Baby Sleep: Interview with Dr. Pamela Douglas on the NDC Possum Approach

Elise Armoiry My Baby Moon
Dec 2
5 min read

Sleep is one of the most frequently discussed topics in breastfeeding consultation...

In another article, I presented the results of studies concerning “normal baby sleep” and sleep-learning methods.

Interview with Dr. Pam Douglas

I am offering you this interview with Dr. Pamela Douglas, author of the book The Little Discontented Baby Book and the NDC Possums sleep-support program for families. She is the one who trained me on this topic.

Could you briefly explain your neurodevelopmental care approach and how you help families resolve their baby’s sleep, feeding, and crying issues?

I have developed the neurodevelopmental care programs (NDC or “Possums”) over the past twenty years, establishing the evidence base in around thirty peer-reviewed research publications. I have used the lenses of evolutionary biology and complexity science to interpret interdisciplinary research concerning breastfeeding and infant sleep and crying problems, and the programs also integrate psychological approaches known as Acceptance and Commitment Therapy and Self-Compassion Therapy. I began offering an initial version of these programs at the Possums Clinic in Brisbane in 2011, and I have been training health professionals for many years. I am currently launching the NDC Masterclasses and NDC Accreditation through my personal website drpam.baby.

You can consult the research publications and articles on pameladouglas.com.au.

Is your approach to sleep reserved for breastfed babies? Or does it also work if the baby is fed with formula?

The Possums program for infant and young-child sleep is for breastfed babies, formula-fed babies, and mixed-fed babies.

Parents are often told that babies must sleep well during the day in order to sleep well at night: what is your response?

This can be problematic, depending on the baby’s sleep needs—some little ones really do not need much daytime sleep, and if they begin having long daytime naps, families may end up with excessive nighttime waking as the weeks go by.

Parents are often told to set up a sleep routine: what do you think about that?

Healthy sleep really depends on the proper functioning of the two sleep regulators, the biological clock and sleep pressure. Routines are therefore useless, given that sleep needs may vary from one day to another for the same baby, and they may become frustrating or even distressing when they do not work. The most important thing is for the caregiver to focus on having a day they enjoy, as much as possible outside the house, and for the baby to fit into it. Sleep will happen on its own.

Is breastfeeding to sleep a bad thing? Because parents are told that the baby will need the breast during the night if they fall asleep at the breast in the evening.

Breastfeeding to sleep is an easy way and the evolutionary norm. It does not create bad habits, but allows the baby to feel full and cuddled as sleep approaches. Excessive nighttime waking is not caused by breastfeeding, but by disrupted sleep regulators.

In France, we are seeing an increase in “self-soothing” approaches. Parents want their baby to be able to fall back asleep alone when waking up at night. Some approaches involve letting the baby cry in their bed or in their parents’ arms and acknowledging their emotions. What do you think of self-soothing?

I am now a grandmother and am still learning how to soothe my own emotions in the face of life’s many challenges. Our children gradually learn to regulate their own emotional expression, and this happens best when they are listened to and receive an empathic response. Our babies need adult soothing to establish neural patterns that support a healthy attachment style and good mental health throughout life. They need our help to regulate their sympathetic nervous system, and this help is needed in various ways throughout childhood, so that they can gradually take over. A crying baby longs for physical contact—perhaps a feed at the breast or bottle, perhaps a change in sensory experience—and by not responding, we teach the baby that we will not respond to their communications. Sometimes I think it can be worse to respond, but deliberately not in the way the baby means (for example, saying soothing things but not picking the baby up)—this is a very confusing message and I advise against it.

What about cortisol levels used in some studies to determine infant stress during sleep-training? Are they reliable?

Cortisol is part of a complex stress response and we really cannot interpret cortisol levels in a simple way. Cortisol measurements are not necessarily a reliable way to measure stress.

Is there an age when it is appropriate to let a baby cry in the arms of a loving adult? (For example, nighttime weaning in toddlers.)

Families make their own decisions about this, taking multiple factors into account. Each family’s situation is unique. As a general rule, the older the child is before being allowed to cry at night, the better—although again, women make their own decisions about when to night-wean. It is important to know that night-weaning does not necessarily reduce the frequency of nighttime awakenings. If the baby is young and is night-weaned, bottles of formula can be used during the night. For an older baby, and certainly for a toddler, you can offer only water at night once night-weaning is complete (the sippy cup will of course likely be thrown across the room if offered at night, but at least you ensure the child is not thirsty). Likewise, it is never necessary to leave a child to cry alone at night—even if the child is learning something new during the night (that mommy’s breast is no longer available), the child is still held by another loving adult.

In France, maternity leave is only 2.5 months, which means many parents are forced to return to work after very disrupted nights. What would be your advice for getting better sleep in this case?

The most important thing is to keep the sleep regulators healthy, by starting the baby’s day at the same time each morning, and ensuring that the baby does not have long daytime naps, which would lead to excessive nighttime waking later. This means ensuring that caregivers give your baby rich and enjoyable sensory nourishment throughout the day, with frequent outings or time in new environments. This helps ensure that babies sleep only when sleep pressure is truly high, and only as long as they absolutely need during the day. As my colleague Renee Keogh likes to say: the day is for living, the night is for sleeping.

I am building a new website at drpam.baby. You will soon be able to access the updated Possums 2023 Infant and Toddler Sleep Program there, as well as the NDC training programs for health professionals.

Interview with Dr. Pamela Douglas on the topic of sleep

Another article on baby sleep and sleep-learning techniques

Please contact me for advice or questions: “My Baby Moon” by Elise Armoiry, IBCLC lactation consultant & founder of My Baby Moon.