crsheader Index Illustration Thumbnail image of: Sleep Diary Form Sleep Diary

If your child has a sleep problem, collect the following information for 3 nights before you make an initial or follow-up appointment. This information will be very useful for designing an appropriate treatment plan.

Morning Awakening (Time):

Nap 1

  1. Asleep at (time):
  2. What you did:
  3. How long your child slept (minutes):

     

Nap 2

  1. Asleep at (time):
  2. What you did:
  3. How long your child slept (minutes):

Evening Bedtime

  1. Asleep at (time):
  2. How long it took to go to sleep (minutes):
  3. What you did:

Night Awakening 1

  1. Awake at (time):
  2. How long your child was awake (minutes):
  3. What you did:

Night Awakening 2

  1. Awake at (time):
  2. How long your child was awake (minutes):
  3. What you did:

Written by Barton D. Schmitt, MD, author of “My Child Is Sick”, American Academy of Pediatrics Books. Published by RelayHealth.
Last modified: 2006-04-19
Last reviewed: 2010-06-02 This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Pediatric Advisor 2011.4 Index
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