"INFANT FAMILY CENTERED DEVELOPMENTAL CARE (IFCDC): Parents should be allowed to fall asleep during Skin to Skin Contact (SSC) or Kangaroo Care (KC)"

Let's talk about risks before presenting the standards by the IFCDC.

"Why can't we just let them sleep?" 

Kangaroo care, as any intervention, has its risks and may have devastating consequences.  Just as the baby needs to be given the green light to be held, the parent or caregiver must also be evaluated to ensure the safety of the dyad.  Sleeping during kangaroo care has been recognized as an important method of increasing duration, outcomes, and satisfaction, however, risks must be identified and mitigated before allowing a caregiver to sleep while holding a baby.

Parents sleeping during kangaroo care brings together two of the main risks:  (1) removing the support the hands provide and (2) the removing the attention of the parent from the baby.  Both need to be "replaced" before allowing a parent to rest. 

The Zaky ZAK is the only device that was engineered to work with other risk mitigation strategies to hold the baby in skin to skin contact and reduce the risk of sliding or dislodging if the parent moves, removes the hands from holding the baby, or gets distracted.   

These Standards were released during the Gravens' Conference, March 2020 and specifically talks about parents sleeping during kangaroo care: 

The Developmental Care Standards for Infants in Intensive Care is the Report of the First Consensus Conference on Standards, Competencies and Best Practices for Infant and Family-Centered Developmental Care in the Intensive Care Unit.

It includes:

"INFANT FAMILY-CENTERED DEVELOPMENTAL CARE (IFCDC): RECOMMENDATIONS FOR SKIN-TO-SKIN CONTACT WITH INTIMATE FAMILY MEMBERS"

Two different competencies mention the use of a kangaroo care wrap/device:

Standard 1: Parents shall be encouraged and supported in early, frequent, and prolonged skin‐to‐skin contact (SSC) with their babies.

Competency 1.5:  Parents should be provided with comfort, including: 

a) safe and comfortable seating or reclining accommodations that are readily available at the baby's bedside;
b) support pillows;
c) secure wraps to support the baby;
d) a mirror to see the baby’s face;
e) hydration and nutrition for parents as needed;
f) privacy, if desired (in private rooms or by privacy screens); and
g) a quiet, therapeutic environment for being with their baby.

Competency 1.10:  Parents should be allowed to fall asleep during SSC or Kangaroo Care (KC) when safety measures are in place that include:

a) parent and baby are in a non-rocking, reclining chair or bed;
b) baby is well secured by an appropriate wrap to the parent's chest;
c) baby is electronically monitored if indicated; and
d) an appropriate healthcare provider is immediately available. 

The presentation "Skin to Skin Contact with Intimate Family Members" at the Gravens' Conference by Raylene Phillips, MD, MA, FABM, FAAP, IBCLC Joy Browne, PhD, PCNS‐BC, IMH‐E(IV) showed the photo of a mom sleeping using our The Zaky ZAK.

One Frequently Asked Question is: WHAT MAKES A KANGAROO CARE WRAP/DEVICE "APPROPRIATE" FOR SECURING THE BABY AND ALLOW PARENTS TO SAFELY FALL ASLEEP DURING SKIN TO SKIN CONTACT?

Let's start from the beginning:  If a Kangaroo care device, or wrap, is not made to keep the baby safe even in the event of parents fall asleep, is like saying "a seat belt keeps you safe unless you get in an accident".  With increased comfort and duration of the kangaroo care sessions, we must assume that parents may fall asleep (regardless of the hospital policy). 

The manufacturer of the kangaroo care device should provide specific instructions about how to secure the baby prior to allowing the parent to remove the hands (e.g., for comfort, interventions, reading, sleeping, crafting, etc) of if they get distracted (e.g., watching a movie in their mobile device).

Before choosing a kangaroo care device or wrap it is always a good idea to ask the manufacturer about their recommendations for parents sleeping during kangaroo care. Not all kangaroo care devices support sleeping.

A Kangaroo Care Device should help to keep the baby safe, supported, and well positioned. It must help the parents to relax and enjoy the kangaroo care session by:

• consistently, reliably and appropriately support the baby's weight so that the baby does not slide

• keep the proper Kangaroo Care position and proper alignment of the baby

• provide a consistent containment, cover, and boundaries from neck to toes. 

In addition, for hospital use:

• it allows instant and quiet access to the baby at all times for transfers and interventions (e.g., breastfeeding, vaccinations, pumping, abdominal ultrasounds, heel sticks, massage therapy, ROP exams, etc.) 

• supports sitting and standing transfers. 

Please note that if the KC device is too loose around the torso, then the baby may slide and dislodge or worse, s/he may slide under the wrap (or fall). If it the wrap is too tight, then the baby's breathing may be compromised. The zippers of The Zaky ZAK make sure the containment is constant from neck to toes, safe, and secure.

During the 3 year design of The Zaky ZAK we tried all closing mechanisms (snaps, hooks, velcro, ties, etc.) and the clear winner were the zippers because they were the only ones that could hold the weight of the baby consistently, reliably, quietly for every parent/baby, were washable, durable, easy to use, and strong.

Yamile slept with Zachary during Kangaroo Care in the NICU, and she vowed to engineer a safety device (The Zaky ZAK) so that other parents could do the same. It was that special!

The ergonomic The Zaky ZAK® is engineered to be safe, reduce risks and human errors, be easy to use, support the baby, be comfortable, accessible, quiet, and provide peace of mind to the parents and staff: 

All these 5 conditions must be met to hold hands-free, rest, or do other tasks while holding and using The Zaky ZAK:

Evidence of The Zaky ZAK

Clinician Opinions and Approaches to Manage Risk Related to Safe Sleep During Skin-to-Skin Care

 A Survey of Neonatal Clinicians’ Use, Needs, and Preferences for Kangaroo Care Devices

Buy The Zaky ZAK here