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Neuroprotective developmental care

3 Dec 2021

Dr Pamela Douglas, the Medical Director of Possums & Co., discusses the Neuroprotective Developmental Care Accreditation Pathway, for which the charity is offering 300 scholarships. She also outlines the “evidence-based paradigm shift” the Possums Program is driving in the domains of breastfeeding, cry-fuss, sleep and perinatal mental health.

Renee, Tarni and Pam (right)

Mid­way through 2021, the char­i­ty Pos­sums & Co. received a $824,450 grant to deliv­er the three-year Neu­ro­pro­tec­tive Devel­op­men­tal Care (NDC) Rur­al Project, as part of the Com­mon­wealth Government’s Peri­na­tal Men­tal Health and Well­be­ing Program.

We are delight­ed that the Gov­ern­ment is sup­port-ing us in bring­ing NDC to rur­al and remote prac­ti­tion­ers and their patients,” says Dr Pamela Dou­glas, who found­ed the char­i­ty in 2013

We’re able to offer 300 schol­ar­ships over the next cou­ple of years to health pro­fes­sion­als locat­ed in rur­al and remote set­tings between MM 3 to MM 7 on the Mod­i­fied Monash Model.” 

The schol­ar­ships cov­er the approx­i­mate­ly $1000 costs of the Pos­sums Pro­gram, which teach­es an evi­dence-based approach to breast­feed­ing, cry-fuss issues, sleep issues, and peri­na­tal men­tal health. Suc­cess­ful appli­cants will receive NDC accred­i­ta­tion upon fin­ish­ing the pro­gram, which can be com­plet­ed ful­ly online.

Dr Dou­glas says the project recog­nis­es that par­ents in rur­al and remote set­tings are dis­ad­van­taged in terms of access to resources and support.

It address­es the prob­lem of the con­flict­ing advice that par­ents receive, by set­ting up a net­work of health pro­fes­sion­als in rur­al and remote com­mu­ni­ties who are on the same evi­dence-based page,” she says.

It also allows 10 par­ents who are con­sult­ing with suc­cess­ful appli­cants to access our Par­ents Hub, a non-judg­men­tal safe place for peer sup­port, mon­i­tored by par­ent men­tors and also a full-time peri­na­tal men­tal health expert, who can coor­di­nate peer sup­port groups through var­i­ous rur­al and remote localities.”

What is the Pos­sums Program?

The NDC Pro­gram is backed by about 30 peer-reviewed pub­li­ca­tions in med­ical lit­er­a­ture, Dr Dou­glas says. It focus­es on set­ting up life- long neur­al tem­plates for secure attach­ment and good men­tal health, as well as gut, immune and meta­bol­ic health, dur­ing the exquis­ite­ly neu­ro-plas­tic first weeks, months, and years of life”.

All [of these fac­tors] have great epige­nom­ic sen­si­tiv­i­ty and can be affect­ed by prob­lems that emerge in breast­feed­ing, sleep, and fuss­ing,” she says, list­ing three major focus points for NDC.

CRANAplus asked Dr Dou­glas to give a few exam­ples of how NDC flips com­mon advice on its head in these domains.

The sleep approach­es we’ve all been trained in and what par­ents find online are gen­er­al­ly a sleep train­ing’ approach,” Dr Dou­glas says.
A sleep train­ing approach is built on the phi­los­o­phy that we can entrain the baby’s biol­o­gy around sleep, by not respond­ing to babies’ cues or by delay­ing response to babies’ cues.

There’s been five sys­tem­at­ic reviews now to show that [tra­di­tion­al sleep rec­om­men­da­tions] don’t decrease night wak­ing… and emerg­ing evi­dence to sug­gest the dom­i­nant sleep approach can exac­er­bate anx­i­ety with­in families.

The big dif­fer­ence with Pos­sums is that we go back to all the sci­ence,” Dr Dou­glas says.

Sleep is a bio­log­i­cal process under the con­trol of two sleep reg­u­la­tors, the cir­ca­di­an clock and sleep/​wake home­osta­sis, so we want to work with our baby’s biol­o­gy and sup­port that respon­sive care or cued care day and night to opti­mise healthy sleep.”

Mean­while, Dr Dou­glas points to over-med­ical­i­sa­tion as a com­mon fault with cur­rent prac­tice in the domain of breast­feed­ing.

Unset­tled infant behav­iour at the breast and nip­ple pain are often inap­pro­pri­ate­ly attrib­uted to med­ical caus­es, like aller­gy, reflux, tongue-tie,” she says. Very often our babies are being unnec­es­sar­i­ly med­icalised and treat­ed, which comes with unin­tend­ed risks. Posi­tion­al insta­bil­i­ty dur­ing breast­feed­ing may be a more like­ly cause.”

She also says that cer­tain pieces of com­mon advice can wors­en breast­feed­ing problems.

Women are often told, if they have blocked ducts or mas­ti­tis, that they should mas­sage out the block­age in the milk duct. That will cause microvas­cu­lar trau­ma in what’s already very vas­cu­lar tis­sue, which increas­es stro­mal swelling, which caus­es ducts to com­press, which caus­es ris­ing pres­sures in the alve­o­lar glands, which caus­es wors­en­ing inflammation.”

She also not­ed that all Pos­sums & Co. Pro­grams inte­grate a mod­ern form of Cog­ni­tive Behav­iour­al Ther­a­py known as Accep­tance and Com­mit­ment Ther­a­py, which is sup­port­ed by a very strong evi­dence base inter­na­tion­al­ly, includ­ing for depres­sion and anx­i­ety, and an emerg­ing evi­dence base in the peri­na­tal period.”

Who should apply?

Dr Dou­glas said Pos­sums & Co. were hop­ing to award schol­ar­ships to a wide range of health pro­fes­sion­als, includ­ing but not lim­it­ed to GPs.

Wouldn’t it be won­der­ful if there was a team in a town – a mid­wife, a lac­ta­tion con­sul­tant work­ing with the GP, a local child health nurse – who all reg­is­tered and became accred­it­ed, because then we’re start­ing to seri­ous­ly deal with the prob­lem of con­flict­ing advice,” Dr Dou­glas says.

Or it may be a com­mu­ni­ty where it’s just the mid­wife, or the child health nurse, in a sit­u­a­tion where there’s not that local care col­lab­o­ra­tion. We’d love to think that those peo­ple could also join us and access peer sup­port online.

We’d also love to invite our Abo­rig­i­nal health work­ers and First Nations health pro­fes­sion­als to par­tic­i­pate and feed back to us… help­ing us shape what we’re doing so that it is cul­tur­al­ly respon­sive and cul­tur­al­ly appropriate.”

For more infor­ma­tion on the NDC Rur­al Project or to apply for a schol­ar­ship, head to edu​ca​tion​.pos​sum​son​line​.com/​o​u​r​-​n​d​c​-​r​u​r​a​l​-​p​r​oject