Martin T. Stein, MD reviewing Feldman R et al. Biol Psychiatry 2013 Oct 3.

Maternal–infant skin-to-skin contact in the form of kangaroo care (KC) in premature infants enhances neuromaturation. KC is associated with better autonomic function, electroencephalogram complexity, pain response, and physiologic stability, as well as improved mother–infant interactions/bonding and maternal mood. Whether these benefits are sustained long-term is not known.

Investigators in Israel prospectively examined the effects of KC in 146 premature infants (mean birth weight, 1270 g; mean gestation, 30.5 weeks); 73 infants were undressed and placed between the mothers’ breasts for 1 hour daily for 14 days while the mother sat in a rocking chair, and 73 case-matched control infants received standard care in an incubator. All children were evaluated seven times during the first decade of life using standardized measurements for autonomic function (respiratory sinus arrhythmia), cognition, and parent mental health. Mother–child interactions at term, and at ages 3 months, 6 months, and 10 years were videotaped and assessed for maternal gaze, “motherese” high-pitched vocalizations, positive affect, and affective touch.

Compared with the control group, maternal attachment behavior and autonomic function were increased during the postpartum period in the KC group. From ages 6 months to 10 years, the KC group showed a sustained reduction in maternal anxiety and higher levels of cognitive development, organized sleep patterns, and executive functions. At age 10 years, KC children had lower cortisol levels in response to a standardized stress test (making a public speech and completing a complex math problem before an unfamiliar judge).


Kangaroo care for premature infants has come a long way from the initial observation in Bogotá, Colombia, where incubators were not available. The physiological and behavioral benefits derived from KC are thought to be a result of early and frequent skin-to-skin contact at a sensitive period of neurological maturation in premature infants. At a time when cost-effective interventions are valued, KC appears to be a good investment.


Feldman R et al. Maternal­preterm skin­to­skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. Biol Psychiatry 2013 Oct 3; [e­pub ahead of print]. ( )