Child’s Due Date (if under 12 months of age)

Child’s Birth Date (if under 12 months of age)

How long did it take your child to regain birth weight? (if under 12 months of age)

Does your child snore?*

YesNo

What does your child sleep in – cot, bed, hammock, bassinet, family bed?*

Please describe what your child sleeps in – sleeping bag, swaddle, blankets, pyjamas?*

Is baby swaddled? If so, what type / brand of swaddle do you use? (if under 12 months of age)

Does your child sleep with any props, e.g. dummy, safety sleep, hammock, comfort toy?

Where does your child sleep for naps and overnight?*

Describe the sleep environment, e.g. room is brightly lit or dark, lots of toys, quiet or noisy?*

Does your child have a pre-sleep routine or ritual? If yes, please describe this.

How is your child fed, e.g. Breast milk, formula, or a combination of both?*

If your child is formula fed please list volume per feed and how many feeds per day.

If breastfed, are there any concerns, e.g. fussiness, poor latch, short feeds?

If your child is eating solids please explain what your child is eating, at what times and how much.

Do you work outside the home? If yes, who looks after your child, how do they get your child to sleep and at what times?

Please describe your child’s naps – when and for how long?*

How do you settle your child for a nap?*

How do you settle your child to sleep at night and what time is bedtime?*

If your child wakes at night how do you settle them back to sleep and how often do they wake?*

What time does your child wake in the morning?*

What are your concerns regarding your child’s naps and night sleep? What would you like to work on solving?*

Have you tried anything to solve this? If so, what was the result?

Does your child have any medical conditions, or do you have any current health concerns?

Does your child have any known allergies?

Please describe your child’s temperament and personality – e.g. easygoing, fussy, grumpy etc?*

Please briefly describe your parenting style – do you prefer to have flexibility or do you like routine and strict guidelines? Would you consider yourself an attachment parentAttachment parenting is a parenting philosophy that proposes methods aiming to promote the attachment of parent and infant not only by maximal parental empathy and responsiveness but also by continuous bodily closeness and touch. More?*

Do you have regular commitments that require you to be out of the house at certain times, e.g. school run, kindy drop offs and pick-ups? If so, please state what time you leave the house and when you are back at home.

Please describe your child’s development – are they reaching age appropriate milestones? Smiling, reaching, laughing, rolling, sitting unassisted, crawling, standing, walking etc?*

Please describe a typical day from wakeup to bedtime – include feed times, sleep times, activity etc*

Please describe a typical night from bedtime to wake up, including times – how often does your baby wake up, at what times, when do you feed them, how are they settled back to sleep etc*