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  • Neuroprotective Developmental Care (NDC) or the Possums programs: preferred terms when communicating with parents
  • A little about the underlying theoretical frameworks from which the gestalt method has been built
  • The gestalt method: developed from clinical experience + ultrasound and vacuum studies, corroborated by real-time MRI
  • The gestalt method: education strategies, innovative models, what's not included
  • Micromovements: the power lies in the detail
  • Using the numeric rating pain scale as we help reduce a woman's experience of nipple during breastfeeding
  • The gestalt method: high level overview of the four steps
  • Differences between the gestalt method of fit and hold and biological nurturing or laid-back breastfeeding

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  • CH 2: Deep dive into the gestalt method of fit and hold

Neuroprotective Developmental Care (NDC) or the Possums programs: preferred terms when communicating with parents

Dr Pamela Douglas7th of Aug 202320th of Dec 2025

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Preferred terms when delivering Neuroprotective Developmental Care or the Possums programs Technical or popular terms that are not recommended
Face-breast bury Facio-mandibular-to-breast symmetry(Thompson et al 2016)
Mother-baby pair, mother-baby CAS (complex adaptive system) Dyad
Dialed up Conditioned sympathetic nervous system (SNS) hyperarousal, stressed
Dialed down Calm
Conditioned dialing up Oral aversion, breast refusal
Fit and hold Latch, attachment, positioning
Fit onto the breast Latch or attach
Open the mouth Gape
Generous breast Large breast
Delicate or petite breast Small breast
Round tummy Fat stomach
Healthy bonding Attachment (psychological)
Difficult thoughts and feelings, worried thoughts Rumination, anxiety, feeling depressed
Dialed up at the breast Oral aversion; breast refusal; conditioned SNS hyperarousal
Sensitivity at the breast Oral aversion; breast refusal; conditioned SNS hyperarousal
Workability and experimentation Natural or instinctual behaviours or natural breastfeeding
Nipple and breast tissue drag in the baby's mouth Vector of force which conflict with intra-oral vacuum, resulting in decrease intra-oral breast tissue volume
Milk removal Draining or emptying the breast, which falsely implies that the breast can be or must be 'emptied' during a feed
Frequent and flexible breastfeeds Breastfeeding on demand
Nipples look Nipples point
Smooth muscle contraction of nipples, nipple contraction Nipple erection
Breast fall - where the breasts and nipples fall naturally in response to gravity
Oral searching reflex Rooting
Too far around the corner Breast tissue drag too far towards the breastfeeding mother's arm (too far towards the same side as the baby is breastfeeding from)
Nipple and areola Nipple-areolar complex
Can't overfeed a breastfed baby; baby is dialing up due to hunger for sensory motor nourishment Overfeeding, overtired, overstimulation

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Selected references

Crawford E, Waldby L, Crook E. New perspectives on responsive infant care: a qualitative study of the ways in which Neuroprotective Developmental Care (NDC) shapes mother-infant co-occupations. Journal of Occupational Science. 2023:https://doi.org/10.1080/14427591.14422023.12236117.

Crawford E, Whittingham K, Pallett E, Douglas PS, Creedy DK. An evaluation of Neuroprotective Developmental Care (NDC/Possums Programs) in the first 12 months of life. Maternal and Child Health Journal. 2022;26(1):110-123.

Douglas PS, Keogh R. Gestalt breastfeeding: helping mothers and infants optimise positional stability and intra-oral breast tissue volume for effective, pain-free milk transfer. Journal of Human Lactation. 2017;33(3):509-518

Thompson RE, Kruske S, Barclay L, Linden K, Gao Y, Kildea SV. Potential predictors of nipple trauma from an in-home breastfeeding programme: a cross-sectional study. Women and Birth. 2016;29:336-344.

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Next up in Deep dive into the gestalt method of fit and hold

A little about the underlying theoretical frameworks from which the gestalt method has been built

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The gestalt method has been built by using the principles of implementation science

The gestalt method of fit and hold is just one part of the comprehensive Possums approaches to breastfeeding and lactation challenges, but experimenting with fit and hold is essential when problems arise - and also if we want to prevent problems.

It's important to name the kind of method that is being used when professionals help with fit and hold, and to be explicit about the models that the approach is built from. This is so that the method can then be evaluated in the research, and taught to other health professionals. The idea that naming a particular approach to fit and hold is…

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Possums acknowledges the traditional owners of the lands upon which The Possums Programs have been created, the Yuggera and Turrbal Peoples. We acknowledge that First Nations have breastfed, slept with, and lovingly raised their children on Australian lands for at least 65,000 years, to become the oldest continuous living culture on Earth. Possums stands with the Uluru Statement from the Heart.