New perspectives on responsive infant care: A qualitative study of the ways in which Neuroprotective Developmental Care (NDC) shapes mother-infant co-occupations

Figures & data

Table 1. Overview of key elements of NDC support

Area of Support	Key elements of support	Described in references
Sleep	Education on normal infant sleep and development and variability amongst infants Provide education and support on two biological sleep regulators – sleep pressure (sleep-wake homeostat) and circadian clock Holistic approach considering interactions between five NDC domains including environmental enrichment Support for maternal sleep efficacy Empowerment through parental education and trial-and-error learning	Ball et al., 2018, 2020 Crawford et al., 2021 Douglas & Gedded, 2018 Öztürk et al. 2020 Whittingham et al. 2020 Whittingham & Douglas, 2014, 2016
Feeding	Gestalt Breastfeeding/ Bottle-feeding Support for baby ‘Fit-and-hold’ for breastfeeding based on gestalt biomechanical model with an overarching goal of maximising intra-oral breast tissue intake to achieve efficient milk transfer with minimal pain including: o mother’s positioning and use of body and limbs o awareness of baby’s positioning and use of micro-movements to adjust o minimising breast tissue drag o achieving positional stability during feeds o use of a clear ‘landing pad’ to avoid interference with fit-and-hold o mindfulness during feeding Use of paced-bottle-feeding when expressed breast milk or formula are being used by the family Offering flexible feeds throughout the day for a range of reasons, including nutrition, responsiveness to infant/maternal connection and allowing the infant to dial down at the breast/ bottle	Crawford et al., 2021 Douglas & Geddes, 2018 Douglas & Keogh, 2017 Douglas et al., 2022
Crying and Fussing	Education on normal infant crying behaviour over time and natural variability between infants Support to understand sympathetic nervous system and hypothalamic arousal and hyperarousal – ‘dialling up’, ‘dialling down’, and ‘conditioned dialling up at the breast’ Education about two tools for dialling down – feeds and sensory nourishment Use of the five-domain approach where sleep, maternal health, infant health, and feeding and sensory domains are considered when cry-fuss communication is considered	Crawford et al., 2021 Douglas et al., 2011 Douglas & Hill, 2011, 2013a, b
Parent Mental Health	Integrating Acceptance and Commitment Therapy approach when facing challenges with maternal mental health and/or infant care (acceptance, cognitive defusion, being present, self as context, values, and committed action) Mothers consider care for self (e.g., uncoupling sleep and maternal self-care) Use of mindfulness approach	Crawford et al., 2021 Harris, 2019 Whittingham & Douglas, 2016 Whittingham et al., 2020

Table 2. Interview Guide

Main Question	Prompting Questions
Demographic Information	Age of participant Age of infant (when interviewed and when first accessed NDC) Gender Educational attainment level Family income bracket Family structure Primary reason for accessing NDC and the number of sessions / types of service accessed
(1) Tell me about a typical day for you, your baby, and your family, from wake-up time right through to bedtime?	Have you incorporated any NDC strategies into that? If so, how? If not, why not? Have you found that these NDC strategies have worked? Have you had any challenges with implementing these strategies?
(2) Since accessing NDC, what has been the biggest change for your family?	Considering this change, what is the story of this change? Tell me about it. How did this change come about? What contributed to this change? What has helped with this change? Has it been a positive or negative change? Did you face any challenges in this process of change? What were they? Did you overcome them? What supported you to do that? What could be better so that you could overcome those challenges?
(3) Thinking about the NDC practitioner that you have been seeing, what could other infant care professionals learn from their work with your family?
(4) What would you like to see to improve in the service you have accessed? What are those improvements? Why do you suggest these changes to practice?
(5) NDC practitioners provide lots of information and do not prescribe what to do, but rather encourage you to experiment with strategies that you feel are a good fit for your family.	How did this feel for you? Tell me more about that Could you provide an example? Where do you think this feeling comes from/what does that mean to you? What could have made things easier/better/ less < insert feeling if negative>
(6) You came to Possums to receive support for sleep/feeding/cry-fuss and NDC advice is different to most of the mainstream advice that’s freely available.	How did receiving this different type of information feel for you? How did the people around you respond to it?
(7) Is there anything we haven’t talked about that you would like to tell me?

Table 3. Characteristics of interview participants

Pseudonym Name	Age	Educational Attainment Level	Family Income Quantile	Age of infant when access to NDC was initiated	Primary Reason for accessing NDC	Services Accessed
						Book	1:1 consult	Online Resources	SMA	PIPPS
Amy	30	Doctorate	3	Pregnancy, 16 weeks	Sleep	✓	✓
Belinda	37	Master’s Degree	3	Pregnancy, 12 weeks	Sleep	✓		✓
Caitlin	39	Master’s Degree	5	12 weeks	Cry-fuss		✓	✓
Daisy	35	Graduate Diploma	5	8 weeks	Feeding		✓		✓
Eva	32	Master’s Degree	4	8 weeks	Feeding		✓		✓	✓
Freya	31	Master’s Degree	2	Pregnancy	Feeding, sleep	✓		✓
Grace	29	Bachelor’s Degree	4	20 weeks	Feeding, sleep			✓
Hannah	31	Bachelor’s Degree	3	12 weeks (2^nd child)	Sleep			✓		✓
Ingrid	34	Master’s Degree	4	20 weeks	Sleep		✓	✓
Josie	36	Bachelor’s Degree	4	Pregnancy, 6 days	Feeding	✓	✓
Kathleen	40	Master’s Degree	4	9 weeks	Feeding		✓
Laura	34	Bachelor’s Degree	4	7 weeks	Feeding, cry-fuss	✓	✓

Note: 1:1 consult denotes a direct consultation with an NDC practitioner either face-to-face or online via a private Zoom session; online resources refer to Possums & Co. website and online videos/documents; book refers to ‘The discontented little baby book’ about NDC by Dr. Pamela Douglas, and PIPPS is the Possums & Co. parent portal (online resource videos, online mother’s group, support from parent mentors).

Ball, H. L., Douglas, P. S., Kulasinghe, K., Whittingham, K., & Hill, P. (2018). The Possums Infant Sleep Program: Parents’ perspectives on a novel parent-infant sleep intervention in Australia. Sleep Health, 4(6), 519–526. https://doi.org/10.1016/j.sleh.2018.08.007

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