Sleep Training 101: The Possums Program

Navigating the world of infant sleep can be a daunting task for parents. Sleepless nights, frequent waking, and exhaustion are common challenges faced by many families. A middle of the night Google will inevitably result in wildly varying advice. In some cases, sleep advice is presented alongside an emotional narrative suggesting that if you don’t subscribe to a particular approach or philosophy you’ll damage your child. Needless to say, this can add anxiety and confusion to an already stressful time. At Baby Sleep Science, our goal is to provide you with unbiased, evidence-based information about sleep in early childhood. The purpose of our Sleep Training 101 series is not to advocate for a particular approach. Our goal is simply to inform you about the scientific evidence that supports (or doesn’t support) a particular strategy. We want you to be informed so you can make parenting decisions that fit your parenting style and baby’s temperament.

In this post, we’re covering the Possums Infant Sleep Program. Although we’ve titled this series “Sleep Training 101,” the Possums Program is really more of an alternative to sleep training. The closest approach to the Possums Program is baby-led sleep training but even that is quite different from the Possums Program. Here, we delve into the science behind the Possums Program, how it works, its effectiveness, appropriate age considerations, and other important insights for parents.

The Science

The Possums Program was first described in a paper by Australian researchers Whittingham and Douglas in 2014. The authors describe the Possums Program as “cued care” rooted in evolutionary theory, sleep science, and contextual behavioral science. This approach is largely based on understanding that babies will need help to fall asleep and to go back to sleep and accepting that reality. The researchers who developed the Possum Program largely reject many traditional recommendations regarding sleep in infants. For example, they recommend responding to night waking immediately, allowing or even encouraging feeding to sleep, ignoring sleep timing recommendations, avoiding the use of “sleepy cues” to determine when to put a baby to sleep, and rejecting the idea that overstimulation interferes with sleep.

One survey of 45 mothers who took the program found that most felt relieved about not having to worry about their baby’s sleep and 22 reported that their baby’s sleep improved. One study involved structured interviews with 12 mothers who reported that they benefited by feeling less pressured to follow a schedule, which allowed them more daytime flexibility. Another study of 24 mothers found no changes in maternal or infant sleep patterns or mother’s perception of their baby’s sleep, but they did find that mothers felt more emotionally available to their babies after participating in the program. These studies did not compare the outcomes of the program to a control group (that is, a group of mothers and babies who did not receive the program). This is important because it is hard to evaluate whether any changes observed result from the program or simply from time because a baby’s sleep improves with age.

Another study surveyed mothers when their babies were 12 months old and compared their reports to a group of mothers who had not participated in the program. This study found that babies cried less after completing the program. They also found that mothers felt better about their own sleep and their baby’s sleep. The study was not randomized, meaning participants were not assigned to the program or a control, which is a weakness of the design.

Notably, none of the studies reported any objective outcomes related to infant's or mother’s sleep, so it’s impossible to know whether sleep improves. These results may seem a bit underwhelming for a sleep program. Importantly though, the point of the Possums Program isn’t really about improving sleep or making a baby wake up less. It’s about accepting your baby’s habits, patterns, and needs and adapting yourself to accommodate your baby.

How Does the Possums Program Work?

The Possums Program involves four 1.5-2-hour sessions over four weeks. During these sessions, a facilitator reviews infant sleep science, including how sleep is variable day-to-day throughout the first few years. Sessions also involve teaching parents about changes that they can make to improve their outlook on sleep (for example, strategies such as feeding their baby right away to go to sleep faster). Some components of the program involve:

Responsive Parenting: This program recommends that parents respond to their babies in whatever manner is most responsive to their baby’s needs. They say that responding in a manner that is different from what a baby expects is not part of their program.

Feeding to Sleep: Unlike most behavioral sleep interventions, the Possums Program recommends that babies be allowed to feed to sleep.

Mostly Ignoring Schedules: The Possums Program recommends waking a baby up at the same time every day to facilitate circadian rhythm adaptation but they do not recommend any specific nap duration targets or amounts for babies to meet. For example, a 10, 20, 30, or 45-minute nap is not considered a problem.

Reliance on Sleep Pressure: This program suggests that you should not obsess over sleepy cues, but rather allow your baby to fall asleep when sleepy in any safe situation.

Focus on Acceptance: This program also has a major focus on accepting what you can’t change and living in the moment.

How Long Does it Take for Sleep to Improve with the Possums Program?

The Possums Program isn’t really about changing a baby’s sleep. It’s more about accepting how things are. Based on the studies that have been done, it seems that many families feel immediate relief knowing that they don’t have to work to change their child’s sleep. However, it’s important to know that there is probably some reporting bias in the studies in that some parents who decided to participate in the program were looking for a program that did not involve sleep training.

What Age is it Appropriate to Use the Possums Program?

The Possums Program is designed for infants from birth. We find that taking a Possums approach is helpful for the first 4-6 months of a baby’s life (that is, understanding that babies need a lot of nighttime parenting and not fighting against your baby’s natural patterns). Some families will embrace the Possums philosophy long beyond that age range, while others will opt to switch to a more traditional behavioral approach.

What Else Should You Know?

We like that the Possums Program takes the pressure off of families who are constantly confronted with emotionally charged information about sleep. This approach won’t be for every family because it does not involve working to change a baby’s sleep. In addition, parents considering taking a Possums approach should discuss it with their partners to ensure that both feel comfortable with the decision. Some mothers who participated in Possums Program studies felt tension with their partner, who wanted to use a strategy that would result in faster sleep consolidation.

How does the Possums Program relate to Baby Sleep Science?

We haven’t completed any Possums Program courses, but we are sleep scientists and medical professionals, with formal education in sleep medicine. This post is based on our reading of the scientific literature surrounding the program. Most of our blogs and our class review more traditional behavioral approaches. We realize this post may seem to be in conflict with those posts, but remember, our goal is to inform you, not to pressure you to accept one way of doing things. When we work with families in one-on-one consultations we do sometimes discuss what would happen if a family decided not to implement a sleep plan because not taking action is an option! For some families, simply having this discussion can be helpful. If the Possums Program seems to be a great fit for you, then we would recommend that you seek a Possums provider. If you want to understand all of your options, we would be happy to help!

References

Ball, H.L., Douglas, P.S., Kulasinghe, K., Whittingham, K. and Hill, P., 2018. The Possums Infant Sleep Program: parents' perspectives on a novel parent-infant sleep intervention in Australia. Sleep Health, 4(6), pp.519-526.

Whittingham, K., Palmer, C., Douglas, P., Creedy, D.K. and Sheffield, J., 2020. Evaluating the “possums” health professional training in parent–infant sleep. Infant Mental Health Journal, 41(5), pp.603-613.

Öztürk, M., Boran, P., Ersu, R. and Peker, Y., 2021. Possums-based parental education for infant sleep: cued care resulting in sustained breastfeeding. European Journal of Pediatrics, 180, pp.1769-1776.

Closson, L., Flykt, M. and Biringen, Z., 2020. Evaluation of possums sleep intervention: A pilot feasibility study.

Crawford, E., Whittingham, K., Pallett, E., Douglas, P. and Creedy, D.K., 2022. An evaluation of Neuroprotective Developmental Care (NDC/Possums Programs) in the first 12 months of life. Maternal and Child Health Journal, pp.1-14.

Whittingham, K. and Douglas, P., 2014. Optimizing parent–infant sleep from birth to 6 months: a new paradigm. Infant Mental Health Journal, 35(6), pp.614-623.

Douglas, P.S., Miller, Y., Bucetti, A., Hill, P.S. and Creedy, D.K., 2015. Preliminary evaluation of a primary care intervention for cry-fuss behaviours in the first 3− 4 months of life (‘The Possums Approach’): effects on cry-fuss behaviours and maternal mood. Australian Journal of Primary Health, 21(1), pp.38-45.