Skin-to-skin care – Transition to at-breast feeding interventions

Skin-to-skin care is an intervention that empowers mothers to express and provide their milk to their infants and supports transition to breastfeeding by offering access and early opportunities for non-nutritive and nutritive sucking at the breast.

What is skin-to-skin care?

Skin-to-skin care (also known as kangaroo mother care - KMC) is a well-known practice of holding the naked infant vertically between the mother’s breasts and below her clothes.¹

Skin-to-skin care is recommended for all infants globally.²

Skin-to-skin care, when possible, can be continuous 24h a day. Intermittent skin-to-skin care (alternating periods of time between a NICU incubator and a minimum of 1 hour with a parent) several times a day is recommended to give therapeutic benefits, and enables the infant to stabilise and regulate core physiological and behavioural functions following transfer.³

NICU infants can commence skin-to-skin care as soon as the infant is physiologically stable after birth; this applies to extremely low birthweight and ventilated infants.^1,2,4

Why is skin-to-skin care important?

Skin-to-skin care supports a significant reduction in infant mortality and morbidity globally.³

Regular skin-to-skin care empowers mothers to

• Express and provide their milk for their infants, resulting in significantly longer duration, exclusive breastfeeding^5-7 and earlier discharge from hospital.⁸
• Express milk during or after skin-to-skin care, significantly increasing expressed milk volumes.⁵

Regular skin-to-skin care supports the NICU infant to transition from enteral to oral feeding through

• Access and early opportunities for non-nutritive sucking (NNS) and nutritive sucking (NS) at the breast.
• Early sensory stimuli enable infants to touch, smell, and taste their mother’s milk.⁹
• Oxytocin stimuli¹⁰ (crucial for milk ejection¹¹) to support bonding and relationship building, specifically in a challenging NICU environment.¹²

How to implement skin-to-skin care

• Stipulate skin-to-skin care for all physiologically and behaviourally stable infants
• Recommend uninterrupted skin-to-skin care for a minimum duration of one hour
• Inform parents to wear clothing that supports skin-to-skin care with the infant
• Encourage and support the mother to express breast milk whilst in skin-to-skin care with the infant, or immediately after.
• Enable the mother to offer the breast for NNS whilst in skin-to skin care (recently expressed breast).
• Document all skin-to-skin care specifying frequency, duration and reasons why the practice was not performed in breastfeeding supportive practices (BFSP) logbook
• Enable a NICU environment that supports parents to participate in extended skin-to-skin care at each parental visit through comfortable seating, space, and visitation access.

How to monitor skin-to-skin care

Collect data on frequency and duration of skin-to-skin care

Carry out a monthly audit of the data to measure:

• Percentage of infants receiving skin-to-skin care at least once per day.

• Daily frequency and duration of skin-to-skin care.

• Reasons for sub-optimal provision of skin-to-skin care.

Audit records monthly to review progress, identify challenges and implement interventions to improve skin-to-skin care practice and support lactation outcomes.

Downloads

Skin-to-skin (pdf)