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Kangaroo Care Effects on Autonomic Nervous System Regulation and Functional Outcomes in Premature Infants Emily Erwin and Brooke Sowards Bellarmine University Physical Therapy Program. Evidence. Introduction. Conclusion. F irst used in Bogota , Colombia as a substitute for incubators 1

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Kangaroo Care Effects on Autonomic Nervous System Regulation and Functional Outcomes in Premature Infants

Emily Erwin and Brooke Sowards

Bellarmine University Physical Therapy Program




  • First used in Bogota , Colombia as a substitute for incubators1
  • Kangaroo Care (KC): “the upright prone positioning of the diaper-clad infant skin-to-skin and chest-to-chest with an adult.”2
  • KC incorporates rhythmic, sensory, and tactile aspects into the mother-infant environment3
  • KC improves:3
    • State organization
    • Thermal regulation
    • Respiratory patterns & O2 saturation
    • Frequency of apneas & bradycardias
  • Theoretical Effectiveness:1
    • Sensitive periods for CNS development
    • Touch and proprioception senses precede development of vision and audition
    • Maternal proximity influences the development of the infant’s biological clock
  • Recent research has investigated impact of KC vs. standard care on:
  • ANS Regulation
    • Heart rate variability in response to painful stimuli2
    • Maturation of Parasympathetic Nervous System (PSNS) and vagal tone4, 5
  • Functional Outcomes
    • Most frequently observed behavioral state1,2, 5
    • Organization of sleep-wake cycle1, 4
    • Mother-child interaction in regards to effect on infant attentiveness and gaze aversion1, 3
    • Maturation of cognitive executive functioning4
    • Psychomotor development4
  • Research supports the effectiveness of KC in overall development of premature infant when held at least one hour a day for 14 consecutive days:
  • ANS Regulation
    • Reduced heart rate variability and decelerations in response to painful stimuli2
    • Increased vagal tone and PSNS maturation4,5
  • Functional Outcomes
    • Infants spent more time in quiet sleep and alert wakefulness states1, 2 ,5
    • Improved organization and rhythmicity of sleep-wake cycle1,4
    • Improved mother-child interaction and infant attentiveness/alertness1, 3
    • Infants demonstrated less gaze aversion1, 3
    • Improvements in PSNS functioning was correlated with improvements in executive functioning,, mother-child interactions, and stress reactivity throughout childhood4
    • Decreased withdrawal behavior during mother-infant interaction4
    • Improved motor maturity4

Effects of Prematurity

  • Preemies are any infant born before 37 weeks
  • 12% of infants in industrial societies are born prematurely each year 4
  • Interrupts brain development and results in decreased myelination4
  • Lower cognitive and motor skills that persist into later childhood3
  • Synactive Theory of Development
  • Development of control of three subsystems
    • ANS: regulation of heart rate, respiratory rate, body temperature, blood pressure
    • Motor: muscle tone
    • State: level of alertness, sleep-wake cycles
  • In preemies, subsystems are under-developed and can lead to delayed cognitive and psychomotor development



  • Feldman R, Weller A, Sirota L, Eidelman AI. Skin-to-Skin contact (Kangaroo care) promotes self-regulation in premature infants: sleep-wake cyclicity, arousal modulation, and sustained exploration. Dev Psychol. 2002;38(2):194-207.
  • Cong X, Cusson RM, Walsh S, Hussain N, Ludington-hoe SM, Zhang D. Effects of skin-to-skin contact on autonomic pain responses in preterm infants. J Pain. 2012;13(7):636-45.
  • Feldman R, Eidelman AI, Sirota L, Weller A. Comparison of skin-to-skin (kangaroo) and traditional care: parenting outcomes and preterm infant development. Pediatrics. 2002;110(1 Pt 1):16-26.
  • Feldman R, Rosenthal Z, Eidelman AI. Maternal-Preterm Skin-to-Skin Contact Enhances Child Physiologic Organization and Cognitive Control Across the First 10 Years of Life. Biol Psychiatry. 2013;
  • Feldman R, Eidelman AI. Skin-to-skin contact (Kangaroo Care) accelerates autonomic and neurobehavioural maturation in preterm infants. Dev Med Child Neurol. 2003;45(4):274-81.

Kangaroo Care has been proven to affect ANS regulation, cognition, and states of consciousness in developing premature infants. These developing processes have a significant impact on sensory, motor, and cognitive functioning throughout childhood. With decreased cognitive functioning, the child is less motivated to explore their surroundings hindering their motor skill development . KC also facilitates mother child interaction which improves infants’ attentiveness and ability to interact with their environment. Preemies who received KC spent more time in quiet restful sleep states and could more effectively transition between sleep wake cycles. Restful sleep is important because this is the behavioral state where neural growth occurs. Current evidence has only investigated outcomes up to eighteen months post intervention. Future longitudinal research is needed to explore the long term effect of KC on motor and functional development throughout childhood and adolescence.