Background Kangaroo mother care is a universally available and biologically sound method of care for all newborns, particularly for premature babies. It facilitates longer duration of breast feeding and has great effect on improving the health of the neonate in babies submitted to KMC. Objective: This study was carried out to assess exclusive breast feeding practice, association between KMC and exclusive breast feeding and factors affecting it among mothers who provided kangaroo mother care to their preterm infants. Methods and materials: A cross sectional study design was conducted among 297 preterm infants who were practiced exclusive breast feeding with their mothers who were under Kangaroo mother care in Black lion hospital high risk follow up clinic, Addis Ababa, Ethiopia. Data were collected using interviewer administered structured, pretested questionnaire and entry was made by Epidata vertion3.1 & analyzed using SPSS window version 20 soft ware. Logistic regression model was used to determine independent determinants of kangaroo mother care. Results: In these study 297 mothers performed kangaroo mother care and the infants that practiced exclusive breast feeding were 166 (55.9%) and p=.000 at the time of hospital discharge.76.1% of the Mothers initiated KMC immediately. 73.1% were practiced KMC continuously in a day. The respondents who were started KMC immediately were 2.3 times increase in breast feeding by KMC.[AOR 2.303, 95% CI 0.871, 6.078] P <0.5. The respondents practiced KMC continuously at home were14.266 times increased to practice exclusive breast feeding,[ (AOR 14.266, 95% CI (3.516, 57.878)] The mothers who got problem during their home stay were 0.222 times less to practice exclusive breast feeding KMC at home [AOR 0.222, 95%CI .076, .652]. Conclusion: The study shows the importance of KMC during the initiation of exclusive breast feeding immediately after delivery and continued at home for breast feeding duration. Hence, KMC has empowering effects on the process of breast feeding in preterm infants.