How Does My Baby Sleep?
© Avi Sadeh
This questionnaire is intended to provide descriptions of sleep of infants and young children (up to 3 years of age). Feedback based on your answers to these questions will be sent to you to the email address you provide below. This feedback is consistent with the current scientific knowledge in the field but is for educational purposes only. Please see a medical or psychological professional if your child has problems you consider serious. The data you provide may also be used for research purposes but your identity will not be made public within the limits of the law. Your email address will not be used for any purpose other then sending you the feedback!
E-mail Address:
Name of Responder (optional):
Role of Responder:
-Select-
Father
Mother
Grandparent
Other
Name of the child (optional):
Child's Date of Birth:
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2012
2011
2010
2009
Sex:
-Select-
Male
Female
Birth order of the child:
-Select-
Oldest
Middle
Youngest
Sleeping arrangement:
-Select-
Infant crib in a separate room
Infant crib in parents room
In parents bed
Infant crib in room with sibling
Other
In what position does your child
sleep most of the time:
-Select-
On his/her belly
On his/her side
On his/her back
How much time does your child spend in sleep during the NIGHT (between 7 in the evening and 7 in the morning):
Hours
0
1
2
3
4
5
6
7
8
9
10
11
12
Min
0
15
30
45
How much time does your child spend in sleep during the DAY (between 7 in the moring and 7 in the evening):
Hours
0
1
2
3
4
5
6
7
8
9
10
11
12
Min
0
15
30
45
Average number of night-wakings per night:
-Select-
0
1
2
3
4
5
6
7
8
9
10
more
How much time during the night does your child spend in wakefulness (from 10 in the evening to 6 in the morning) :
Hours
0
1
2
3
4
5
6
7
8
Min
0
15
30
45
How long does it take to put your baby to sleep in the evening:
-Select-
0-5 min
6-15 min
16-30 min
30-60 min
1 hour or longer
How does your baby fall asleep:
-Select-
While feeding
Being rocked
Being held
In bed alone
In bed near parent
When does your baby usually fall asleep for the night:
Hours
5pm
6pm
7pm
8pm
9pm
10pm
11pm
12pm
01am
02am
Min
0
15
30
45
Do you consider your child's sleep as a problem:
-Select-
A very serious problem
A small problem
Not a problem at all
