| Variables in Child Sleep Habit Questionnaire (CSHQ) | ||||
| Question# | Question | Field name | Response nature | Response options |
| 1 | Participant ID | PID | ### | |
| 2 | Child ID | csq_A | 9### | |
| 3 | Initials of the child | csq_B | XX | |
| 4 | Researcher's code | csq_C | ## | |
| 5 | Date of interview | csq_D | ##-XXX-## | dd-mmm-yy |
| 6 | Age of the child | csq_E | ## | |
| Bedtime | ||||
| 7 | Weeknights…………../………am/pm | ##:## | hh:mm | |
| 8 | Weekends…………../……… am/pm | ##:## | hh:mm | |
| 9 | Child goes to bed at the same time at night. | csq_1 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 10 | Child falls asleep within 20 minutes after going to bed. | csq_2 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 11 | Child falls asleep alone in own bed. | csq_3 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 12 | Child falls asleep in parent’s or sibling’s bed | csq_4 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 13 | Child falls asleep with rocking or rhythmic movements. | csq_5 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 14 | Child needs special objects to fall asleep (doll, special blanket, stuffed animals, etc). | csq_6 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 15 | Child needs parent in the room to fall asleep. | csq_7 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 16 | Child resists going to bed at bedtime. | csq_8 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 17 | Child is afraid of sleeping in the dark. | csq_9 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| Sleep behavior | ||||
| 18 | Write in your child’s usual amount of sleep each day (combining nighttime sleep and naps) ……..hours and…….minutes | ##:## | hh:mm | |
| 19 | Child sleeps about the same amount each day. | csq_10 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 20 | Child is restless and moves a lot during sleep. | csq_11 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 21 | Child moves to someone else’s bed during the night (parents, siblings, etc). | csq_12 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 22 | Child grinds teeth during sleep (your dentist may have told you this). | csq_13 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 23 | Child snores loudly. | csq_14 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 24 | Child awakens during night screaming, sweating, and inconsolable. | csq_15 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 25 | Child naps during the day. | csq_16 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 26 | Child wakes up once during the night. | csq_17 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 27 | Child wakes up more than once during the night. | csq_18 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| Morning wakeup time | ||||
| Write in the time child usually wakes up in the morning : | ||||
| 28 | Weekdays……../………am/pm | ##:## | hh:mm | |
| 29 | Weekends……./………am/pm | ##:## | hh:mm | |
| 30 | Child wakes up by him/herself. | csq_19 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 31 | Child wakes up very early in the morning (or, earlier than necessary or desired). | csq_20 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 32 | Child seems tired during day time. | csq_21 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 33 | Child falls asleep while involved in activities. | csq_22 | # | 1=Always, 2=Usually, 3=Sometimes, 4=Rarely, 5=Never |
| 34 | Remarks: | TXT | ||