How The Possums Baby and Toddler Sleep Program came about

This article is part of a collection inside The Possums Sleep Program called Deeper Dive, which explores the more complex scientific, historical and social contexts in which families and their babies or toddlers live and sleep. You don't need to read Deeper Dive articles to be helped by The Possums Sleep Program.

About the development of The Possums Sleep Program

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.

There were just two conflicting approaches to infant sleep internationally prior to publication of The Possums Sleep Program in the research literature in 2014.

• 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.

• 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

• Named and acknowledged excessive night waking and other sleep struggles

• Translated the research into a skilful intervention shaped by clinical experience

• Helped families mend disrupted sleep patterns and develop an enjoyable relationship with their baby's or toddler's sleep

• At the same time as breastfeeding was protected.

I also imagined that this approach would act preventatively.

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.

I gratefully acknowledge the work and support of Dr Koa Whittingham, psychologist and researcher at The University of Queensland, in 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.

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 improved and updated The Possums Sleep Program one last time in this 2024 legacy 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 changed the metaphors that I use 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 believe 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. Of course, only time will tell. Preliminary evaluations 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 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.

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.