PEDIATRICS Vol. 102 No. 2 August 1998, p. e17

Kangaroo Mother Care and the Bonding Hypothesis

Réjean Tessier*, Marta Cristo, Stella Velez, Marta Girón, SW; Zita Figueroa de Calume,
Juan G. Ruiz-Paláez, Yves Charpak, and Nathalie Charpak

From the *School of Psychology, Laval University, Québec, Canada; ISS-World Lab, Kangaroo Mother Care Program, Clinica del Nino, Santa Fe de Bogotá, Colombia; Clinical Epidemiology Unit, Faculty of Medicine, Javeriana University, Santa Fe de Bogotá, Colombia; and EVAL (Institut pour l'Évaluation dans le domaine Médical, Médico-social et de Santé Publique), Paris, France.

The Bonding Hypothesis

After the publication of Klaus and colleagues' work,¹³^,¹⁴ the concept of bonding has withstood the test of time, and the perception that instantaneous bonding is a vital component of the "ideal" birth experience has dominated our perception of childbirth. The clinical benefits of humanizing the process of giving birth, resulting from the changes in intensive care nursery that Klaus et al supported, were widely recognized and accepted. On the other hand, although 25 years have passed since Klaus et al.'s article was published and despite a plethora of studies in the 1970s and 1980s on early mother-child bonding, controversial comments, critiques, and confusing conclusions abound. The importance of early contact between the mother and infant first was reviewed by Lamb and Hwang¹⁵ in 1982 and critically analyzed by Diane Eyer¹⁶ in 1992. Despite its apparent clinical importance, the bonding hypothesis still is not recognized universally.

Is there a postnatal bonding effect? Based on the literature and available empirical data, nothing is less obvious: the duration of both the bonding period and its effects are unknown. Furthermore, the nature of the attachment behavior is not clearly defined. On the other hand, in skin-to-skin contact, short-term effects (lasting for up to 1 month) are observed, and the mother's perception and behavior are different from those observed in the control groups. For all these reasons, replicate studies would be very useful to clarify some of the unanswered questions noted above.

KMC and the Bonding Hypothesis

Theoretically, KMC is based on the idea that a bonding effect is induced by early skin-to-skin contact between the child and its caregiver. After Bogotá's recent tradition and drawing on the well known importance of early social interactions with the caregiver, such as holding, touching, and eye contact, some neonatal intensive care units use KMC to add an emotional complementary dimension to routine care. This approach is an attempt to humanize care given during the period in the neonatal intensive care unit (NICU) and to improve both communication and attachment between caregiver and child. Moreover, KMC should be seen as a means to ensure the successful discharge of a fragile infant from the NICU by enhancing family caregiving during the post-NICU period.

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