ABOUT YOUR CHILD
What is your child’s date of birth? I assume that they will be able to fill in dates vs. check
•YYYY/MM/DD
What is your child’s sex? I would think that "Other" could be deleted without offending especially in a 2-8 year old.
•Male
•Female
•Other:___________
•Prefer not to answer
ADDITIONAL INFORMATION ABOUT YOU
I would think that would be a question about what relation the person completing the survey is to the child? Or many, the heading could say "Additional Information about the person completing the survey for child"
DAYTIME SLEEPINESS
Your child seems tired --This question is confusing to me. What are the numbers for? It just lacks clarity. It does make more sense now that I have read Nighttime ...but since this one comes first, it needs the same instructions added.
Usually (5-7) Sometimes (2-4) Rarely (0-1)
Problem?
Yes No N/A
During the past week, your child has appeared very sleep or fallen asleep during the following Sleep should be sleepy
YOUR CHILD’S HEALTH CONDITIONS
Has a doctor or health care professional ever told you that your child had any of the following, check all that apply:
Allergies Allergies is missing a box
YOUR CHILD’S SLEEP APNEA Either needs a Not Diagnosed option or better yet just a note which says complete only if your child has been diagnosed with Sleep Apnea.
The options under During Sleep and During the day need to be lined up correctly.
If your child had a sleep study, how satisfied were you with the experience that your child had on the night of the study? sleep ? out of place
YOUR CHILD’S SLEEP APNEA TREATMENT (Again a note that says something like "Complete this survey only if your child has been diagnosed with Sleep Apnea.")
How satisfied were you with this treatment? (ques is prompted for each treatment) (Ques??? needs clarity)
YOUR INTEREST IN RESEARCH--Boxes aren't lined up.
CPAP company y Extra Y
