Children'S Sleep Habits Questionnaire
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1
2NICHD SECCYD—Wisconsin
CHILDREN’S SLEEP HABITS QUESTIONNAIRE
(ABBREVIATED)
The following statements are about your child’s sleep habits and possible difficulties with sleep. Think about
the past week in your life when you answer the questions. If last week was unusual for a specific reason, choose
the most recent typical week. Unless noted, check Always if something occurs every night, Usually if it occurs
5 or 6 times a week, Sometimes if it occurs 2 to 4 times a week, Rarely if it occurs once a week, and Never if it
occurs less than once a week.
BEDTIME
Write in your child’s usual bedtime: Weeknights
_____:_____ am/pm
Weekends
_____:_____ am/pm
7
5-6
2-4
1
0
Always
Usually
Sometimes
Rarely
Never
1. Child goes to bed at the same time at night.
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2. Child falls asleep within 20 minutes after
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going to bed.
3. Child falls asleep alone in own bed.
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4. Child falls asleep in parent’s or sibling’s bed.
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5. Child falls asleep with rocking or rhythmic
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movements.
6. Child needs special object to fall asleep (doll,
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special blanket, stuffed animal, etc.).
7. Child needs parent in the room to fall asleep.
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8. Child resists going to bed at bedtime.
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9. Child is afraid of sleeping in the dark.
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SLEEP BEHAVIOR
Write in your child’s usual amount of sleep each day
(combining nighttime sleep and naps):
_____ hours and _____ minutes
7
5-6
2-4
1
0
Always
Usually
Sometimes
Rarely
Never
10. Child sleeps about the same amount each
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day.
11. Child is restless and moves a lot during sleep.
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