Sleep Questionnaire

At four months, many parents are ready to begin establishing routines and strategies for managing their baby's sleep. Your baby is probably sleeping for longer periods and may even sleep through the night. Babies continue to cycle through periods of deep sleep and light sleep (REM sleep). Some babies may fall asleep at about the same time each night and sleep for about the same amount of time no matter what you do. Other babies are sensitive to noise and other changes. During light sleep your baby may move, cry out, or wake up. Your baby can learn to self calm to get back to sleep, especially if he is used to falling asleep in the crib.

At times you may need to help your baby calm down and return to sleep. Helping your baby manage light and deep sleep cycles allows her—and you—to sleep through the night! If your baby is fussy or wakes at night, give her a few minutes to calm herself before you take over. This may be easier to do if your baby associates falling asleep with being in her crib rather than in your arms. You can also help your baby discover ways to self calm without leaving your baby to "cry it out".

Which statement(s) best describe your baby's sleep patterns?

	My baby falls asleep after a bed time routine and sleeps for 5-7 hours.
	My baby wakes up every few hours during the night.
	My baby has difficulty falling asleep and is easily disturbed from sleep.
	I can't predict when my baby will fall asleep but once asleep he/she will stay asleep for 5-7 hours.
	Other__________________________________

My baby sleeps:

in the same bed with me	in a crib in the same room
in a crib in his/her own room	Other_______________________

I think my baby is:

easy to calm	hard to calm
easily overstimulated	active
Other__________________________________

The things that disturb my baby's sleep are:

any sound, even very soft sounds	radio or TV
people talking	phone ringing
Other__________________________________

When my baby wakes up he/she is usually:

fussy	crying
hungry	alert but quiet
alert and active	smiling when I approach
Other__________________________________

My baby can help calm him/herself to sleep by:

sucking on thumb or fingers	holding a favorite blanket or soft toy
sucking on a pacifier	Other_______________________

When my baby needs help at night to calm down I:

pick him/her up	try talking and gently rubbing his/her back
let him/her cry before I go in	give him/her a pacifier or a bottle
Other__________________________________

I feel the best way to help my baby sleep through the night is to:

	stick to the same bedtime routine
	feed my baby shortly before putting him/her to bed
	let my baby cry him/herself to sleep
	comforting my baby whenever it's needed
	nothing I do seems to help
	Other__________________________________

BUSM©. Department of Pediatrics, Boston Medical Center.