Kangaroo Mother Care and the Bonding Hypothesis

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

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.

Objectives and Hypothesis

In this study, mothers in a KMC group practicing 24-hour-a-day skin-to-skin contact were compared with mothers in a traditional care group (TC). Furthermore, infants in the TC group were kept in incubators at the minimal care unit until they met standard discharge criteria, after which they were sent home and received the same outpatient care as infants in the KMC group (see below). This randomized, controlled trial permits timing of mother-infant contact to be determined (1 to 65 days after birth) and takes into account the infant’s health status and the marital and socioeconomic status of the parents. Because high-risk infant births can hinder the development of maternal attachment, such as in the mothering-disability syndrome that threatens the survival of neonates,17,18 the KMC intervention in this context could produce major changes in the mothers’ attachment behaviors and perceptions.

Two series of outcomes are taken as manifestations of a mother’s attachment behavior. The first is the mother’s feelings and perceptions of her premature birth experience, including her sense of competence, feelings of worry and stress, and perception of social support. The second outcome is derived from observations made of the mother and child’s responsiveness to each other during breastfeeding, at the gestational age of 41 weeks. Our general hypothesis is that the skin-to-skin contact practiced in the KMC group will induce a positive perception and a state of readiness in the mother to detect and respond to infant cues. We suggest that KMC will be most effective

1. when the interval between birth and start of intervention is short; and
2. when the infant’s health is fragile and intensive care during hospitalization is needed.

Pediatrics (ISSN 0031 4005). © 1998 by the American Academy of Pediatrics