Children's Sleep Habits Questionnaire
Please complete this survey to help assess your child's sleep patterns and routines. Your responses will remain confidential and are intended for general assessment purposes only.
Child's Age Group
*
Please Select
0-2 years
3-5 years
6-8 years
9-12 years
On most nights, what time does your child go to bed?
*
Hour Minutes
AM
PM
AM/PM Option
On most mornings, what time does your child wake up?
*
Hour Minutes
AM
PM
AM/PM Option
How long does it usually take your child to fall asleep after going to bed?
*
Please Select
Less than 15 minutes
15-30 minutes
31-60 minutes
More than 1 hour
Does your child have difficulty falling asleep?
*
Never
Rarely
Sometimes
Often
Always
How often does your child wake up during the night?
*
Never
Once
2-3 times
More than 3 times
How would you rate your child's overall sleep quality?
*
1
2
3
4
5
How consistent is your child's bedtime routine?
*
Very consistent
Somewhat consistent
Inconsistent
Please indicate if your child experiences any of the following during sleep (select all that apply):
Snoring
Sleepwalking
Nightmares
Bedwetting
Restless movements
None of the above
Please share any additional observations or concerns about your child's sleep habits.
Submit
Should be Empty: