Ethics and safety: questions to ask when you're looking for help with baby or toddler sleep that's not sleep training

This article is part of a collection inside The Possums Sleep Program called Deeper Dive, which explores the complex scientific, historical and sociocultural contexts in which we live (and sleep) as families with babies or toddlers, or as health professionals. You don't need to read Deeper Dive articles to be helped by The Possums Sleep Program.

How to make a safe, ethical choice when you're looking for baby or toddler sleep help

The video below discusses questions to ask about programs available to you when you're looking for baby and toddler sleep help that's not sleep training.

This next video explains that if you make what I consider to be an ethical choice of a baby and toddler sleep program (that is not sleep training), you will in my view be making the safest choice. This is because infant sleep is intimately connected to all other aspects of infant care, including breastfeeds, feeds, the gut, and medical diagnoses.

If you are needing help in an individual consultation concerning your baby's or toddler's sleep, I recommend that you find an NDC Accredited Practitioner. NDC Practitioners, who are registered health professionals in their own country of origin, are fully trained, qualified, engaged in the NDC Network, and committed to ongoing updating of their delivery of The Possums Sleep Program. You can find an NDC Accredited Practitioner here.

The term 'evidence-based' is now used as a marketing tool for non-sleep-training approaches to infant and toddler sleep

Everyone claims that their sleep program is evidence-based these days, including the growing number of educators and health professionals offering non-sleep-training approaches! The term 'evidence-based' has been hijacked to become, like so much else, a marketing tool, divorced from an understanding of implementation science and what a genuinely evidence-based program might look like.

As I wrote in the Conclusion of a 2023 Letter to the Editor in Sleep Health:

"Currently, social media influencers wield unprecedented power over dissemination of information and the well-being of parents with infants, arbitrating the financial survival of small businesses operating in this space. In social media and online promotions, the descriptor ‘evidence-based’ is used as a potent but potentially misleading marketing tool for the new genre of non-extinction-based infant sleep education products, since parents do not receive explanations about what might comprise a genuinely scientific evidence-base to clinical or educational programs.

Similarly, health professionals are often not trained to understand how the principles of implementation science apply to the development of novel, genuinely evidence-based programs. Careful adherence to ethical standards in infant sleep research, including acknowledgement of others’ prior work and of conflict of interest, is vitally necessary to protect parents and providers alike - whether or not the infant sleep models and interventions being promoted rely upon extinction methods."

Many programs which claim to offer gentle approaches to infant sleep are stuck between paradigms

Many programs which claim to be gentle or responsive still integrate elements of sleep training. In my clinical experience, by using a blend of first wave behavioural and other approaches, these approaches can actually prolong sleep distress within families, which would otherwise quickly resolve with The Possums Sleep Program. Examples of residual elements of first wave behavioural philosophies are

• Recommendation of certain kinds of daytime or evening routines

• Advice to contact nap or extend sleep cycles

• Attention to tired signs

• Counting up hours of sleep durations

• Advice concerning sleep windows

• Recommendations to avoid overtiredness and overstimulation

• Gradual withdrawal of the breast while baby is still drowsy with intention of teaching baby to go to sleep without the breast

• The belief that babies often resist sleep.

The Possums Sleep Program is built from a different paradigm altogether (known as Neuroprotective Developmental Care). The Possums Sleep Program works with your little one's biology, rather than by aiming to entrain or extinguish complex, interconnected biological processes. This is how we best protect the flourishing of your small child's unspeakably precious little brain and being.

This is, I believe, the way of the future in baby or toddler care.

Selected references

D'Souza L, Cassels T. Contextual considerations in infant sleep: offering alternative interventions to families. Sleep Health. 2022:S2352-7218(2322)00077-00078.

Ioannidis JPA. Evidence-based medicine has been hijacked: a report to David Sackett. Journal of Clinical Epidemiology. 2016:doi:org/10.1016/j.jclinepi.2016.1002.1012.