Commentary
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Continuous Skin-to-Skin Care in the Neonatal Intensive Care
Unit: Kangaroo or “‘Possum” Care?
Keith J. Gallaher, MD, FAAP
Continuous skin-to-skin care, affectionately known as “kangaroo
care,” involves the placing of the diaper clad but otherwise naked
infant on the bare chest of the caregiver. Skin-to-skin care was initially
proposed as an alternative care method in Bogota, Columbia in 1978.1
While initially used in areas with limited health resources, it has since
been adopted by many nurseries in the developed world. Hesitancy to
adopt the concept of kangaroo care in some neonatal intensive care
units has been largely related to physiological concerns. Numerous
clinical studies documenting both the safety and the benefits of this
technique have largely alleviated these concerns.2 A concern that remains unresolved, however, is more philosophical. The question is not
so much about the risks and benefits of skin-to-skin contact, but
rather, why kangaroos? Because kangaroo care has its origins in the
Western Hemisphere, it would seem natural to use a Western Hemisphere animal analogy rather than a South Pacific one. Kangaroos are
only native to Australia and the surrounding island countries. It is
harder to get further away from North America than that! I would
make a plea that rather than kangaroo care, “‘possum care” is the
more appropriate term. Opossums, or ‘possums as they are commonly
known here in the South, are native to both North and South America
and are North America’s only marsupial. They have been around for
70 to 80 million years, making them one of the Earth’s oldest surviving mammals.3–5 They should get some credit for this honorary title
solely based on seniority!
Marsupial mammals make good analogies for the skin-toskin care of premature human newborns. Marsupial newborns are
born at very immature stages of development, and they subsequently spend time attached to mom’s nipples while nestled inside
her pouch. These facts are equally true for opossums and kangaroos. It is in other traits that the species diverge. It is with respect to
these other traits that it becomes even more clear that the ‘possum
is the more appropriate choice.
‘Possums are very recognizable, especially to North Americans.
They are often noted to be napping next to or on our roadways! They
are gentle and placid, preferring to avoid all confrontations. Their
tendency to “play dead” is such an effective way of coming to terms
with the world and its more belligerent folks that this tendency has
been adopted by many Homo sapiens, and has been commonly referred
to as “playing ‘possum.” Is there such a phrase as “playing kangaroo,”
and if so, what does it mean? ‘Possums may more closely mimic our
ethnically diverse society than do kangaroos, as they appear to be put
together using parts from multiple other animals. They have the fur of a
rabbit, a cute pink nose and pink feet like hamsters, the naked tail of
rodents, and naked palms with opposable thumbs like infant humans
(Figure 1). ‘Possums usually give birth to multiple babies; this is certainly
a trend seen in North America for human pregnancies. Kangaroos generally have a single offspring, referred to as a Joey. This name is of questionable political correctness in today’s society. Why not a Judy or a Cindy?
How about one of the more unisex names such as a Pat or a Lee? Kangaroos are completely herbivorous animals, a characteristic that is only
noted in a small minority of humans. In contrast, ‘possums are omnivorous, preferring some meat with their fruits and vegetables. This is a diet
that more closely mimics the nutritional pyramid recommended by most
human dietary experts.
So why is it that kangaroos have been chosen for this position of
distinction? I would hope that their “cute” faces with long eyelashes
have not been the deciding factors giving them priority over our more
homely native marsupials. This is certainly not a precedent that the
medical community, or society in general, should choose to support.
It is likely that others more knowledgeable about animals could come
up with even longer lists supporting the claim of the ‘possum as the
animal of choice to be honored by the medical establishment. Perhaps if they could add their voices to this debate, the humble and
Department of Neonatology, Cape Fear Valley Medical Center, Fayetteville, NC.
Address correspondence and reprint requests to Keith J. Gallaher, MD, Department of Neonatology, Cape Fear Valley Medical Center, P.O. Box 2000, Fayetteville, NC 28302. E-mail address: [email protected]
Figure 1. Note the similarities between the palm print of the common Virginia
opossum (Didelphis virginia) and an infant human (Homo sapiens). Both have
naked palms and opposable thumbs.
Journal of Perinatology 2000; 5:318 –319
© 2000 Nature America Inc. All rights reserved. 0743– 8346/00 $15
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www.nature.com/jp
Kangaroo Versus ‘Possum Care
unassuming ‘possum could achieve its rightful position as the role
model for neonatal intensive care unit skin-to-skin care.
Gallaher
2. Feldman R, Eidelman AI. Intervention programs for premature infants: how do
they affect development? Clin Perinatol 1998;25:613–26.
3. The Outback. http://vger.rutgers.edu/⬃tempest/Roo㛬encyc.ht.
References
1. Whitelaw A, Sleath K. Myth of the marsupial mother: home care of very low birth
weight babies in Bogota, Colombia. Lancet 1985;1:1206 –9.
Journal of Perinatology 2000; 5:318 –319
4. Opossum Facts. http://www.op.
5. Opossum FAQ. http://ourworld.compuserve.com/homepages/shultz/FaqAlles.html.
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