This questionnaire will allow your orthodontist to have a better understanding of the sleep-wake rhythm of your child and of any problems in his/her sleep behaviour.
Answer every question; in answering, consider each question as pertaining to the past 6 months of the child’s life. Please answer the questions by selection which one is most accurate.
1= Never
2= Occasionally (once or twice per month or less)
3= Sometimes (once or twice per week)
4= Often (3-4 times per week)
5= Always (daily)

Your child has difficulty breathing in the night

The child gasps for breath or is unable to breathe during sleep

The child snores

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