BSQ_1 |
Initials of the child |
BSQ_2 |
Field Worker code |
BSQ_3 |
Date of Interview DDMMYY |
BSQ_4 |
Sleeping arrangement: 1=Infant
crib in a separate room , 2=Infant crib in parents’ room, 3=In parents’ bed,
4=Infant crib in room with sibling, 5=Other, Specify: |
BSQ_4i |
If others, Specify |
BSQ_5 |
In what position does your
child sleep most of the time? 1=On
his/her belly, 2=On his/her side, 3=On his/her back |
BSQ_6 |
How much time does your child
spend in sleep during the NIGHT (between 7 in the evening and 7 in the
morning)? Hours: ______ Minutes: ______ |
BSQ_7 |
How much time does your child
spend in sleep during the DAY (between 7 in the morning and 7 in the
evening)? Hours: ______ Minutes: _______ |
BSQ_8 |
Average number of night waking
per night: |
BSQ_9 |
How much time during the night
does your child spend in wakefulness (from 10 in the evening to 6 in the
morning)? Hours: ______ Minutes: ______ |
BSQ_10 |
How long does it take to put
your baby to sleep in the evening? Hours: ______ Minutes: ______ |
BSQ_11 |
How does your baby fall asleep?
1=While feeding, 2=Being rocked, 3=Being held, 4=In bed alone, 5=In bed near
parent |
BSQ_12 |
When does your baby usually
fall asleep for the night: Hours: ______ Minutes: ______ |
BSQ_13 |
Do you consider your child’s
sleep as a problem? (1=A very serious problem, 2=A small problem, 3=Not a problem at all) |
BSQ_13i |
If yes, Specify |
|
|