MANIBA BHULA NURSING COLLEGE

SUBJECT: CHILD HEALTH NURSING

TOPIC: ROOMING IN AND KANGAROO MOTHER CARE (KMC)

SUBMITTED TO: MR. GIBIN THOMAS

Asst. Professor, Dept. of CHN, MBNC

SUBMITTED BY: MANISH R. DAFDA

1ST year M.Sc.Nursing, MBNC

SUBMITTED ON: 24/11/2016

 ROOMING IN
Definition:-

It is the practice followed in hospitals and nursing homes where the babys crib kept
by the side of the mothers bed.
Soon after birth, if mother is fit, baby is kept in a cot by the beside of mother. This
establishes mother-child relationship. Mother also learns the art of baby care.
This arrangement gives opportunity for the mother and father to know their baby.
The bond between the parent and the child is well established in roomed in babies.
There is better chance of success with breast feeding in roomed-in babies.
Parents do not have the fear of baby-switching while roomed-in.

WHEN YOU ROOM-IN ?

You can more easily hold, cuddle, look at, and learn to respond to get to know your
baby.
Your baby can get to know you more easily.
Your baby should cry less than babies in the nursery who are away from their mothers.
Your baby can learn to breastfeeding faster and gain weight sooner.
You should feel more able to take care of your baby when you go home.

WHEN TO EXPECT?

You and the staff will work together on bonding with your baby, keeping your baby
warm, and if you choose, breastfeeding.
This is an exciting time for you and your family. We suggest you limit your visitors for
the first few hours after you get to your private room so you and your partner can give
all your attention to your new baby.
Your baby may need to go to the nursery for a short period of time to:
- Have a circumcision (if you choose for your son).
- Be examined by his or her doctor with special equipment in the nursery.
- Let you be cared for if you are not feeling well or allow staff to watch you or the baby
more closely.
You might think you will get less sleep if your baby is with you. However studies actually
show that mother get more sleep with their baby in the room.
For the first few hours, we suggest that you keep your diapered baby directly against
your skin (called skin to skin contact). When you are sleeping, we ask that you put the
 baby in the pram next to your bed to be safe. Please talk to your babys doctor about
sleeping with the baby in your bed if you plan to do this at home.
If you have visitors, please ask them to wash their hands thoroughly. Hand washing is
the best way to prevent passing colds or infections. Everyone, including children, should
use an alcohol-based hand gel like purell. Dispensers are located throughout the
hospital.
If hands are visibly dirty, use soap and water to clean them. In addition, to keep you and
your baby healthy, please ask your visitor to stay home if they have any symptoms of
cold or diarrhea, or have recently been exposed to chicken pox, measles, mumps,
rubella or the flu.

We want this to be the best possible experience for you. If you have question, please ask the
nurse who is caring for you. Rooming-in is just one way to get to know your baby. It will help
you learn all the exciting noises your baby makes and see the many things your baby can do.

Results of rooming in

A baby in mothers room will:

Cry less
Maintain more stable body temperature
Encourage mothers mature breast milk to come in sooner.
Stay healthier and have a lower incidence of infant cross-infection.

A mother who has her baby with her will:

Learn more about her babys normal responses and sleep-wake cycle.
Bond more easily with her baby.
Be more successful at breastfeeding
Be more confident

Nurses as role models and teachers for parents

We help to model ways for parents to care for their baby

Changing diapers, swaddling, bathing
We help to model ways for parents relate to their baby
How to soothe, what to do when baby cries
We help parents to understand their babys behaviors
What to do when baby sneezes, hiccups, normal reflexes
CARE FOR BABY IN MOMS ROOM:-

Bath
Nursing assessment
Pediatric assessment
Vital sign
Weights
Hearing screening
Medications
Labs

WAYS TO ENCOURAGE ROOMING-IN

Educate parents parenatally & on admission

better for baby
ring your light, Im here for you
Naps during the day
Limit visitors
Help dad to earn comfort techniques
Do not offer sepration
just like you will at home
 KANGAROO MOTHER CARE (KMC)

INTRODUCTION: - kangaroo mother care or skin to skin care, is a technique practiced on

newborn, usually preterm, infants where in the infants is held, skin to skin, with an adult.
Kangaroo care for pre-term infants may be restricted to a few hours per day, but if they are
medically stable that time may be extended. Some parents may keep their babies in arms for
many hours per day.

Kangaroo care, named for the similarity to how certain marsupials carry
their young, was initially developed to care for pre-term infants in areas where incubators are
either unavailable or unreliable.

DEFINITION:-

kangaroo mother care is care of low birth weight/ preterm infants in skin to skin contact with
mother, it is powerful, easy to use method to promote the health and well being of low birth
weight and preterm babies.

HISTORY:-
Peter de Chateau in Sweden first described studies of "early contact" with mother
and baby at birth in 1976, articles do not describe specifically that this was skin-to-skin contact.
Klaus and Kennel did very similar work in the USA, better known in the context of early
maternal-infant bonding. The first report use of the term "skin-to-skin contact" is by Thomson
in 1979 and quotes the work of de Chateau in its rationale. This is contemporary or even
precedes the origins of Kangaroo Mother Care in Bogota, Colombia. This latter did however
make the concept more widely known.
Scientific rationale:-
Mainstream clinical medicine has not accepted Kangaroo Mother Care, or
skin-to-skin contact, as more than an adjunct to reliance on advanced technology that requires
maternal infant separation. However, in primates, early skin-to-skin contact is part of a
universal reproductive behavior, and early separation is used as a research modality to test the
harmful effects on early development. Research suggests that for all mammals, the maternal
environment (or place of care) is the primary requirement for regulation of all physiological
needs (homeostasis), maternal absence leads to deregulations and adaptation to adversity.
 Even for humans, it would appear that skin-to-skin contact has a better
scientific rationale than the incubator. All other supportive technology can be provided as part
of care to extremely low birth weight babies during skin-to-skin contact, and appears to
produce a better effect.
Based on the scientific rationale, it has been suggested that skin-to-skin
contact should be initiated immediately, to avoid the harmful effects of separation (Bergman
Curationis). In terms of classification and proper defining for research purposes, the following
aspects that categorise and define skin-to-skin contact have been proposed:

Initiation time, (minutes, hours from birth), ideal is zero separation.

Dose of skin-to-skin contact, (hours per day, or as percentage of day), ideal >90%.
Duration, (measured in days or weeks from birth), ideally until infant refuses.
Safe technique should ensure that obstructive apnea cannot occur. Since the mother must be
able to sleep to provide adequate dose, this requires keeping the airway safely open, and close
containment to mothers bare chest using a garment, various of these are described in the
WHO guidelines.[6]
Mother should be the primary provider of skin-to-skin contact, as only she can breastfeed.
However, it is almost always necessary that father should also provide skin-to-skin contact to
achieve adequate dose; other family members can also be used. Since skin-to-skin contact is
basic to early bonding and attachment, it should probably not be done by hospital staff and
other surrogates

Criteria:- Originally babies who are eligible for kangaroo care include pre-term infants
weighing less than 1,500 grams (3.3 lb), and breathing independently. Cardiopulmonary
monitoring, oximetry, supplemental oxygen or nasal (continuous positive airway pressure)
ventilation, intravenous infusions, and monitor leads do not prevent kangaroo care. In fact,
babies who are in kangaroo care tend to be less prone to apnea and bradycardia and have
stabilization of oxygen needs.
During the early 1990s, the concept was advocated in North America for premature babies in
NICU and later for full term babies. Research has been done in developed countries but there is
a lag in implementation of kangaroo care due to ready access of incubators and technology.
Restrictions for eligibility to receive skin-to-skin contact are becoming fewer; the main
constraint has probably been caregiver confidence and experience.
TECHNIQUE:-
In kangaroo care, the baby wears only a small diaper and a hat and is placed in
a flexed (fetal position) with maximal skin-to-skin contact on parent's chest. The baby is secured
with a wrap that goes around the naked torso of the adult, providing the baby with proper
support and positioning (maintain flexion), constant containment without pressure points or
creases, and protecting from air drafts (thermoregulation). If it is cold, the parent may wear a
shirt or hospital gown with an opening to the front and a blanket over the wrap for the baby.
The tight bundling is enough to stimulate the baby: vestibular stimulation from
the parent's breathing and chest movement, auditory stimulation from the parent's voice and
natural sounds of breathing and the heartbeat, touch by the skin of the parent, the wrap, and
the natural tendency to hold the baby. All this stimulation is important for the babys
development.
"Birth Kangaroo Care" places the baby in kangaroo care with the mother within
one minute after birth and up to the first feeding. The American Academy of Pediatrics
recommends this practice, with minimal disruption for babies that don't require life support.
The baby's head must be dried immediately after birth and then the baby is placed with a hat
on the mother's chest. Measurements, etc. are performed after the first feeding. According to
the US Institute of Kangaroo Care, healthy babies should maintain skin-to-skin contact method
for about 3 months so that both baby and mother are established in breastfeeding and have
achieved physiological recovery from the birth process.
For premature babies, this method can be used continuously around the clock
or for sessions of no less than one hour in duration (the length of one full sleep cycle.) It can be
started as soon as the baby is stabilized, so it may be at birth or within hours, days, or weeks
after birth.
Kangaroo care is different from the practice of baby wearing. In kangaroo care, the
adult and the baby are skin-to-skin and chest-to-chest, securing the position of the baby with a
stretchy wrap, and it is practiced to provide developmental care to premature babies for 6
months and full-term newborns for 3 months. In baby wearing the adult and the child are fully
clothed, the child may be in the front or back of the adult, can be done with many different
types of carriers and slings, and is commonly practiced with infants and toddlers.
BENEFITS:-

For parents
Kangaroo care is beneficial for parents because it promotes attachment and
bonding, improves parental confidence, and helps to promote increased milk production and
breastfeeding success.
For fathers
Both preterm and full term infants benefit from skin to skin contact for the first few
weeks of life with the baby's father as well. The new baby is familiar with the father's voice and
it is believed that contact with the father helps the infant to stabilize and promotes father to
infant bonding. If the infant's mother had a caesarean birth, the father can hold their baby in
skin-to-skin contact while the mother recovers from the anesthetic.
For pre-term and low-birth-weight infants
Kangaroo care arguably offers the most benefits for pre-term and low-birth-weight
infants, who experience more normalized temperature, heart rate, and respiratory rate,
increased weight gain, fewer nosocomial infections and reduced incidence of respiratory tract
disease. Additionally, studies suggest that preterm infants who experience kangaroo care have
improved cognitive development, decreased stress levels, reduced pain responses, normalized
growth, and positive effects on motor development. Kangaroo care also helps to improve sleep
patterns of infants, and may be a good intervention for colic. Earlier discharge from hospital is
also a possible outcome Finally, kangaroo care helps to promote frequent breastfeeding, and
can enhance mother-infant bonding. Evidence from a recent systematic review supports the
use of kangaroo mother care as a substitute for conventional neonatal care in settings where
resources are limited.
Promotes more successful breastfeeding of full-term infants

Infant nursing shortly after birth

According to some authorities there is a growing body of evidence that suggests that early skin-
to-skin contact of mother and baby stimulates breast feeding behavior in the baby. Newborn
infants who are immediately placed on their mothers skin have a natural instinct to latch on to
the breast and start nursing, typically within one hour of being born. It is thought that
immediate skin-to-skin contact provides a form of imprinting that makes subsequent feeding
significantly easier. The World Health Organization reports that in addition to more successful
breastfeeding, skin-to-skin contact between a mother and her newborn baby immediately after
delivery also reduces crying, improves mother to infant interaction, and keeps baby warm.
According to studies quoted by UNICEF, babies have been observed to naturally follow a unique
process which leads to a first breastfeed. After birth, babies who are placed skin to skin on their
mothers chest will:

Initially babies cry briefly a very distinctive birth cry

Then they will enter a stage of relaxation, recovering from the birth
Then the baby will start to wake up
Then begin to move, initially little movements, perhaps of the arms, shoulders and head
As these movements increase the baby will actually start to crawl towards the breast
Once the baby has found the breast and therefore the food source, there is a period of rest.
Often this can be mistaken as the baby is not hungry or wanting to feed
After resting, the baby will explore and get familiar with the breast, perhaps by nuzzling,
smelling and licking before attaching
Providing that there are no interruptions, all babies are said to follow this process and it is
suggested that trying to rush the process or interruptions such as removing the baby to weigh
or measure is counter-productive and may lead to problems at subsequent breastfeeds.[43]
For institutions
Kangaroo care often results in reduced hospital stays, reduced need for
expensive healthcare technology, increased parental involvement and teaching opportunities,
and better use of healthcare dollars.
For the community
Overall, kangaroo care helps to reduce morbidity and mortality, provides
opportunities for teaching during postnatal follow-up visits, and decreases hospital-associated
costs.

Conclusion: I would to like conclude my topic rooming in & KMC.in rooming in define, when
rooming in ?, what to expect ?,result of rooming in , care of baby in mothers room, ways to
encourage rooming in and in KMC defining , history of KMC , rational, criteria, techniques,
benefits

Summary: Today we learned regarding rooming in and KMC basis of that we can
discuss ideas,share ideas with other,solve the problems, and chance to present their
speeches separately.
BIBLIOGRAPHY:-

Marlow R. Dorthy and Redding a Barbara. Textbook of pediatric nursing 6th edition. New delhi;
WB saunders company: pp:

Kurian soumya, Textbook of pediatric nursing 1st edition, published by EMMESS medical
publisher, banglore:2016.pp:

Kp neerja; Textbook of growth and development for nursing; jaypee brothers published;
2006:pp

Parul dutta; pediatric nursing 2nd edition. Published by jaypee brothers medical
publishers(p)ltd:2010:pp

Baillierse nurses dictionary Barbara f. weller 25th edition 2009 elsevier limited.