Possums-based parental education for infant sleep: cued care resulting in sustained breastfeeding


For infants and their families, sleep consolidation is important in maturing neural and circadian rhythms, and in family dynamics. The Possums Infant Sleep Program is a cued care approach to infant sleep, responding to infant cues in a flexible manner, dialing down the infant’s sympathetic nervous system. The current study evaluated the effect of the Possums program on infant sleep and breastfeeding in infants (6–12 months) from a well-child outpatient clinic in Turkey, with the program intervention group (n = 91) compared with usual care (n = 92). In total, 157 mother-infant dyads completed the study. Infant sleep and breastfeeding rates were assessed at baseline and after 3 months. Nocturnal wakefulness, daytime sleep duration, naps, and night wakening decreased in both groups. Nocturnal sleep duration and the longest stretch of time the child was asleep during the night increased significantly in both groups without any change in total sleep duration. Night wakening was significantly lower and nocturnal sleep duration was significantly higher in the intervention group. However, mixed effects model analyses indicated no significant differences between the groups on any of the sleep outcomes after adjusting for confounders. Despite this, breastfeeding rates were significantly higher in the intervention group compared with those in the usual care group at follow-up.

Conclusion: The Possum infant sleep program provided equivalent positive results on sleep parameters compared to usual care while advocating a more cued response. The critical difference was evident in sustained breastfeeding.

What is Known:
Responsive sleep programs produce sleep consolidation, by responding to the infant’s cues without ignoring, and then gradually reducing parental interaction.
Breastfeeding to sleep may be considered an undesirable sleep association in some infant sleep interventions.
What is New:
The Possums Infant Sleep Program provided equivalent positive results to usual care while advocating a more cued response.
The critical difference was in sustaining breastfeeding, and the program was associated with better breastfeeding rates.

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Fig. 1

Data availability




American Academy of Pediatrics


Acceptance and Commitment Therapy


Brief Infant Sleep Questionnaire


Randomized controlled trial


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We acknowledge that Honorary Associate Professor Peter S. Hill critically reviewed and edited the manuscript.


This study was sponsored by Marmara University Scientific Research Commission, BAPKO (SAG-C-TUP-100216-0036).

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O.M contributed to the conception and design of the work and acquisition of data, revised it critically, approved the final version, and agrees to be accountable for all aspects of the work related to the accuracy of any part of the work.

B.P contributed to the conception and design of the work and the acquisition, analysis, and interpretation of data, drafted the work, revised it critically, approved the final version, and agrees to be accountable for all aspects of the work related to the accuracy of any part of the work.

E.R contributed to the interpretation of data, revised it critically, approved the final version, and agrees to be accountable for all aspects of the work related to the accuracy of any part of the work.

P.Y contributed to the analysis and interpretation of data, revised it critically, approved the final version, and agrees to be accountable for all aspects of the work related to the accuracy of any part of the work.

Corresponding author

Correspondence to Perran Boran.

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Ethical approval was obtained from the Marmara University School of Medicine’s board with the approval number 09.2015.215.

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Communicated by Gregorio Paolo Milani

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Öztürk, M., Boran, P., Ersu, R. et al. Possums-based parental education for infant sleep: cued care resulting in sustained breastfeeding. Eur J Pediatr (2021). https://doi.org/10.1007/s00431-021-03942-2

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  • Infant
  • Breastfeeding
  • Parents
  • Sleep
  • Wakefulness