Newborn Sleep Questionnaire

Thank you for choosing Live Love Sleep® to support you on your child’s sleep journey. To help your sleep consultant create the best plan that will work for your family, please set aside 15-20 minutes to complete the Preliminary Sleep Questionnaire below based on your child’s age.

Preliminary Newborn Sleep Questionnaire

I’d like to ask you to take a 15-20 minutes to answer some questions about your little ones’ sleep habits, which will allow me to learn more about their current struggles and specifically what I can do to support you on your journey to sleep.

Email*

What is your newborn's full name?*

Does your baby go by a different name or a nickname? If so, what name does your newborn go by?

What are parent's names?*

Does your newborn have any siblings? What are their names and ages?*

How old is your newborn baby?*

What is your newborn's Date of Birth?*

Was your newborn born premature? If so, what was their gestational age?*

Have there been any health issues or concerns with your newborn?*

Have you spoken to your newborn's pediatrician about the sleep difficulties you are experiencing?*

Who is your newborn's pediatrician?

Does your newborn snore?*

What type of milk does your newborn drink (breastfed, formula fed, whole milk, other)? *

Approximately how many ounces of milk does your newborn drink?*

Does your newborn use any of the following with regards to sleep?*

Pacifier

Night light

Sound machine

Music

Room darkening shades / curtain

Does your newborn rely on any of the following to fall asleep?*

Feeding - breast or bottle

Rocking

Bouncing

Needing to be held

Co-sleeping / sleeping in bed with you

Singing

Lovey / stuffed animal / blanket

How do you dress your newborn to sleep?*

Pajamas

Onesie or regular clothes

Swaddle

Sleep sack

How dark is your newborn's room on a scale of 1 (being light) and 10 (being pitch black) in the early morning hours and for naps?*

What is the temperature in your newborn's room when they sleep?*

How many naps a day is your newborn taking?*

How long do your newborn's naps usually last? *

Ideally, what time would you like your newborn to start their day?*

What time does your newborn actually wake up to start the day?*

What happens at this time? Is your baby given a bottle, breastfeed, other activities, etc. *

What time do you start getting your newborn ready for bed?*

What is your current bedtime routine with your baby? (bath, brush teeth, sing songs, read stories, prayers, etc)*

What time does your newborn actually fall asleep at bedtime?*

What happens with your newborn's sleep during the night - best case scenario?*

What happens with your newborn's sleep during the night - worse case scenario?*

What is/are the most difficult issue(s) around your newborn's sleep? *

Night wakings

Won't go to sleep on their own

Needs you in order to go back to sleep

Early morning wakings

Isn't easy to get down for a nap

Gets overtired easily

Going down at bedtime

Won't stay in their crib/bassinet

Has your family experienced major life changes, loss, or trauma?*

Is your newborn under the care of a nanny or daycare?*

At home with me

Daycare

Nanny / sitter / family member

Is there any personal history or are you currently struggling with depression, anxiety or major illness?*

What is the family’s daily schedule? Do you or your partner work full time/part time in the home or outside the home? Do you have activities that you have to take your newborn or siblings to during the day or night?*

If doing a virtual consultation, which format would you prefer?*

Phone call

FaceTime

Zoom

WhatsApp Video

N/A - Doing an in-home consultation

If referred, please provide me with the name of your referral so I can thank them

Please provide me with your mailing address and phone number so that I can keep in touch*

Is there anything else you would like me to know about your newborn before our consultation?