Welcome, Please take a few minutes to answer some up-to-date questions about your child and their sleep habits before we talk again on our phone-call. This enable us to make the best use of our time together. If you open this on a computer, you can just type the answers, save it, and return it as an attachment back to me (lynsey@flutterbysleepconsultancy.com)
Full Name
Email*
How old is your child now?
Are there any health issues or concerns? Are they being treated, or have they been resolved?
Does your child snore of mouth breath most of the time
Yes
No
Is your child on any medication currently? If so, what, and what is it to treat?
What developmental milestones are they working on?
Standing
Walking
Speech
Others
Where does your child now sleep, and on what?
Cot
Bed
Shared Room with Sibling
Own Room
Your Bed
Other
What time does your child wake to start his/her day?
What happens at this time?
Bottle
Breastfeed
Solids
Play
TV
Other
If napping during the day, what time are naps and how long do they last? (A sleep log for 2-3 days would help immensely to visualise their day and see where improvements could be made)
Where do naps take place?
Cot
Bed
Shared Room with Sibling
Own Room
Your Bed
Other
Describe the hour before nap and your nap routine?
How do they get to sleep for naps?
Independently
Dummy
Rocking
Holding
Feeding to Sleep
Bedsharing
Car
Pram
How long does it take them to drift off to sleep?
Do you allow a 10-minute wait if your little one wakes early from a nap (under one hour long)?
What time do you start getting your son/daughter ready for bed?
What happens the hour before bed?
Describe your bedtime routine order? (For example: bath, brush teeth, sing songs, massage, read stories, play a game, feed, medications etc.)
What time does your child actually fall asleep at bedtime?
How does your child fall asleep at this time?
How are the nights now?
Sleeps Through
1 Night Wake
Multiple Night Wakes
Early Morning Wakes
How do you handle any cries/upset in the night currently?
Have any “props” been re-introduced – dummy/ rocking/ feeding to sleep/ bedsharing?
What is your current issue/s in relation to sleep?
Cooperation at bedtime
Won’t stay in bed
Cries a lot around bedtime
Won’t go to sleep independently
Night wakes or early wake up’s
Nap reluctance
Feeds reintroduced
Other
How long has this been happening?
Did anything trigger the changes?
Holiday
Illness
Sibling born
Moved room at nursery
Moved provider
Bereavement in family
Relationship breakdown
Moved house
Other
Can you describe what milk and solid food consumption looks like for your child through the day with times (and night). E.g. milk feeds, whether breast or bottle, and solid food times and amounts. Appetite etc.
What is the family’s weekly schedule? What day/s is your child at home/ other care-givers / nursery/ daytime classes and what times are they from and to.
Does your child watch a TV/computer/tablet? If so at what time of the day usually/how long for?
Is there anything else you would like to share with me that you think I should know?
Please provide me with your current home address so that I can update my records and keep in touch with you/ send any thank you referral gift cards:
That's it – you made it! Thanks in advance for getting this back to me, and I look forward to our call and getting you back on track.
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