For premature and medically fragile infants, the earliest moments of life often involve intensive care, tubes and incubators instead of the warmth of a parent's arms. Yet one simple, evidence-based practice is changing that: kangaroo care. By placing newborns skin-to-skin on their parents’ chest, kangaroo care offers many benefits for both infants and caregivers, from enhancing physical stability and emotional regulation to parent-infant bonding. At the same time, neonatal physiotherapy plays a vital role in supporting movement and development from these beginning days. Together, these two approaches create a model of care that fosters growth and attachment.

Kangaroo care, also known as skin-to-skin contact, involves holding a newborn baby directly against a bare chest. Originally developed in Colombia as a life-saving strategy for preterm infants when incubators were scarce, it has since been adopted globally as a standard practice in neonatal care.

During kangaroo care, the baby wearing only a nappy and sometimes a hat is held upright against the parent’s chest and typically covered with a warm blanket or wrap. Sessions can range from 20 minutes to several hours, depending on the baby’s condition and the hospital setting.

In Australia, hospitals such as The Royal Women’s Hospital in Melbourne, advocate kangaroo care as part of routine neonatal care for both preterm and full-term babies. The hospital emphasises its role in enhancing infant development and fostering emotional closeness between baby and caregiver.

Decades of research have demonstrated that kangaroo care supports:

• Thermoregulation: Maintaining a stable body temperature.
• Cardiorespiratory stability: More regular heart and breathing rates.
• Weight gain: Improved digestion and feeding patterns.
• Reduced stress: Lower cortisol levels and less crying.

In neonatal intensive care units (NICUs), physiotherapists play an essential role in supporting the motor, sensory and neurological development of infants, particularly those born prematurely or with medical complications. Their work begins early, often within the first days of life. Neonatal physiotherapists focus on:

• Positioning and handling: Helping with developmentally supportive positioning, which is important for musculoskeletal development.
• Muscle tone and movement patterns: Providing gentle interventions to promote normal movement.
• Sensory regulation: Supporting infants’ responses to light, sound and touch, all of which can be overwhelming in the NICU environment.
• Feeding and respiratory function: Assisting with positioning to help with sucking, swallowing and breathing.

While both kangaroo care and neonatal physiotherapy offer advantages, combining the two can create a powerful therapeutic synergy. When physiotherapists incorporate kangaroo care into their treatment approach, it supports physical development along with emotional bonding and sensory regulation.

• Enhancing Motor Development: Skin-to-skin positioning naturally encourages the infant to engage postural muscles, particularly those involved in head and neck control. For preterm babies, this can gently stimulate muscle tone and alignment. Physiotherapists can guide parents on optimal positioning during kangaroo care, using small towel rolls or wraps.
• Supporting Neurodevelopment: Being upright on the caregiver’s chest connects the baby with the rhythmic movement of breathing and heartbeat. Physiotherapists can time kangaroo care sessions to coincide with periods of wakefulness, using the moment to support eye contact, tracking and gentle movement.
• Strengthening Parent-Infant Bonding: Many physiotherapists also use kangaroo care to build caregiver confidence. When parents are shown how to safely hold and interact with their medically fragile baby, they become active participants in therapy, not just observers. This improves bonding, reduces parental stress, and promotes long-term emotional resilience for both parent and child.

A 2023 position statement by the Australian Physiotherapy Association (APA) encourages physiotherapists to collaborate closely with neonatal nurses in delivering developmentally supportive care that includes regular, safe kangaroo care sessions for suitable infants.

Going back to the Royal Women’s Hospital, staff are trained to initiate kangaroo care even in infants requiring respiratory support, provided the baby is stable. Physiotherapists work alongside NICU nurses to:

• Assess muscle tone and posture before and after skin-to-skin sessions.
• Provide positioning aids and guidance to maintain symmetrical, flexed postures.
• Monitor tolerance to ensure kangaroo care enhances recovery and growth.

Kangaroo care is more than a comforting hug. It is a clinically powerful, evidence-based intervention that supports the physiological, neurological and emotional development of vulnerable infants. When combined with neonatal physiotherapy, it becomes a great tool to promote motor function, regulation and attachment from the earliest days of life. For physiotherapists working in neonatal settings, kangaroo care offers a unique opportunity to support babies and their families in a hands-on way. As research and practice continue to grow in Australia, the integration of kangaroo care and physiotherapy will no doubt play a pivotal role in shaping neonatal outcomes.