E.O. Boundy, R. Dastjerdi, et al, in AAP Pediatrics Jan 2016

There is actually very good reason to suspect that the practice is a risk factor for something known as sudden unexpected postnatal collapse (SUPC). This happens in the first week of life when a low-risk (healthy) newborn suddenly and unexpectedly has difficulty breathing, which can lead to their heart stopping. In the U.S. and Canada, we typically refer to this as early SIDS and sudden unexpected early neonatal death (SUEND). The outcome is frequently tragic, and half of the children affected die, with many of the remaining newborns are disabled in some fundamental way. Thankfully, the overall incidence of these events for low-risk (healthy term and near-term) babies is very low, but exact incidence figures are challenging to come by because of different definitions used across nations.

For infants who die in the first week of life in this manner, studies have shown that when complications like prematurity, illness, injury, etc were ruled out, it’s typically the result of being in prone position (face down) in a skin-to-skin situation, something that pediatricians have universally recommended against since 1994. In fact, during a review of the literature, the authors of this study found that 75% of all SUPC cases happened during in this position during skin to skin contact and initial attempts at breastfeeding.

Let me be clear –  Kangaroo Mother Care and Skin-to-Skin practices encourage the biggest risk factor for SUPC and potential death of a newborn baby, which is prone positioning in prolonged skin-to-skin situations, which often result in sleep. And not just infant sleep. In the early days of a baby’s life, this means often sleeping with their face pressed against the mother’s chest and breast, while the exhausted mother is also asleep.

The WHO's handbook on Kangaroo Mother Care

The WHO’s handbook on Kangaroo Mother Care

If you think about it, it makes perfect sense. First and foremost, and especially during the first few hours of life when most of these incidences occur, this is a time of transitioning for mother and baby. The first 24 hours of life is typically a very sleepy period where newborns have diminished responsiveness to the outside world. They often barely arouse even with feeding attempts. And some babies are simply suffocated by their sleeping mother. And this can occur while dad or grandma is sitting on the couch admiring their beautiful child or grandchild and the peacefully sleeping mother.

Don’t get me wrong. I don’t mean to throw the baby out with the bathwater. There are benefits to KMC/S2S, although nothing earth shattering for healthy term infants of appropriate size. But I’m not going to tell a mother that the experience of it isn’t meaningful and important to them. The key is providing a safe environment for the intervention, and I’m hardly alone in this observation.

In order to reduce the risk of injury or fatalities during Kangaroo Mother Care and Skin-to-Skin hospital staff and pediatricians must first recognize which newborns may be a particular risk and provide appropriate monitoring. A term and well-grown newborn whose mother was on a medication that may result in a sedated baby would be just one of many examples. If a nurse isn’t available to monitor the child continuously (family members don’t count), then perhaps monitoring the child’s oxygen would be appropriate (such as with the devices adults wear on their fingertip in the hospital, called a pulse oximeter). Second, provide education and awareness to parents about proper positioning, and mothers should always be advised to place the baby in the bassinet, or the arms of an alert caregiver, if she is feeling sleepy.

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Categories: Accidents, Injuries, + Abuse, Ages + Stages, Newborns + Infants, Science 101 + Mythbusting