Creating Beautiful Smiles for Life

Sleep Disturbance Questionnaire for Children

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.

Your child has difficulty breathing in the night

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

The child snores