Little Dream Zone

Sleep assessment

This questionnaire helps me understand your child and their sleep before we speak. It takes about 30–40 minutes. Answer as much as you can; only questions marked * are required. If you're not sure, a rough answer is fine.

Your answers are private. They are encrypted on your own device before they are sent, and only your consultant can unlock them. Nobody else can read them, including the website host. No cookies or tracking are used on this page. Read the privacy notice.

Your answers are kept in this browser tab while you fill it in, so a page refresh won't lose them. They are cleared when you close the tab or send the form.

About you and your family
Does your child live with both parents?
Do both parents currently work?
For example: shift work, early starts, working from home, a return-to-work date.
Your baby
First name only, please.
So the advice suits their exact age.
If your baby arrived early or late, this helps me work out their adjusted age.
Type of birth
Only share what you're comfortable with.
Does your child have any brothers or sisters?
For example: shares a room with a 4-year-old who wakes early.
Health

This helps me make sure the plan is safe and suitable. Share only what you're comfortable with.

Does your child have any long-term or recent health issues or diagnoses?
Any signs of tongue tie?
Any signs of reflux or colic?
Any allergies or intolerances?
Eczema or any other skin condition?
Is your child on any prescribed medication, including prescribed formula?
Is your child taking any medication to help them sleep?
Any vaccinations in the last few weeks?
How many courses of antibiotics has your child had?
Feeding
How is your child fed?
If breastfed, just the number of feeds is fine.
Does your child seem uncomfortable during or after feeds?
Has your child started solid food?
Development and personality
Would you say your child is early, average or late with their milestones?
For example: rolling, crawling, standing, teething, a growth spurt.
For example: swimming Tuesday 10am, baby sensory Friday 11am.
Signs during sleep

Some signs are worth checking with a GP before sleep work starts, so please tick anything you've noticed.

Have you noticed any of these?
For example: how often, how loud, day or night.

If you notice pauses in breathing, gasping or very laboured breathing, please speak to your GP. Call 999 if your child is struggling to breathe.

The sleep problem
For example: illness, teething, a holiday, a new sibling, returning to work.
For example: a hospital stay, a house move, a family separation or loss.
Your parenting style
For example: attachment parenting, gentle parenting, routine-based, no particular style.
Which approach feels right for you?
For example: co-sleeping, late family meals, religious festivals.
Sleep environment
Where does your child sleep at night?
Cot or bed, blackout blinds, white noise, night light, temperature, sleeping bag, anything that might disturb them.
For example: at a grandparent's, the other parent's home.
TV, tablet, phone, including screens on in the background.
Daytime and naps
For example: 9.30am for 40 minutes in the cot; 1pm for 1½ hours in the pram.
If they go to nursery or a childminder, are nap times…
Evenings and bedtime
Including dinner time and the last milk feed.
Is your child put into bed awake, drowsy or already asleep?
How does your child usually fall asleep at bedtime?
For example: waking again after 15–45 minutes, lots of wriggling, very long to settle.
Night-time
Roughly when they wake, how long they're awake, and how you settle them back to sleep each time.
When they wake at night, what usually gets them back to sleep? Tick all that apply.
Do you track sleep or feeds in an app?
Anything else
Consent

Sleep consultancy is not a medical service. If you're worried about your child's health, contact your GP, health visitor or NHS 111. In an emergency call 999.