1. Have you ever seen your child stop breathing during the night?
2. Snore more than half the time?
4. Have "heavy" or loud breathing?
5. Have trouble breathing or struggle to breathe?
6. Tend to breathe through their mouth during the day?
7. Have a dry mouth on waking in the morning?
8. Occasionally wet the bed?
9. Wake up feeling unrefreshed in the morning?
10. Have a problem with sleepiness during the day?
11. Have a teacher or other supervisor who commented that your child sleeps during the day?
12. Find it hard to wake up in the morning?
13. Wake up with headaches in the morning?
III. Did your child stop growing at a normal rate at any time since birth?
IV. Is your child overweight?
1. Does not seem to listen when spoken to directly.
2. Has difficulty organizing tasks and activities.
3. Is easily distracted by extraneous stimuli.
4. Fidgets with hands or feet or squirms in seat.
5. Is 'on the go' or often acts as if 'driven by a motor.'
6. Interrupts or intrudes on others (e.g. butts into conversations or games).
IF YOU ANSWERED YES TO ANY OF THE QUESTIONS ABOVE, YOUR CHILD MAY BE AT RISK OF SLEEP APNEA
Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.
