Developmental Care

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Kangaroo Care, Baby Swaddle Bathing & NICU Medical Supplies 


Kangaroo Care

Swaddle Bath


Kangaroo Zak provides the safest and most comfortable way to hold your baby skin-to-skin. Guaranteed!  

Kangaroo Zak provides the baby with a proper positioning, comfort and a sense of security while effectively removing the risk of slipping and/or falls that cause medical equipment to become displaced. It also provides immediate access to the baby in an emergency and is the only device that allows the parent to hold babies of any size without using the hands.

Part of our extensive range of maternity products, Kangaroo Zak gives the baby safe continuous skin-to-skin contact with the parent and promotes the deep sleep required for growth, development and healing of the brain.

Kangaroo Zak is made with natural fibres for a soft, strapless, thin, stretchy and breathable sleep belt that covers the parent’s torso and closes on a selected size with a zipper. There are no added layers, pouch, uneven wrap pressure, buttons or Velcro. The material is thin and light in colour so position and fluids are easy to view for maximum safety. Wear a front open gown over if extra warmth is required, still allowing quick emergency release. Some procedures can still take place by pulling or folding Kangaroo Zak up or down. Expressing and breastfeeding can also still take place.

Available in two adjustable sizes, making six size options

Size 1 adjusts to Small / Medium / Large. Size 2 adjusts to XL / 2XL / 3XL. Smaller size is available upon request.

Hospitals that use Kangaroo Zak as standard of care for skin-to-skin include Loma Linda Children’s Hospital, Mayo Clinics, Albany Regional Medical Center, Parkland Hospital in Dallas, Wake Forest and Brenner in North Carolina, REX Healthcare and many more!

Developmental care tools Kangaroo Zak and The Zaky to over 400 hospitals in more than 50 countries.

Breast-Warmers, the safe self-warming breastfeeding aid, can be worn for breast comfort and easily removed from Kangaroo Zak before placing baby skin-to-skin. The Zaky hands, the positioning device, are warmed and scented by placing them near the parent’s neck while kangarooing.

An Ergonomic Approach to NICU Kangaroo Care

Kangaroo Zak is designed for hospitalised babies in NICU and post-partum. It can only be used at home with adequate training and professional instruction.

The consistent use of the Kangaroo Zak™ care product can achieve the following results:

  • Support physiological stability and neurobehavioral organisation of preterm infants
  • Relieve maternal and infant stress
  • Support family-centric care
  • Improve outcome of maternal breastfeeding
  • Achieve all the advantages of Kangaroo Care in a safe, consistent and effective way

“Best Practice is Kangaroo Care as soon as possible, for as long as possible, and as uninterrupted as possible”  Nyqvist et al., 2010, May Acta Paediatrica


Kangaroo Care Sessions

Who can be kangarooed: If the baby is in condition to be moved or lifted to be weighed, s/he can be transfered to Kangaroo Care.

Time of holding: No less than one hour per session, and there is no maximum time – the more the better. Since a complete sleep cycle is one hour, it is NOT recommended that the babies are held on kangaroo if the parent cannot hold for at least that long (especially for small preemies as it may cause reverse effects). The stress of the transfer only is outweighed if the baby is held for at least one sleep cycle.

Rule of thumb: preemies are “Kangarooed” for 6 months and full-term babies within one minute from birth until the first feeding and as much as possible for 3 months.

Ideally it starts with Birth Kangaroo Care Birth Kangaroo Care Competency Checklist by the USIKC (United States Institute of Kangaroo Care)

To maximize effectiveness of Kangaroo Care sessions, parents and caregivers must have some basic knowledge and understanding of the practise. 

What parents needs to know before they hold their babies in Kangaroo Care

Learn the benefits of Kangaroo Care and to distinguish signs of stability of the baby and warning signs of instability (to stop the kangaroo session). Learn how to wear the Kangaroo Zak for standing and sitting transfer.

Kangaroo Zak can be opened just enough to allow the baby to sniff and explore the mother’s breasts, for breastfeeding/pumping, and numerous medical interventions while holding. Know that they may do the transfer alone, but ONLY after the training and approval of a medical professional.

Wear the Kangaroo Zak without anything underneath, with the zippers to the side.  Over it, wear comfortable clothing that easily opens in the front or a hospital gown. Remove jewelry that might come in contact with the baby. Refrain from using powder, lotion or perfume on the chest before doing skin to skin care. The baby needs to feel the parent’s natural scent.

To provide evidence-based developmentally supportive care AROUND THE CLOCK, complement kangaroo care with The Zaky, which is the only ergonomic device that keeps the scent of the parents and simulates the shape, touch, feel, and warmth of the parents’ hands when the baby is not held.

The Zaky compliments the purpose of the Kangaroo Care by improving the well being of the child and fomenting the involvement of the parents in his/her care.” Clemency Mayorga M.D. Director, Military University Hospital, Nueva Granada,

More Resources

World Health Organisation Kangaroo Mother Care: A Systematic Review of Barriers and Enablers

Kangaroo Zak Research Results published in Newborn & Infant Nursing Reviews, Standard of Care

For Finance Departments; Cost Model Evaluation of Kangaroo Care NICU Impacts 2017 –, Includes the cost of Developmental Care Tools Kangaroo Zak and The Zaky. Jan 2017 (Model can be expanded to include your specific figures and variations) Consultation on hospital, regional and state level is available with our analyst.

Safe criteria and procedure for kangaroo care with intubated preterm infants. J Obstet Gynecol Neonatal Nurs.

Twenty-year Follow-up of Kangaroo Mother Care American Academy of Pediatrics, Dec 2017

Skin-to-skin care in preterm infants receiving respiratory support: Royal Women’s Hospital VIC Australia

World Health Organisation and UNICEF Baby Friendly USA (BFHI) Guideline 2016   Includes Kangaroo Care

Results and Video Interview of a Kangaroo Care implementation Quality Improvement Project in 4 hospitals in Portugal. The Sobreviver Project (Survive)


Watch Mary Coughlin, RN, MS, NNP (the author) explaining why they chose Kangaroo Zak from Nurtured by Design in the Sobreviver Project.

The Zaky Provides the Extension to Your Hands, Evidence Based Family-Centred Developmental Care for Premature and Sick Babies

The Zaky® is a product by Nurtured by Design and is the ergonomic device designed to provide evidence based nurturing developmental care to babies in the NICU.  It was released in 2004 after 3 years of development in Houston Texas USA. Now used in any unit in the hospital with babies and toddlers; NICU, PICU, oncology, cardiology etc. This is a hospital product, used under medical observation for developmental care, not to be used at home unattended with babies under 6mo of age, unless otherwise recommended by paediatrician. We are delivering a consistent message for safe sleep; positioning devices are used for developmental care in hospital-The Zaky is used in hospital and stays in hospital. Various improvised containment solutions can give mixed messages to parents. The Zaky is an evidence based ergonomic device, see research and links below. Please also refer to anecdotal evidence and endorsement by London’s international NIDCAP trainer.

The award-winning The Zaky is a human hand mimetic and pediatric bolster support device ergonomically designed to simulate the shape, warmth, weight (500 grams), and touch of the parents’ hands and forearms. Parents are encouraged to scent The Zaky by placing it directly on the skin (chest or neck) to provide more effective, family centred and evidence based nurturing developmental care to hospitalised infants on the bed or infant incubator. The weight is adjustable from only having the soft fabric on the baby, with the weight used as containment, to using the full weight according to the baby’s development and medical condition.

This paediatric support device is ergonomically designed to replicate the weight, warmth, shape and touch of the parent’s forearms and hands. Scenting The Zaky through contact with the neck or chest of the parent helps further improve the child’s development during hospitalisation.

The Zaky does not just mimic the presence of the parent: it also positions the baby for optimum musculoskeletal development, comfort, boundaries, containment and a sense of security. This combination ensures the baby is calm and relaxed while promoting sleep in hospital.

They settle the babies, especially those withdrawing from drug abuse” ( NAS – Neonatal Abstinence Syndrome) Wendy Nye, Nursery Nurse, Birmingham Women′s Hospital, Birmingham, England

Research The Zakys

Clinical research shows that The Zakys significantly reduce life-threatening apnea and bradycardia and significantly improve self-regulation and organization, needed for brain development [1]

[1] Neuroprotective Core Measure 2: Partnering with Families – Effects of a Weighted Maternally-Scented Parental Simulation Device on Premature Infants in Neonatal Intensive Care, Published here; Newborn & Infant Nursing Reviews

This independent clinical research about The Zaky [maternal simulated intervention] was presented at the American Public Health Association’s (APHA) Annual Meeting (Washington DC, Nov. 2011), and at the National Association of Neonatal Nurses (NANN) Annual Conference (Palm Springs, CA, Oct. 2012) Georgia Souther University, The Medical Centre of Central Georgia, Georgia College and State University USA.

It was funded in its entirety by Georgia College and performed at the Regional Medical Center of Central Georgia. We want to congratulate and thank the principal investigators and all the team that worked on this groundbreaking research:

  • Kendra Russell, PhD, RN – Macon Graduate Center, Georgia College & State University
  • Barbara Weaver, RN
  • Robert L. Vogel, Ph.D, – HSU College of Public Health, Georgia Southern University
Conclusion: Neuroprotective supportive care using a weighted maternally-scented parental simulation device resulted in increased physiologic stability of premature and early term infants through the promotion of self-regulation seen by reduction of stressful behaviors, and decreased apnea, and bradycardia.

Research published “Give Them A Hand To Develop Their Brain”;  Download Poster and Research

Conversation with Dr. Robert Vogel, PhD, principal investigator and biostatistician. Professor of Biostatistics,
Jiann-Ping Hsu College of public Health, Georgia Southern University, Statesboro, GA.  
Professor Vogel Video

Instructional Videos on how to use The Zaky click here;  Medical Staff

Testimonial Videos click here;  NIDCAP Trainer,  NICU Nurse, NICU Nurse, NICU Nurse, NICU Nurse

An Innovative Form of Premature Baby Care

One universal size is available in both left and right hand variants. It is designed to provide full body support, adjustable weight, containment and constant boundaries while aiding with sidelying/supine/prone positioning, development, olfactory stimulation and parental bonding when scented.

Only one pair of The Zaky is used by the baby for the duration of its hospitalisation, effectively replacing all other items used for developmental care. The ergonomic, multifunctional design provides everything required to provide the baby with physical, psychological, neurological and physiological support.

It’s easy to learn how to use The Zaky, after which you will need training on developmental stages and how to meet the needs of the patient.

Storage and inventory needs are downsized into the single product, optimising quality control, order management, infection control and decision making. The Zaky eliminates the need for alternative developmental support devices.

It doesn’t take long for parents to become familiar with The Zaky, allowing them to become involved in providing evidence based development care for their baby. This also provides support in what may be one of their most traumatic experiences.

“We introduced The Zaky a few years back and it seems to capture people’s imagination. Nurses and parents instinctively respond to the idea of the hand shaped positioning support – they just “get it”. Other positioning aids end up doing all the wrong things. The Zaky seems to inspire people to consider the baby’s comfort. Parents like to replace their hand with The Zaky when they have to tear themselves away from their baby – it feels better for them and for the baby. I have introduced The Zaky to many units in different countries and it speaks for itself. Everyone understands what it can do. It is versatile and can be used in many different ways. I don’t recommend many products – The Zaky is one of the few that I endorse with confidence because I see babies relaxed and comfortable with this support when they cannot be in the arms of their parents. A great invention. Thank you.” Inga Warren, London (UK), International NIDCAP Trainer.


Process Standards (sample) NNICU/Level II Nursery PDF

The Features of The Zakys are Unmatched


The shape is familiar and therapeutic: hand/forearm that weighs 500 grams. Multipurpose design: for every developmental stage, medical condition, size, and position.

Universal size: equivalent to a woman’s medium size hand and forearm, the same size is used for every baby, regardless of positioning, size, medical condition, age, and/or developmental stage. No need for small/medium/large or light/medium/heavy.

Ergonomic design researched and developed for 3.5 years before releasing it to the market. Invented by a PhD in ergonomics engineering.

Adjustable weight to use on the top of the baby: Displace all the filling and use only the weight of the fabric for micropreemies. 6-7 lb babies can take the full weight of The Zaky (500 grams).


Fully Washable: includes washing bag – wash/dry without disassembly. Recyclable: wash as baby clothing protocol and reuse for same baby. Between patients; wash up to 90°C in washing-bag provided up to 60 times.

Scent of the parents by placing them directly on their skin (chest or behind the neck) for at least one hour. Warm and soft: place the Zakys in the towel warmer or dryer to get it warm.

Infection Control: hospitals that have zero incidents of infections use the Zakys as standard for developmental care. Soft and soothing material: antipilling microfleece immediately soothing for the baby.

The Zaky meets all infection control requirements for being a safe, therapeutic aid. The Zaky is washable unlike the multitude of stuffed animals brought in by parents and used by the staff as positioning or comforting aids, for supporting tubes and other patient care equipment.” Kathy Ware, RN, CIC, Infection Control Nurse for Level 2 and 3 Neonatal Intensive Care Unit  Texas Children’s Hospital Houston, Texas

Safe materials: the filling is made out of a special type of plastic in the shape of smooth plastic micro-spheres that are antimicrobial, antiallergenic, antifungal, washable, quiet, and do not get hot under a heating source. Quiet operation: filling is quiet when the Zaky is moved. This is important for the NICU baby’s developmental support.

This is not a sleep device for home use, The Zaky is a evidence based, weighted maternally scented, developmental care positioning device for hospital use. If the hospital does not supply The Zakys parents may purchase them, wash and bring to hospital for use as per hospital protocol.

Warming The Zaky:

Infant thermoregulatory requirements vary and health care providers and parents must be aware of isolette needs prior to applying the Zaky to an infant whose thermoregulatory needs fluctuate widely.

Additionally The Zaky position cannot impede flow of the air in the isolette.
How this translates into practice is when you have an infant who is requiring high levels of isolette heat for thermoregulation and homeostasis it is necessary to warm The Zaky to a similar temperature prior to placing it next to the infant.

If the infant is in skin to skin care this may be accomplished by placing The Zaky in the skin to skin top with the mother and placing it next to her breast tissue on the outside of her breast in the top or by using the isolette to warm it when the baby is in skin to skin care.

Similar to any device used near an infant who has high thermoregulatory needs the product must be heated to the infants isolette temperature to avoid compromising infant thermoregulation and stability.

Warnings and Therapeutic Considerations:

Adjust the weight to be placed on top of a baby: Displace the filling of the Zaky so that the weight on the baby is selected according to his/her size and medical condition. For example, babies weighing 500-600 grams need only the weight of the fabric (displace all the filling by holding it vertically by the hand; or displace the filling from the middle of the Zaky) Infants of 5-6 lbs can take the entire weight of the Zaky.

Do not use The Zakys on the face.
Wash/Dry The Zakys in the washing bag provided. Warm them in the dryer or towel warmer if desired.
Do not use The Zakys for any other purpose other than the ones recommended by the manufacturer.
Do not leave the baby unattended with The Zakys at home if paediatrician has recommended you use them at home.

For babies younger than 6 months old, The Zakys will provide an environment so the baby falls asleep, however, The Zakys must be removed once the baby is asleep and/or if parents are not around, unless otherwise recommended by the pediatrician. Reasons some paediatricians may recommend The Zakys to stay with the baby include: the baby needs developmental care at home, s/he is not sleeping (thus not developing the brain), wakes up too much, has colic, experiences separation anxiety, is getting a flat head, must sleep on the side, etc.


Simple Solutions International Authorised Distributor for Nurtured By Design to hospitals and parents in Australia and New Zealand. The Zaky and Kangaroo Zak are Trademarked by Nurtured by Design. All Rights Reserved.

Swaddle Bathing Made Easy with TurtleTub                                  

Catapult Products understands the impact of positive experiences on the developing infant, the family and the caregiving staff. 

TurtleTub is a tool to provide the family-centered, positive experiences that last beyond the NICU.  TurtleTub swaddle bath engages the baby’s family and helps them care for their infant in a typical parenting activity. Swaddle bathing made easy while providing family-centred developmental care in the NICU. TurtleTub is beneficial for both pre-term and full-term infants.


  • Supports family-centered care3,6
  • Mimics compact environment of womb3
  • Decreases physiologic and motor stress1,3,4
  • Conserves energy1,3,4
  • Improves state control6
  • Enhances ability to feed after bath3,6
  • Decreases temperature loss1,3
  • Causes less crying6
  • Facilitates social interaction6
  • Should be routine in your hospital1,3,6



  1. Ribs and high sides supports infant
    Click Image To View
  2. Fleece blanket has excellent thermal properties    
  3. Temperature strip designed for infant bathing
  4. Rinse cup stores conveniently
  5. Neutral PH mild TurtleTub baby wash    
  6. Convenient Pour Spout
  7. Smooth contours for easy cleaning
  8. Flow through design keeps water circulating around baby
  9. Stackable for easy storage
  10. Now with disposable liners (optional)

Swaddle bathing using TurtleTub is an easy, safe and important activity for parents to care for their baby/babies in hospital. Family Centred Developmental Care has become the standard of care in leading international hospitals. Calm and effective swaddle bathing with TurtleTub is fast becoming routine for this practice.

A personal TurtleTub is ideally assigned for babies admitted for an extended period of time, with tub stored in the supplied net bag together with personal accessories and labeled with ID. For shared TurtleTubs the best practise for infection control includes our disposable liners. This provides an economical option while offering the best swaddle bath practice and infection control. Most hospitals require a combination of personal and shared TurtleTubs.

Instructions for use, please click here

Download TurtleTub Brochure, please click here

Educational Slide Show:

Reducing Premature Infants’ Length of Stay and Improving Parents’ Mental Health Outcomes With the Creating Opportunities for Parent Empowerment (COPE) Neonatal Intensive Care Unit Program: A Randomized, Controlled Trial  Paediatrics October 2006

Recommendations for involving the family in developmental care of the NICU baby  Journal of Perinatology September 2015

TurtleTub is routinely used in over 100 hospitals since the launch January 2017. Exclusively available in Australia from Simple Solutions International since May 2017

Educational video

About Catapult Products  

Catapult Products was founded in 2013 in Salt Lake City, UT.  The two founders have over 30 years of experience in developing, manufacturing and marketing dozens of medical products in a variety of healthcare settings, and they bring 18 years of infant and pediatric clinical experience to their product designs.  Our mission is to develop superior products that bring positive experiences to infants and their families.

Find out all about Primo-Lacto: A Closed System for Colostrum Collection, click logo: 

Swaddle Bathing Reference List

  1. American Academy of Pediatrics, Committee on Fetus and Newborn and Section on Surgery, Canadian Pediatric Society and Fetus and Newborn Committee. “Prevention and Management of Pain in the Neonate: An Update.” Pediatrics 118 (2006) 2231-2241
  2. Anderson GC, Lane AE, Change H. Axillary temperature in transitional newborn infants before and after tub bath.  Appl Nurs Res. 1995; 8:123-128.
  3. Association of Women’s Health, Obstetric and Neonatal Nurses. Neonatal Skin Care 3rd Edition – Evidence Based Clinical Practice Guideline. 2013; 12-20
  4. ALS H, Duffy F, McAnulty G et al.  “Early Experience Alters Brain Function and Structure.” Pediatrics 113 (2004):  846.
  5. Arockiasamy, Vincent, Liisa Holsti and Susan Albersheim. “Father’s Experiences in the Neonatal Intensive Care Unit: A Search for Control.” Pediatrics 121 (2008) e215-e222.
  6. Bryanton J, Walsh D, Barrett M, et al. Tub bathing versus traditional sponge bathing for the newborn.  J Obstet Gynecol Neonatal Nurs. 2004; 33:704-712.
  7. Bly, Lois. Motor Skills Acquisition in the First Year. Texas: Therapy Skill Builders, 1994.
  8. Cole, J, Brissette N, Lunardi B. Tub baths or sponge baths for newborn infants? Mother Baby J. 1999;4:39-43
  9. Craig, JW, et al. Recommendations for involving the family in developmental care of the NICU baby.  Journal of Perinatology. 2015 Dec: 35(Suppl 1): S5-S8.
  10. Edraki M, et al. Comparing the effects of swaddled and conventional bathing methods on body temperature and crying duration in premature infants: a randomized clinical trial.  Journal of Caring Sciences, 2014; 3 (2), 83-91.
  11. Fern, D, et al, Swaddled bathing in the newborn intensive care unit. Newborn and Infant Nursing Reviews, 2002; 2(1), 3-4
  12. Hall K. Practising developmentally supportive care during infant bathing: reducing stress through swaddle bathing. Infant, volume 4 issue 6, 2008.
  13. Hennigsson A, Nystrom B, Tunnel R. Bathing or washing babies after birth. Lancet. 1981;19:1401-1403.
  14. Hylen A, Karlsson E, Svatberg L, et al. Hygiene for the newborn: to bathe or to wash? J Hyg. 1983; 91:529-534.
  15. Liaw J, et al. Effects of tub bathing procedures on preterm infants’ behavior. Journal of Nursing Research, 2006; 14 (4), 297-305.
  16. Liu, FL, et al, The development of potentially better practices to support the neurodevelopment of infants in the NICU. Journal of Perinatology. 2007;27, S48-S74
  17. Lund C. Bathing and Beyond Advances in Neonatal Care, Oct 2016; Vol. 16, No. 5S, S13-S20
  18. Melynyk, Bernadette Mazurek, Nancy F. Feinstin, et al. “Reducing Premature Infants’ Length of Stay and Improving Parents’ Mental Health Outcomes With the Creating Opportunities for Parent Empowerment (COPE) Neonatal Intensive Care Unit Program: A Randomized, Controlled Trial.” Pediatrics 118 (2006) e114-1427
  19. Merenstein, Gerald B., Sandra L. Gardner. Handbook of Neonatal Intensive Care,  sixth addition. Missouri: Moby Elsevier, 2006
  20. Milgrom J, et al. Earl sensitivity training for parents of preterm infants: impact on the developing brain. Pediatr Res. 2010 Mar;67(3):330-5.
  21. Peters, KL. Bathing premature infants: physiological and behavioral consequences.  American Journal of Critical Care, 1998; 7(2), 90-100
  22. Quraishy K, Bowles SM, Moor J. A protocol for swaddled bathing in the Neonatal Intensive Care Unit. NAINR. 2013;13(1):48-50.
  23. Smith, CG, et al. NICU Stress is Associated with Brain Development in Preterm Infants.” Ann Neruol. 2011 Oct: 70(4): 541-549.
  24. Stiles J, Jernigan TL. The Basics of Brain Development. Neuropsychology Review. 2010;20(4):327-348. doi:10.1007/s11065-010-9148-4.
  25. Sweeney, Jane K., Teresa Gutierrez, “Musculoskeletal Implications of Preterm Infant Positioning in the NICU. Journal of Perinatal and Neonatal Nursing.” 16(1) (2002)58-70.
  26. Tau GZ, Peterson BS. Normal Development of Brain Circuits. Neuropsychopharmacology. 2010;35(1):147-168. doi:10.1038/npp.2009.115.
  27. Techlin, Jan Stephen. Pediatric Physical Therapy, 2nd Edition.  Philadelphia: J.B. Lippincott Co., 1994.
  28. VanSleuwen, BE, et al. Swaddling: a systemic review. Pediatrics, 2006; 120( 4), 1097-1106.
  29. Vergara,Elsie R. , Rosemarie Bigsby.  Developmental & Therapeutic Interventions in the NICU. Maryland: Paul H. Brookes Publishing Co., Inc.,  2004.