Child Sleep Apnea Questionnaire

    Answer the questions below about your child to assess potential sleep-related breathing disorders.

    While sleeping, does your child…
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    Have you ever…
    YesNo
    Does your child…
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    Does your child…
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    This child often…
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo

    ***More than 8 positive responses may indicate a problem with sleep related breathing disorder***