About This Worksheet
Assess whether tongue tie may be affecting your baby's feeding efficiency and nighttime sleep consolidation.
This worksheet helps you organize and calculate the key information for tongue tie sleep feeding assessment. Fill in each section carefully. Use the calculation areas to verify your numbers before transferring them to the official form.
How to Complete This Worksheet
- Print this worksheet or use it on screen.
- Complete each section in order.
- Use a calculator for all math. Do not estimate.
- Double-check every calculation before moving to the next section.
- Transfer final figures to your official form when complete.
- Keep this worksheet with your records.
Tongue Tie Sleep Calculations
Enter your figures for tongue tie sleep feeding assessment below. Pull numbers from official documents, not estimates.
Tongue Tie and Sleep Feeding Assessment
| A. | Total hours of nighttime sleep (from bedtime to morning wake, minus wakings) | hrs ________ |
| B. | Number of night wakings | # ________ |
| C. | Total minutes awake during night wakings | min ________ |
| D. | Nap 1 duration | min ________ |
| E. | Nap 2 duration | min ________ |
| F. | Nap 3 duration (if applicable) | min ________ |
| G. | Total daytime sleep (D + E + F) | min ________ |
| H. | Total 24-hour sleep (A + G converted to hours) | hrs ________ |
| I. | Longest stretch of uninterrupted night sleep | hrs ________ |
Your Information
Enter your details as they appear on your official documents.
As it appears on your government ID.
Today's date, MM/DD/YYYY.
From prior tongue tie sleep feeding assessment filings. Write N/A if none.
Additional Notes
Record any other information relevant to your tongue tie sleep feeding assessment calculations.
Verification
Before transferring figures to your official form, confirm:
- All figures are accurate and match your source documents.
- All calculations have been double-checked with a calculator.
- Names and dates match your official identification.
- Information is consistent with requirements for tongue tie sleep feeding assessment.