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Health Education Specialist Corner

SIDS, Suffocation, Skin to Skin Contact, and Breastfeeding

The rates of Sudden Infant Death Syndrome have been reduced by 50 percent since the American Academy of Pediatrics recommended infants be placed on their backs to sleep in 1992.  In 1994 the NICHD launched the Back to Sleep campaign, named for its recommendation to place healthy babies on their backs to sleep, the most effective action that parents and caregivers can take to reduce the risk of SIDS. As the rates decline and research evolves it is important to maintain the recommendations and ensure they are considered in the application of infant health and development recommendations such as skin to skin contact also known as kangaroo care.  There is a likelihood that some recommendations might seem to conflict with other recommendations.  It becomes crucial to address conflicts so messaging is clear and consistent to new parents that are facing a host of challenges as they strive to provide a healthy and safe environment for their babies.

There is currently sufficient data that indicates for a preterm infant skin to skin contact benefits the infant-mother dyad.  The World Health Organization has a Kangaroo Care Practical Guide that can be found at http://whqlibdoc.who.int/publications/2003/9241590351.pdf. The Guide details the history and benefits.  In recent years there has been an increase of promotion of skin to skin practices in well baby and full term infants to promote bonding and breastfeeding.  The question then is what data is available for healthy term infants for skin-to-skin contact benefits and are there adverse events to be considered?

Exclusive breastfeeding for 6 months is recommended by the American Academy of Pediatrics. Breastfeeding has many dose-response health benefits to mother and baby when this recommendation is followed (AAP, 2012). In western culture it as been routine for infants to be separated from their mothers immediately following delivery.  Recent trends though indicate the practice of Skin to Skin care is being offered more frequently and some studies have shown that early initiation of skin-to-skin contact increases the duration of exclusive breastfeeding (Moore, 2012).    While there is data that indicates this promotes initiation of breastfeeding,  there is limited data  regarding whether this practice increases duration of breastfeeding to 3, 4, 6 months or beyond (Puig G, Sguassero Y, 2007).

As more and more hospitals and clinicians begin to implement skin to skin contact and infants rooming with mothers post partum it will become important to weave the SIDS and suffocation risk reduction recommendations into the current practices and clear guidance for parents.  Modeling infant care practices that families will be able to continue once they go home will be key.  It will also be important to communicate clearly with families when there appears to be a contradiction in practices.  Skin to skin contact is practiced chest to chest and oftentimes baby will fall asleep in this position and perhaps the care provider as well.  Once the baby is asleep, parents need to be guided on placing the infant down to sleep on the back in an appropriate sleep environment.  We should be clear to parents on the benefits and provide anticipatory guidance on possible challenges.  Below are some resources and references regarding skin to skin contact and considerations including some practice guideline models.  We invite your feedback.  Please contact barb@firstcandle.org with questions and concerns.


Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003519. DOI: 10.1002/14651858.CD003519.pub2.

World Health Organization http://apps.who.int/rhl/newborn/gpcom/en/index.html

Puig G, Sguassero Y. Early skin-to-skin contact for mothers and their healthy newborn infants: RHL commentary (last revised: 9 November 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.

American Academy of Pediatrics. (2009). Safe & healthy beginnings: A resource toolkit for hospitals and physicians’ offices. Elk Gove Village, IL: American Academy of Pediatrics.

Gabriel, M., Martin, I. L., Escobar, A. L., Villalba, E. F., Blanco, I. R., & Pol, P. T. (2009). Randomized controlled trial of early skin-to-skin contact: Effects on the mother and the newborn. Acta Paediatrica, 99, 1630-1634.

Haxton, D., Doering, J., Gringas, L., & Kelly, L. (2012). Implementing Skin-To-Skin Contact at Birth Using the Iowa Model. Nursing for Women’s Health, 16(3), 220-230.

Hung, K., & Berg, O. (2011).  Early skin-to-skin after cesarean to improve breastfeeding. Maternal Child Nursing, 36 (5), 318-324.

Moore, E. R., Anderson, G. C., Bergman, N., & Dowswell, T. (2012). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane database of systematic reviews, 2012 (5), 1-107.

Lawn JE, Mwansa-Kambafwile J, Horta BL, et al APR 2010’Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY   Volume: 39   Pages: 144-154   Supplement: Suppl. 1

Nyqvist KH, Anderson GC, Bergman N, et al,  JUN 2010, State of the art and recommendations Kangaroo mother care: application in a high-tech environment. ACTA PAEDIATRICA   Volume: 99  Issue: 6   Pages: 812-819

Nyqvist KH, Anderson GC, Bergman N, et al,  JUN 2010 Towards universal Kangaroo Mother Care: recommendations and report from the First European conference and Seventh International Workshop on Kangaroo Mother Care, ACTA PAEDIATRICA   Volume: 99   Issue: 6   Pages: 820-826

Nagai S, Andrianarimanana D, Rabesandratana NH, et al,  JUN 2010 Earlier versus later continuous Kangaroo Mother Care (KMC) for stable low-birth-weight infants: a randomized controlled trial ACTA PAEDIATRICA   Volume: 99   Issue: 6   Pages: 827-835

Mori R, Khanna R, Pledge D, et al,( April 2010) Meta-analysis of physiological effects of skin-to-skin contact for newborns and mothers. PEDIATRICS INTERNATIONAL   Volume: 52   Issue: 2   Pages: 161-170

Gabriel MAM, Martin IL, Escobar AL, et al NOV 2010Randomized controlled trial of early skin-to-skin contact: effects on the mother and the newborn PAEDIATRICA   Volume: 99  Issue: 11   Pages: 1630-1634

Zambito S, Leash J, Baublitz W, et al, (September 2010) Kangaroo Care: A Solution to Minimize Mother and Baby Separation JOURNAL OF OBSTETRIC GYNECOLOGIC AND NEONATAL NURSING  Volume: 39   Special Issue: Sp. Iss. SI Suppl. 1   Pages: S109-S109   Supplement: Sp. Iss. SI Suppl. 1

Neu M, Robinson J JUL-AUG 2010Maternal Holding of Preterm Infants During the Early Weeks After Birth and Dyad Interaction at Six Months JOGNN-JOURNAL OF OBSTETRIC GYNECOLOGIC AND NEONATAL NURSING   Volume: 39   Issue: 4   Pages: 401-414

de Almeida H, Venancio SI, Sanches MTC, et al MAY-JUN 2010The impact of kangaroo care on exclusive breastfeeding in low birth weight newborns JORNAL DE PEDIATRIA   Volume: 86   Issue: 3   Pages: 250-253

Calais E, Dalbye R, Nyqvist KH, et al. (JUL 2010) Skin-to-skin contact of fullterm infants: an explorative study of promoting and hindering factors in two Nordic childbirth settings. ACTA PAEDIATRICA   Volume: 99   Issue: 7   Pages: 1080-1090

Kervell H, Grant J, (mar-may 2010)  Getting connected: How nurses can support mother/infant attachment in the neonatal intensive care unit AUSTRALIAN JOURNAL OF ADVANCED NURSING   Volume: 27   Issue: 3   Pages: 75-82

Carlo WA, Goudar SS, Jehan I, et al. (Feb 2010) Newborn-Care Training and Perinatal Mortality in Developing Countries NEW ENGLAND JOURNAL OF MEDICINE   Volume: 362   Issue: 7   Pages: 614-623