CSHQ

Child's Sleep Habits Questionnaire

Instructions

The following statements are about your child's sleep habits and possible difficulties with sleep. Think about the past week in your child's life when answering the questions.

Answer USUALLY if something occurs 5 or more times in a week

Answer SOMETIMES if it occurs 2-4 times in a week

Answer RARELY if something occurs never or 1 time during a week

Also, please indicate whether or not the sleep habit is a problem by selecting "Yes," "No," or "Not applicable (N/A)."

Bedtime
1. Child goes to bed at the same time at night
2. Child falls asleep within 20 minutes after going to bed
3. Child falls asleep alone in own bed
4. Child falls asleep in parent's or sibling's bed
5. Child falls asleep with rocking or rhythmic movements
6. Child needs special object to fall asleep (doll, special blanket, etc.)
7. Child needs parent in the room to fall asleep
8. Child is ready to go to bed at bedtime
9. Child resists going to bed at bedtime
10. Child struggles at bedtime (cries, refuses to stay in bed, etc.)
11. Child is afraid of sleeping in the dark
12. Child is afraid to sleep alone
Sleep Behavior
hours minutes
13. Child sleeps too little
14. Child sleeps too much
15. Child sleeps the right amount
16. Child sleeps about the same amount each day
17. Child wets the bed at night
18. Child talks during sleep
19. Child is restless and moves a lot during sleep
20. Child sleepwalks during the night
21. Child moves to someone else's bed during the night (parent, brother, sister, etc.)
22. Child reports body pains during sleep
23. Child grinds teeth during sleep
24. Child snores loudly
25. Child seems to stop breathing during sleep
26. Child snorts and/or gasps during sleep
27. Child has trouble sleeping away from home
28. Child complains about problems sleeping
29. Child awakens during night screaming, sweating, and inconsolable
30. Child awakens alarmed by a frightening dream
Waking During the Night
31. Child awakes once during the night
32. Child awakes more than once during the night
33. Child returns to sleep without help after waking
Morning Waking
34. Child wakes up by him/herself
35. Child wakes up with alarm clock
36. Child wakes up in negative mood
37. Adults or siblings wake up child
38. Child has difficulty getting out of bed in the morning
39. Child takes a long time to become alert in the morning
40. Child wakes up very early in the morning
41. Child has a good appetite in the morning
Daytime Sleepiness
42. Child naps during the day
43. Child suddenly falls asleep in the middle of active behavior
44. Child seems tired
Sleepiness During Activities

During the past week, your child has appeared very sleepy or fallen asleep during the following activities:

45. Play alone
46. Watching TV
47. Riding in car
48. Eating meals

Child's Sleep Habits Assessment Results

Total CSHQ Score

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Bedtime Resistance

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Sleep Onset Delay

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Sleep Duration

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Sleep Anxiety

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Night Wakings

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Parasomnias

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Sleep Disordered Breathing

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Daytime Sleepiness

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Clinical Interpretation

Overall Sleep Assessment:

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Sleep Pattern Analysis:

  • Sleep pattern analysis will appear here

Recommendations:

  • Recommendations will appear here

Important Disclaimer

This questionnaire is a screening tool and should not be used as a substitute for professional medical evaluation. If you have concerns about your child's sleep patterns, please consult with a qualified healthcare provider or sleep specialist for comprehensive assessment and appropriate treatment recommendations.