Children'S Sleep Habits Questionnaire Page 2
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1
2NICHD SECCYD—Wisconsin
7
5-6
2-4
1
0
Always
Usually
Sometimes
Rarely
Never
12. Child moves to someone else’s bed during
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the night (parent, sibling, etc.).
13. Child grinds teeth during sleep (your dentist
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may have told you this).
14. Child snores loudly.
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15. Child awakens during the night and is
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sweating, screaming, and inconsolable.
16. Child naps during the day.
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Write in the number of minutes the nap usually lasts:
_____ minutes
WAKING DURING THE NIGHT
7
5-6
2-4
1
0
Always
Usually
Sometimes
Rarely
Never
17. Child wakes up once during the night.
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18. Child wakes up more than once during the
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night.
MORNING WAKE UP
Write in the time child usually wakes up in the morning:
Weekdays
_____:_____ am/pm
Weekends _____:_____ am/pm
7
5-6
2-4
1
0
Always
Usually
Sometimes
Rarely
Never
19. Child wakes up by him/herself.
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20. Child wakes up very early in the morning (or,
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earlier than necessary or desired).
21. Child seems tired during the daytime.
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22. Child falls asleep while involved in activities.
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