Comparison of Skin-to-Skin (Kangaroo) and Traditional Care: Parenting Outcomes and Preterm Infant Development

PEDIATRICS Vol. 110 No. 1 July 2002, pp. 16-26 
Ruth Feldman, PhD*, Arthur I. Eidelman, MD, Lea Sirota, MD and Aron Weller, PhD*

*Department of Psychology Bar-Ilan University, Ramat Gan, Israel Department of Neonatology, Shaare Zedek Medical Center, and Department of Pediatrics, Hebrew University School of Medicine, Jerusalem, Israel Schneider Children’s Hospital and Department of Pediatrics, Sackler School of Medicine, Tel-Aviv University, Israel


To examine whether the kangaroo care (KC) intervention in premature infants affects parent-child interactions and infant development.


Seventy-three preterm infants who received KC in the neonatal intensive care unit were matched with 73 control infants who received standard incubator care for birth weight, gestational age (GA), medical severity, and demographics. At 37 weeks' GA, mother-infant interaction, maternal depression, and mother perceptions were examined. At 3 months' corrected age, infant temperament, maternal and paternal sensitivity, and the home environment (with the Home Observation for Measurement of the Environment [HOME]) were observed. At 6 months' corrected age, cognitive development was measured with the Bayley-II and mother-infant interaction was filmed. Seven clusters of outcomes were examined at 3 time periods: at 37 weeks' GA, mother-infant interaction and maternal perceptions; at 3-month, HOME mothers, HOME fathers, and infant temperament; at 6 months, cognitive development and mother-infant interaction.


After KC, interactions were more positive at 37 weeks' GA: mothers showed more positive affect, touch, and adaptation to infant cues, and infants showed more alertness and less gaze aversion. Mothers reported less depression and perceived infants as less abnormal. At 3 months, mothers and fathers of KC infants were more sensitive and provided a better home environment. At 6 months, KC mothers were more sensitive and infants scored higher on the Bayley Mental Developmental Index (KC: mean: 96.39; controls: mean: 91.81) and the Psychomotor Developmental Index (KC: mean: 85.47; controls: mean: 80.53).


KC had a significant positive impact on the infant’s perceptual-cognitive and motor development and on the parenting process. We speculate that KC has both a direct impact on infant development by contributing to neurophysiological organization and an indirect effect by improving parental mood, perceptions, and interactive behavior.


Kangaroo Care • parent-infant interaction • maternal depression • fathers • Bayley • infant development


KC, kangaroo care • SD, standard deviation • GA, gestational age • NICU, neonatal intensive care unit • CRIB, Clinical Risk Index for Babies • BDI, Beck Depression Index • NPI, Neonate Parental Inventory • HOME, Home Observation for Measurement of the Environment • ICQ, Infant Characteristic Questionnaire • MDI, Mental Developmental Index • PDI, Psychomotor Developmental Index • MANOVA, multivariate analysis of variance

Received for publication July 26, 2001; accepted January 9, 2002.