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BISQ R Short Mar 2020 Final 1

This document is a 20-question survey that asks caregivers about their infant's sleep patterns over the past two weeks. It inquires about bedtime routines, where the infant falls asleep, night wakings, total sleep times, and whether caregivers consider the infant's sleep a problem. The survey is intended to assess aspects of an infant's sleep such as bedtime behaviors, sleep location, night wakings, and caregivers' perceptions of any sleep problems.

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212 views4 pages

BISQ R Short Mar 2020 Final 1

This document is a 20-question survey that asks caregivers about their infant's sleep patterns over the past two weeks. It inquires about bedtime routines, where the infant falls asleep, night wakings, total sleep times, and whether caregivers consider the infant's sleep a problem. The survey is intended to assess aspects of an infant's sleep such as bedtime behaviors, sleep location, night wakings, and caregivers' perceptions of any sleep problems.

Uploaded by

suziza asrina
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Brief Infant Sleep Questionnaire – Revised

Short Form

Please answer a few questions about your family.

1. What is your relationship to your child?


□ Mother □ Grandparent
□ Father □ Other
2. What is the highest degree that you completed?
□ Less than high school/secondary
□ High school/secondary
□ College/university
□ Graduate (e.g., MS, MD, JD, Ph.D.)
□ Prefer not to answer
3. How old is your child (in months)?
________months
4. Was your child premature (born before 37 weeks’ gestation)?
□ Yes
□ No
□ I don’t know
5. My child’s biological sex is
□ Male
□ Female
□ Intersex
6. In which country/region do you currently reside?

Country/region: __________________________

7. How many nights per week are you involved with your child at bedtime and/or
overnight?
□ 0 □ 1 □ 2 □ 3 □ 4 □ 5 □ 6 □ 7 nights

Page 1 of 4
Please think about your child’s sleep during the past two weeks in answering the
following questions.

1. What time do you usually start your child’s bedtime routine (start getting your child
ready for bed)?
Example: 7:45 PM would be written as _____7_:_45_PM

I start getting my child ready for bed at _______:_______

2. In a typical week, how often does your child have the exact same bedtime routine?
□0 □1 □2 □3 □4 □5 □6 □ 7 nights
3. Where does your child usually fall asleep at bedtime?
□ Crib □ Bassinet/infant seat
□ Own bed (any size) □ Swing/stroller
□ Parents’ bed □ Parent’s/adult’s arms
□ Co-sleeper (attached to parents’ bed) □ Other
4. How does your child usually fall asleep at bedtime?
□ While being held or rocked
□ With an adult in the room, but not being held or rocked
□ On own (without an adult in the room)
5. At bedtime, does your child usually fall asleep while breastfeeding, bottle feeding, or
drinking from a sippy cup?
□ Yes
□ No
6. What time do you usually put your child to bed at night (lights out)?
Example: 8:30 PM would be written as ____8__:_30_PM

I put my child to bed at _______:_______

7. Typically, how difficult is bedtime?


□ Very easy
□ Somewhat easy
□ Neither easy nor difficult
□ Somewhat difficult
□ Very difficult

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8. How long does it usually take your child to fall asleep?
Example: If you put your child to bed at 6:30 pm and your child falls asleep at 8:00 pm, it
takes 1 hour and 30 minutes for your child to fall asleep.

_________ hours
_________ minutes

9. In what room does your child sleep for most of the night?
□ In his/her own room □ In sibling’s or other bedroom
□ In parents’ room □ In another room of the house
10. Where does your child sleep for most of the night?
□ Crib □ Bassinet/infant seat
□ Own bed (any size) □ Swing/stroller
□ Parents’ bed □ Other
□ Co-sleeper (attached to parents’ bed)
11. How many times does your child usually wake during the night?

_______ times per night

12. When your child wakes up during the night, what do you usually do?
(check all that apply)
□ Pick up my child and put him/her □ Breastfeed/nurse my child back to
back down while still awake sleep
□ Bottle feed or give a sippy cup to □ Play with my child, watch TV, or
put my child back to sleep use/show smartphone/tablet
□ None of these
13. How much total time during the NIGHT is your child usually awake (between when
your child goes to bed and wakes for the day)?
Example: If your child wakes up 2 times and is awake for about 15 minutes each time,
your child’s total time spent awake is 30 minutes. In that case, write “0 hours, 30
minutes.”
________ hours
________ minutes

14. What is the longest stretch of time that your child is asleep during the NIGHT without
waking up?

________ hours
________ minutes

15. What time does your child wake up in the morning?

My child wakes up at _______:_______

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16. How much total time does your child spend sleeping during the NIGHT (between
when your child goes to bed and wakes for the day)?
Example: If your child sleeps for 3 hours, wakes up, then sleeps for 5 hours and 30
minutes more, your child sleeps for 8 hours and 30 minutes total.

________ hours
________ minutes

17. How well does your child usually sleep at night?


□ Very well
□ Well
□ Fairly well
□ Poorly
□ Very poorly
18. On a typical DAY, how many naps does your child take (between when your child
wakes for the day and goes to bed at night)?

________ naps

19. How much total time does your child spend sleeping during the DAY (between when
your child wakes for the day and goes to bed at night)?
Example: If your child took 2 naps and slept 1 hour each time, your child’s total time
spent sleeping during the day is 2 hours.

________ hours
________ minutes

20. Do you consider your child’s sleep a problem?


□ Not a problem at all
□ A very small problem
□ A small problem
□ A moderate problem
□ A serious problem

Avi Sadeh, D.Sc., Jodi A. Mindell, Ph.D., and Liat Tikotzky, Ph.D.
Brief Infant Sleep Questionnaire – Revised Short Form, version Mar 2020 Page 4 of 4

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