BEARS SLEEP SCREENING ALGORITHM Toddler/preschool (2-5 years) School-aged (6-12 years) Adolescent (13-18 years) 1. Bedtime problems Does your child have any problems going to bed? Falling asleep? Does your child have any problems at bedtime? (P) Do you have any problems going to bed? (C) Do you have any problems falling asleep at bedtime? (C) 2. Excessive daytime sleepiness Does your child seem overtired or sleepy a lot during the day? Does she still take naps? Does your child have difficulty waking in the morning, seem sleepy during the day or take haps? (P) Do you feel tired a lot? (C) Do you feel sleep a lot during the day? In school? While driving? (C) 3. Awakenings during the night Does your child wake up a lot at night? Does your child seem to wake up a lot at night? Any sleepwalking or nightmares? (P) Do you wake up a lot at night? (C) Have trouble getting back to sleep? Do you wake up a lot at night? Have trouble getting back to sleep? (C) 4. Regularity and duration of sleep Does your child have a regular bedtime and wake time? What are they? What time does your child go to bed and get up on school days? Weekends? Do you think he/she is getting enough sleep? (P) What time do you usually go to bed on school nights? Weekends? How much sleep do you usually get? (C) 5. Snoring Does your child snore a lot or have difficult breathing at night? Does your child have loud or nightly snoring or any breathing difficulties at night? (P) Does your teenager snore loudly or nightly? (P) (P) Parent-directed question (C) Child-directed question Source: “A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems” by Jodi A. Mindell and Judith A. Owens; Lippincott Williams & Wilkins
Source: “A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems” by Jodi A. Mindell and Judith A. Owens; Lippincott Williams & Wilkins
Bedtime Pass The Bedtime Pass is used with children (ages 3 & up) who get out of their
bed or call out to parents (e.g., “Can I have a drink?”; “Can I have a hug?”)
multiple times after they have been put to bed.
Steps for using the bedtime pass:
1. Put your child to bed at the same time every night.
2. Remind your child of the rules of using the bedtime pass. Practice the
rules with younger children or if you think your child may have
difficulty understanding.
3. Give your child 4 bedtime passes.
4. Any time your child leaves their room they must give you a pass.
a. A pass gets one “free trip” out of the room or one parent visit
b. Visits should be short (e.g. less than 3 minutes) & have a
specific purpose (drink, hug)
5. Once passes are gone, ignore all attempts to get your attention.
a. If your child leaves his room after all his passes are gone, guide
him back to the room without talking or looking at him.
6. Allow your child to select a prize in the morning if he has one or more
un-used passes from the previous night.
a. Letting your child pick his or her breakfast on morning or buy a
“boring” cereal and a “fun” cereal and they can eat the fun
cereal if they have a pass they did not use
b. A snack after school
c. Pick a small prize or treat out of a prize box or “grab bag”
d. Getting an extra book at bedtime the next night
e. Screen time in the morning
_________’s Bedtime Pass!
Use one time per night to get out of bed
If you do not use it, you can get a reward in the morning
_________’s Bedtime Pass!
Use one time per night to get out of bed
If you do not use it, you can get a reward in the morning
_________’s Bedtime Pass!
Use one time per night to get out of bed
If you do not use it, you can get a reward in the morning
_________’s Bedtime Pass!
Use one time per night to get out of bed
If you do not use it, you can get a reward in the morning
Reading/story telling before bed
Why reading and Storytelling?
Having a bedtime routine helps children fall asleep faster and can reduce the struggle to get your child in bed. Reading
and telling stories is a great addition to your routine for many reasons:
▪ Reading and storytelling helps your child’s brain get ready for sleep
▪ Every word you say to your child builds your child’s brain!
▪ Children who hear more words are better prepared for school because they know more words, are better
readers, and score higher on tests
▪ Fun experiences with books help children enjoy reading and learning
Read “with” your child instead of “to” your child
▪ Choose books that have vivid pictures or are of interest to your child
▪ Ask Questions
▪ You leave a blank at the end of the sentence for the child to fill in
▪ Ex. “I think I would be a black cat. A little plump, but not too ___” let the child say fat.
▪ Ask what they think might happen in the book, give them an opportunity to change their prediction in the
middle of the book, and ask them at the end if they were right
▪ Ex. What did you think would happen to the dog in the story? What actually happened to the dog?
▪ Focus on the pictures in the books
▪ Ex. What's happening in this picture? Where is the brown bear? Where is something you can eat?
▪ Use who, what, where, when, why, and how questions
▪ Ex. How did he get up there? Why is she angry? Where are they going?
▪ Ask children to relate the pictures or words in the book to their own life
▪ Ex. "Remember when we went to the animal park last week. Which of these animals did we see
there?"
▪ Read familiar books! Children learn a lot from hearing the same story over and over
▪ Mix it up: Change what you do from reading to reading
▪ Don't push children with more prompts than they can handle
▪ Keep it fun!
Change it up: Instead of reading every night, try telling stories!
If your child does not enjoy reading or needs a break from reading every night, try telling stories at bedtime. Just make
up stories and see where they go!
3 steps to storytelling
▪ Tune In
o Pay attention to what your child is communicating to you, repeat what they say back to them so
they know you heard them, and build on what they say
▪ Talk More
o Use descriptive words to aid in building your child’s vocabulary (e.g., adding details such as the color
of the sky, or the type of dog)
o Challenge them with new words and ideas daily
▪ Take Turns
o If your child is able to talk, have them take turns telling or coming up with the story
Prescription for Safe SleepFollow these guidelines for every sleep for a healthy, well-rested family:
Routine is the key to good sleep habits. Consistently putting your baby to sleep in the same place, using the same routine will lead to good sleep habits. It may take time, but sticking to the routine will be worth the effort!
Create a calming environment with low lights, reading and singing.
ALWAYS put babies on their back to sleep, in their own crib that is free from blankets, pillows, bumpers and stuffed animals for bedtime and naptime. If the baby falls asleep elsewhere, they should be placed in their safe environment.
Your baby sleeps safest in the room where you sleep, but not in your bed. AAP recommends infants share their parents’ rooms for at least the first six months and, optimally, for the first year of life.
TWO WEEK SLEEP DIARYINSTRUCTIONS: 1. Write the date, day of the week, and type of day: Work, School, Day Off, or Vacation.2. Put the letter “C” in the box when you have coffee, cola or tea. Put “M” when you take any medicine. Put “A” when you drink alcohol. Put “E” when you exercise. 3. Put a line (l) to show when you go to bed. Shade in the box that shows when you think you fell asleep. 4. Shade in all the boxes that show when you are asleep at night or when you take a nap during the day. 5. Leave boxes unshaded to show when you wake up at night and when you are awake during the day. SAMPLE ENTRY BELOW: On a Monday when I worked, I jogged on my lunch break at 1 PM, had a glass of wine with dinner at 6 PM, fell asleep watching TV from 7 to 8 PM, went to bed at 10:30 PM, fell asleep around Midnight, woke up and couldn’t got back to sleep at about 4 AM, went back to sleep from 5 to 7 AM, and had coffee and medicine at 7:00 in the morning.
