About the development of The Possums Baby and Toddler Sleep Program (from 2011 ongoing)
Unsettled infant behaviour and cross-cultural experience
From when I first started general practice in 1987, I’d wondered why baby and toddler sleep caused us so much grief in Western societies but was of little concern in other cultures. My experiences as a mother and as a breastfeeding medicine physician shaped my interests and my concerns. I was also foundationally influenced by my first job as a GP working with Australian First Nations Peoples. You can read about the influence the Australian First Peoples have had upon my work here and here.
I created the earliest version of The Possums Sleep Program directly out of the research (including cross-cultural and anthropological studies) that existed at the time, developing it up incrementally in the late 1990s and 2000s, as part of my interest in unsettled babies more generally. I've always been convinced that once we were better able to help families with unsettled babies, we'd start to improve breastfeeding rates in high income countries, since unsettled baby behaviour was at the time, and continues to be, very poorly managed, yet remains a major reason for premature weaning.
Creating a new paradigm in infant sleep
There were just two conflicting approaches to infant sleep internationally prior to publication of The Possums Sleep Program in the research literature in 2014.
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One was the 'go with the flow' approach of breastfeeding advocates, which normalised infant night waking and failed to acknowledge and address the serious and complex sleep problems parents faced.
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The other was the dominant Western health system approach of sleep training, which in my experience also largely failed parents, and created or worsened sleep problems.
I aimed to develop a third, new paradigm, which
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Named and acknowledged excessive night waking and other sleep struggles
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Translated the research into a skilful intervention shaped by clinical experience
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Helped families mend disrupted sleep patterns and develop an enjoyable relationship with their baby's or toddler's sleep
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At the same time as breastfeeding was protected.
I also imagined that this approach would act preventatively.
The Possums Sleep Program has been iteratively refined in response to research evaluations and feedback from parents in the clinic
I first offered the Possums Sleep Program to parents and health professionals in 2011 in the new little Possums Clinic I’d started up with some colleagues in Brisbane. The crucial elements of The Possums Sleep Program were and remain completely innovative translations of research through the lens of what I found worked (or didn't work) in the clinic. I knew my approach to infant sleep was ground-breaking, on multiple fronts, with nothing else like it available internationally. This is why from 2013, in our materials and promotions, I and my colleagues boldly referred to The Possums Sleep Program as a baby sleep revolution, part of what I called the Possums knowledge revolution in the care of mothers and babies.
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I gratefully acknowledge the work and support of Dr Koa Whittingham, psychologist and researcher at The University of Queensland, who came into the ongoing the development of The Possums Sleep Program between 2012 and 2017. Dr Whittingham introduced herself to me after hearing me present about The Possums Sleep Program in the first Great Baby Sleep Debate conference, and offered to help.
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I also gratefully acknowledge my collaboration with Professor Helen Ball and her team at the Durham Infancy and Sleep Centre (2017 ongoing), which adapted The Possums Sleep Program for the UK context, resulting in the program Sleep, Baby & You, which is available for providers and health professionals through both Durham Infancy and Sleep Centre and The NDC Institute (home of the Possums programs). A preliminary evaluation demonstrating the benefits of Sleep, Baby & You is published here.
I recorded the next upgrade and revision, The Possums Baby and Toddler Sleep Program 2020, during the worst of the pandemic. I sat in front of my aging webcam on a creaky wooden chair, and recorded about 40 short videos in which I answered the common questions parents had asked me over the years in the clinic about their baby’s and toddler’s sleep.
I've very substantially improved and updated The Possums Sleep Program in this 2024 version. I've tried to address everything that parents ask when they come into the clinic with concerns about their little one's sleep, going back into the research over and over. Since 2017, I've also completely altered the metaphors that I use which are drawn from Acceptance and Commitment Therapy. I now also draw heavily from Compassionate Mind Training strategies, which come from Compassion-focused Therapy, to reflect what I've found works best in the clinic.
I like to think there'll come a time when The Possums Sleep Program is shown in evaluations to be far more effective than sleep training for most families. Five preliminary evaluation studies confirm what I and my NDC Accredited colleagues know from our work with parents: that The Possums Sleep Program transforms lives. There's a long research journey ahead, but I am grateful to those colleagues who even now are finalising new evaluations of The Possums Sleep Program and NDC more broadly.
In the meantime, I hope you and your family find The Possums Sleep Program helps you grow joy in life with your little one.
Recommended resources
How have the steps of implementation science been used to develop The Possums Sleep Programs?
What is the Neuroprotective Developmental Care Contextual Model of Infant Sleep (NDC-MIS)?
Timeline of development of The Possums Sleep Program
Selected references
Ball H, Taylor CE, Thomas V, Douglas PS, Sleep Baby and You Working Group. Development and evaluation of ‘Sleep, Baby & You’ - an approach to supporting parental well-being and responsive infant caregiving. Plos One. 2020;15(8): e0237240.
Ball H, Douglas PS, Whittingham K, Kulasinghe K, Hill PS. The Possums Infant Sleep Program: parents' perspectives on a novel parent-infant sleep intervention in Australia. Sleep Health. 2018;4(6):519-526.
Crawford E, Waldby L, Crook E. New perspectives on responsive infant care: a qualitative study of the ways in which Neuroprotective Developmental Care (NDC) shapes mother-infant co-occupations. Journal of Occupational Science. 2023:https://doi.org/10.1080/14427591.14422023.12236117.
Crawford E, Whittingham K, Pallett E, Douglas PS, Creedy DK. An evaluation of Neuroprotective Developmental Care (NDC/Possums Programs) in the first 12 months of life. Maternal and Child Health Journal. 2022;26(1):110-123.
Douglas PS. The need to acknowledge similarities between the 2022 D'Souza and Cassels and the 2014 Whittingham and Douglas contextual models of infant sleep. Sleep Health. 2023;9:797-800.
Douglas PS. The Possums Sleep Program: supporting easy, healthy parent-infant sleep. International Journal of Birth and Parent Education. 2018;6(1):13-16.
Douglas P, Hill PS. Behavioural sleep interventions in the first six months of life do not improve outcomes for mothers or infants: a systematic review. J Dev Behav Pediatr. 2013;34:497–507.
Ozturk M, Boran P, Ersu R, Peker Y. Possums-based parental education for infant sleep: cued care resulting in sustained breastfeeding. European Journal of Pediatrics. 2021;180:1769-1776.
Whittingham K, Palmer C, Douglas PS, Creedy DK, Sheffield J. Evaluating the 'Possums' health professional training in parent-infant sleep. Infant Mental Health Journal. 2020;41(5):603-613.
Whittingham K, Douglas PS. "Possums": building contextual behavioural science into an innovative evidence-based approach to parenting support in early life. In: Kirkaldy B, editor. Psychotherapy in parenthood and beyond. Turin, Italy: Edizioni Minerva Medica; 2016. p. 43-56.
Whittingham K, Douglas PS. Optimising parent-infant sleep from birth to 6 months: a new paradigm. Infant Mental Health Journal. 2014;35:614-623.
