Children & Adolescents Clinic

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Clinical Reference Systems: Pediatric Advisor 10.0
Illustration

Sleep Diary

For a sleep diary chart, click here

If your child has a sleep problem, please collect the following information for three nights before you make an initial or follow-up appointment. This information will be very useful for designing an appropriate treatment plan.

MORNING AWAKENING (TIME):

Nap 1

  1. Asleep at (time):

  2. What you did:

  3. How long your child slept (minutes):

    Nap 2

  4. Asleep at (time):

  5. What you did:

  6. How long your child slept (minutes):

EVENING BEDTIME

  1. Asleep at (time):

  2. How long it took to go to sleep (minutes):

  3. What you did:

NIGHT AWAKENING 1

  1. Awake at (time):

  2. How long your child was awake (minutes):

  3. What you did:

NIGHT AWAKENING 2

  1. Awake at (time):

  2. How long your child was awake (minutes):

  3. What you did:


Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright 1999 Clinical Reference Systems