20 AAP News •
www.aapnews.org • September 2015
by Melissa Jenco • News Content Editor
Intermittent skin-to-skin care (SSC) for
infants in the neonatal intensive care unit
(NICU) can improve
breastfeeding and parental bonding,
according to a new AAP clinical report
published in the September issue of
Pediatrics (2015;136:596-599; http://
The report, Skin-to-Skin Care for Term
and Preterm Infants in the Neonatal Intensive Care Unit, encourages health
care providers to facilitate SSC between
parents and the newborn with proper
“The environment in our NICUs is so
chaotic and stressful, if you can just be
there and skin-to-skin, the temperature
regulation might be better, the calming
effect might be better,” said Kristi L.
Watterberg, M.D., FAAP, chair of the
AAP Committee on Fetus and New-
born, which released
SSC is a modified
version of kangaroo
mother care used
countries. It can be
used for varying periods of time by both
parents and offered to less stable infants
as young as 26 weeks.
There aren’t enough data available to
link SSC in resource-rich countries with
decreased mortality like kangaroo care in
resource-limited areas, the report says.
However, there are a number of other
benefits. Chief among them is longer
and more exclusive breastfeeding and
higher volumes of expressed milk. Stud-
ies also have indicated intermittent SSC
improves parents’ attachment to the baby
and decreases feelings of helplessness.
“You’re feeling out of control as a
mom or a dad whose baby isn’t coming
home with you … and anything you can
do to increase your participation in that
care will make you feel like you’re doing
something,” Dr. Watterberg said. “You
are doing something.”
SSC also may help sleep, neurobehav-
ioral maturation and nonpharmacologic
pain management, though the evidence
is not as clear.
Before participating in SSC, the report
recommends checking parents for skin
infections that might need cleansing,
especially if the infant has open lesions.
Infants in the NICU also should be
monitored continuously during SSC.
Health care providers should make sure
babies’ heads are in the correct position
to keep the airways open and that any
life-support equipment is stabilized.
To encourage greater participation in
SSC, Dr. Watterberg said it is important
to get the nursing staff on board.
“I think it’s just a matter of finding
your champions in your unit and doing
this in a sort of systematic way so that
somebody is not just doing it on their
own,” she said.
Implications for clinical practice
• Skin-to-skin care has been shown
to result in improved breastfeeding,
milk production, parental satisfaction and bonding.
• Mothers and fathers alike can provide skin-to-skin care with appropriate protocols for both preterm
and term infants in the NICU.
• Infants in the NICU should have
continuous cardiovascular monitoring during SSC, and care should
be taken to monitor correct head
positioning for airway patency as
well as the stability of the endotra-cheal tube, arterial and venous access devices, and other life-support
• Information for parents on the Healthy
Children website on the basics of skin-to-skin care, http://bit.ly/1gjiOqP, and
advice on caring for premature infants, http://bit.ly/1KvoquO.
• A study in Pediatrics on the effects of
skin-to-skin contact on sleep among
premature infants, http://bit.ly/1LT
AAP report encourages skin-to-skin care for NICU babies