{"id":160,"date":"2017-05-16T15:39:33","date_gmt":"2017-05-16T20:39:33","guid":{"rendered":"http:\/\/dentalsleeppros.net\/?page_id=160"},"modified":"2017-05-25T05:47:29","modified_gmt":"2017-05-25T10:47:29","slug":"pediatric-sleep-questionnaire","status":"publish","type":"page","link":"https:\/\/www.kempdesignservices.com\/dentalsleeppros\/pediatric-sleep-questionnaire\/","title":{"rendered":"Pediatric Sleep Questionnaire"},"content":{"rendered":"

Please answer the following questions as they pertain to your child in the past month<\/em><\/strong>. For this questionnaire, the word “usually” means “more than half the time” or “on more than half the nights.”<\/p>\n\n

\n

<\/p>

    <\/ul><\/div>\n
    \n
    \n\n\n\n\n\n\n<\/div>\n
    \n\t

    Your Name: \n\t<\/p>\n\t

    Your Email: \n\t<\/p>\n\t

    Phone:    \n\t<\/p>\n\t

    Child's Name: \n\t<\/p>\n\t

    Child's Date of Birth: \n\t<\/p>\n\t

    1. When sleeping, does your child:<\/strong>\n\t<\/p>\n\t

      \n\t\t
    • \n\t\t\t

      Snore more than half the time?\n\t\t\t<\/p>\n\t\t\t

      \n\t\t\t\t

      YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t\t

    • \n\t\t\t

      Always snore?\n\t\t\t<\/p>\n\t\t\t

      \n\t\t\t\t

      YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t\t

    • \n\t\t\t

      Snore loudly?\n\t\t\t<\/p>\n\t\t\t

      \n\t\t\t\t

      YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t\t

    • \n\t\t\t

      Have \"heavy\" or loud breathing?\n\t\t\t<\/p>\n\t\t\t

      \n\t\t\t\t

      YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t\t

    • \n\t\t\t

      Have trouble breathing, or struggle to breath?\n\t\t\t<\/p>\n\t\t\t

      \n\t\t\t\t

      YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t<\/ul>\n\t

      \n\t\t

      2. Have you ever seen your child stop breathing during the night?<\/strong>\n\t\t<\/p>\n\t\t

      \n\t\t\t

      YesNoDon't Know\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t

      3. Does your child:<\/strong>\n\t<\/p>\n\t

        \n\t\t
      • \n\t\t\t

        Tend to breathe through the mouth during the day?\n\t\t\t<\/p>\n\t\t\t

        \n\t\t\t\t

        YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t\t

      • \n\t\t\t

        Have a dry mouth on waking up in the morning?\n\t\t\t<\/p>\n\t\t\t

        \n\t\t\t\t

        YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t\t

      • \n\t\t\t

        Occasionally wet the bed?\n\t\t\t<\/p>\n\t\t\t

        \n\t\t\t\t

        YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t<\/ul>\n\t

        4. Does your child:<\/strong>\n\t<\/p>\n\t

          \n\t\t
        • \n\t\t\t

          Wake up feeling unrefreshed in the morning?\n\t\t\t<\/p>\n\t\t\t

          \n\t\t\t\t

          YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t\t

        • \n\t\t\t

          Have a problem with sleepiness during the day?\n\t\t\t<\/p>\n\t\t\t

          \n\t\t\t\t

          YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t<\/ul>\n\t

          \n\t\t

          5. Has a teacher or other supervisor commented that your child appears sleepy during the day?<\/strong>\n\t\t<\/p>\n\t\t

          \n\t\t\t

          YesNoDon't Know\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t

          \n\t\t

          6. Is it hard to wake your child up in the morning?<\/strong>\n\t\t<\/p>\n\t\t

          \n\t\t\t

          YesNoDon't Know\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t

          \n\t\t

          7. Does your child wake up with headaches in the morning?<\/strong>\n\t\t<\/p>\n\t\t

          \n\t\t\t

          YesNoDon't Know\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t

          \n\t\t

          8. Did your child stop growing at a normal rate at any time since birth?<\/strong>\n\t\t<\/p>\n\t\t

          \n\t\t\t

          YesNoDon't Know\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t

          \n\t\t

          9. Is your child overweight?<\/strong>\n\t\t<\/p>\n\t\t

          \n\t\t\t

          YesNoDon't Know\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t

          \n\t\t

          10. Has your child been diagnosed with ADHD or taking Ritalin?<\/strong>\n\t\t<\/p>\n\t\t

          \n\t\t\t

          YesNoDon't Know\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t

          11. Does your child often:<\/strong>\n\t<\/p>\n\t

            \n\t\t
          • \n\t\t\t

            Wake up feeling unrefreshed in the morning?\n\t\t\t<\/p>\n\t\t\t

            \n\t\t\t\t

            YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t\t

          • \n\t\t\t

            Have a problem with sleepiness during the day?\n\t\t\t<\/p>\n\t\t\t

            \n\t\t\t\t

            YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t\t

          • \n\t\t\t

            Is easily distracted by extraneous stimuli?\n\t\t\t<\/p>\n\t\t\t

            \n\t\t\t\t

            YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t\t

          • \n\t\t\t

            Fidgets with hands or feet, or squirms in seat?\n\t\t\t<\/p>\n\t\t\t

            \n\t\t\t\t

            YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t\t

          • \n\t\t\t

            Is \"on the go\" or often acts as if \"driven by a motor\"?\n\t\t\t<\/p>\n\t\t\t

            \n\t\t\t\t

            YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t\t

          • \n\t\t\t

            Interrupts or intrudes on others (e.g. butts into conversations or games)?\n\t\t\t<\/p>\n\t\t\t

            \n\t\t\t\t

            YesNoDon't Know\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/li>\n\t<\/ul>\n\t


            \n
            \n
            \n<\/span>\n\t<\/p>\n\t

            \n\t<\/p>\n<\/div>

            <\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"

            Please answer the following questions as they pertain to your child in the past month. For this questionnaire, the word “usually” means “more than half the time” or “on more than half the nights.”<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":" Quiz: Is your Child at Risk of sleep disordered breathing?","_seopress_titles_desc":"Wetting the Bed, ADHD and being sleepy all the time are risk factors for sleep disordered breathing. Take the quiz to see if your child is at risk and get help.","_seopress_robots_index":"","footnotes":""},"class_list":["post-160","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.kempdesignservices.com\/dentalsleeppros\/wp-json\/wp\/v2\/pages\/160","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.kempdesignservices.com\/dentalsleeppros\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.kempdesignservices.com\/dentalsleeppros\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.kempdesignservices.com\/dentalsleeppros\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.kempdesignservices.com\/dentalsleeppros\/wp-json\/wp\/v2\/comments?post=160"}],"version-history":[{"count":17,"href":"https:\/\/www.kempdesignservices.com\/dentalsleeppros\/wp-json\/wp\/v2\/pages\/160\/revisions"}],"predecessor-version":[{"id":230,"href":"https:\/\/www.kempdesignservices.com\/dentalsleeppros\/wp-json\/wp\/v2\/pages\/160\/revisions\/230"}],"wp:attachment":[{"href":"https:\/\/www.kempdesignservices.com\/dentalsleeppros\/wp-json\/wp\/v2\/media?parent=160"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}