Skin-to-skin care

Attachment refers to the baby’s emotional connection with the parents (or the primary caregiver) and can be described as a secure, reciprocal, and long lasting bond. The attachment process begins shortly after birth, develops rapidly in the following months, and continues developing throughout life.

Bonding refers to the parents’ sense of connection to their child. The bonding process already begins before birth and is heavily influenced by experiences during pregnancy and delivery. After birth, bonding usually develops very quickly in the first days and weeks of life.

Physical contact with the parents’ skin is the first very important component to initiate the bonding process right after birth. Further, interactions between parents and child and the implementation of daily care procedures supports the establishment of a strong and safe bond between parents and their baby.

Interactions can include speaking to the baby, kangaroo-care, where the infant is held skin-to-skin by the mother or father, breastfeeding, or simply watching the baby. Even watching a picture of the baby may help to strengthen the relationship.

Although every baby inevitably develops a bond with the parents, different attachment and bonding qualities can influence social and emotional development and behaviour of the child later in life. The separation of parents and their baby immediately after birth can lead to the interruption of these fundamental bonding processes. The attachment quality of a baby towards parents has an influence on how the baby will behave later in life.

Attachment forms by interaction between baby and parents. Involving parents in the daily care and encouraging them to interact with their baby from the early beginning may have a positive influence on the parent-child-relationship and child development later in life.

Skin-to-skin care, also called kangaroo care, usually means to have a baby placed on the parent’s bare chest. The medical care team decides whether the baby’s health condition is stable enough to do so. Respecting the sleep of a preterm born baby is very important. It is preferable to wait until the baby is rousing from sleep before kangaroo care.

Skin-to-skin care can be done in a comfortable chair or bed. The parent is in a sedentary or semi-reclined position and not able to walk around with their baby. The infant should be naked with only a nappy on and the parents’ chest should be bare. Hat and bootees are sometimes recommended by healthcare professionals to avoid that the baby is getting cold. The transfer of the baby is usually done by one or two nurses to take care of lines and/or breathing tubes. The nurse usually wraps the baby in a blanket for transfer.

The infant is placed in skin-to-skin contact in the frontal position with flexed arms and flexed legs in a frog-like position and the head turned sideways with chin up. Mothers or fathers can support the baby’s head and back with their hands.

Additionally, a towel or blanket can be used to secure and cover the baby. If the baby needs be returned into the incubator it can take some time for the child to adjust. It can be comfortable for the baby if the parent stays next to the incubator, talking quietly, cupping the head with warm hands, or leaving a cloth with the parent’s smell on to help the infant to fall back to sleep again. During the whole period of time the baby will be monitored by the NICU team to check on the vital signs.

Multiple studies showed great benefits of skin-to-skin care for mother and child. In the meanwhile, there are studies available, which provided similar results for skin-to-skin contact with the father. Therefore, skin-to-skin care has been widely adopted in many hospitals all over the world and is recommended by the World Health Organisation (WHO).

Benefits include among others:

  • Enhanced bonding and attachment
  • Increased breast milk volume, higher rates of successful breastfeeding and increased duration of breastfeeding
  • Consistently high and stable oxygen saturation
  • Stable body temperature, heart rate, and breathing frequency
  • Reduced crying associated with painful procedures
  • Increased weight gain
  • More restful and longer duration of sleep
  • Less and less severe infections
  • Reduced neonatal mortality


Skin-to-skin contact can support parents and their baby to get to know each other. It allows the baby to hear the voice and the heartbeat of the mother or father and to get to know their smell. It re-establishes the closeness and helps parents to get more confident.

Skin-to-skin care with the mother gives the baby early opportunities for breastfeeding and a greater chance of breastfeeding success. The warmth of contact between baby and mother stimulates the milk production. At the age of 30-32 weeks of gestation kangarooed infants will already start to turn their head towards the breast and may lick some drops of milk directly from the breast. Skin-to-skin care also helps the baby to digest the food. Therefore, it can be combined with tube feeding as well.

Skin-to-skin care has a pain-relieving effect. A loving and comforting contact between parent and child can help the baby to cope with painful medical procedures.

Therefore, certain necessary medical treatments such as blood sampling could be given to the baby during kangaroo care. After the procedure parents are able to comfort their child.

Parents should be supported to hold their baby skin-to-skin as long as they are comfortable with it. The sleep-wake cycles of the baby should always be considered. Healthcare professionals inform about how parents can prepare themselves before providing kangaroo care to their child, e.g. to wear comfortable clothes, which can be opened at the front, to pull back hair, or to wash hands. Parents can also talk or sing to their baby and they can use a hand mirror to look at their baby during skin-to-skin care.

For successful skin-to-skin care, it is important to inform parents about the procedure as well as the benefits for their child. The planning should always be done in consultation with the parents.