Sleep Consultation

Sleep Intake Form

In this questionnaire I will ask you to describe the situation as accurately as possible. There is no need to filter information — on the contrary, please be precise down to the smallest details.

Personal Information

Is the child in daycare? Please provide days and hours.

1
2
3
4

Health Background

Choose one or more options

Feeding

Choose one or more options

If so, how many a day? (Breakfast, lunch, snack, dinner)

Milestones

Please choose the relevant options

Behavior and Temperament

What time?

Please specify (for example: agitated / relaxed / crying)

Sleep During the Day

If so, list the number of naps

If so, describe what you do

For example: in a carrier or sling / yoga ball / on the hands / in a stroller / independently

For example: with movement, while crying, with touch

Family Life

For example: new sibling / moving to a new house / going to daycare

50
0 — not at all100 — very much

I'd love to hear any more details or comments related to sleep, family dynamics, or anything else you'd like to share.

Terms of Use *

Terms of Use

IMPORTANT: Adi Levhar operates Mothers & Minis (the "Site") and provides certain advice and services (the "Services"). Each time you use the Site or the Services, you agree to be bound by these Terms of Use. You acknowledge and agree that your use of the Internet and access to the Site and the Services is solely at your own risk. You also understand that the confidentiality of any communication or material transmitted to or from the Site over the Internet cannot be guaranteed. Mothers & Minis LLC is not responsible for the security of any information transmitted to or from the Site or Services.

The Site and Services are for informational purposes only and do not provide medical advice. The information, content, and advice provided on the Site and as part of the Services is for informational purposes only and is not medical advice. You are not establishing a medical professional/patient relationship by accessing or using the Site or the Services. The information, content, and advice provided on the Site and through the Services is intended for use with healthy children with common sleep issues that are unrelated to medical conditions. The information, content, and advice provided is not intended to be, and is not, a substitute for professional medical advice. Always seek the advice of your physician regarding any medical condition or the health and welfare of your baby.

Pediatric Approval. You agree to consult with and obtain approval from your pediatrician prior to following any advice or using any techniques offered on the Site or through use of the Services.

Limitation of Liability. Reliance on the information, content, and advice offered on the Site and through the Services is solely at your own risk. Neither Mothers & Minis LLC nor any of its members, managers, officers, employees, agents, or contractors is responsible or liable to you or anyone else for any loss or injury, or any indirect, incidental, consequential, special, exemplary, punitive, or other damages under any contract, negligence, strict liability, or other theory arising out of or relating in any way to (i) the use of or inability to use the Site and/or the Services; (ii) any content contained on the Site and/or through the Services; (iii) statements or conduct posted or made publicly available on the Site and/or through the Services; or (iv) any product or service purchased or obtained through the Site or the Services. In no event shall Mothers & Minis LLC be liable to you for any claims, damages, injuries, losses, or expenses arising from using the Site and the Services.

Refund Policy. Due to the amount of time, effort, and commitment provided within a consultation, refunds are not possible once this intake form is submitted.

Copyright Notice. The information and content provided on the Site and through the Services may not be reproduced, republished, or transmitted in any form or by any means, whether mechanical or electronic, including photocopying and recording, or by any information storage or retrieval system, without the approval of Mothers & Minis. All information and content provided on the Site or through the Services, whether verbal, written, or implied, remains the sole and exclusive property of Mothers & Minis at all times. Written permission of Mothers & Minis is required to reproduce, record, publish, or share verbally any details of any such information or content (including, without limitation, any sleep plan, e-guides, charts, notes, advice transcript or summary in any format, or details or information published on any blogs, forums, or similar boards). All information and content provided or offered on the Site or through the Services is confidential. Any dissemination or sharing of such information or content is strictly forbidden and subject to the protection of United States and foreign copyright laws.

General. These Terms of Use shall be governed by, and interpreted in accordance with, the laws of the State of Connecticut. Mothers & Minis reserves the right to amend or modify these Terms of Use at any time.

Disclaimer About Crying *

Do I believe in cry it out?

If the question is whether or not I advocate leaving a baby alone to cry until they fall asleep from sheer exhaustion, then the answer is absolutely not! I never suggest that a parent should leave a baby to cry it out, not check on them, and let them fall asleep because they got so tired crying. That is just not my style. I believe a child should be loved before bedtime, comforted when upset, and responded to in a reasonable amount of time. I also believe that bedtime should be a very happy and pleasant experience, not something dreaded for both you and your baby. With that being said, let's talk about crying realistically. Because to believe that there will be absolutely no tears during this process is completely unreasonable.

You have to be realistic and understand that some tears will be shed. If someone took away your favorite pillow or blanket that you use to fall asleep, you would be angry, right? You're probably not going to cry about it, but you would most likely be very angry. Well, that's how your baby feels when you take away their sleep prop, except they can't tell you they're angry. Instead, they cry. Eventually, they will get over it and find a new way to fall asleep... if you give them the opportunity. If you always run in at the slightest whimper, how will your baby ever learn to fall asleep on their own? Why would they even want to when they know that all they have to do is cry, and mommy will come in and do it for them?

I know how it feels to hear your baby cry. I'm a huge sucker for tears. No matter what the cry is about, it's heartbreaking. However, you have to keep in mind that you are doing what's best for your baby. You want a well rested and happy baby - a baby that is able to practice milestones and have fun during the day without being cranky or overtired. You want them to sleep through the night and not wake all throughout the night because they are so dependent on you to put them to sleep. According to the National Sleep Foundation, "Sleep is especially important for children as it directly impacts physical and mental development." During the deep stages of sleep, "blood supply to the muscles is increased, energy is restored, tissue growth and repair occur, and important hormones are released for growth and development." So when you start feeling bad about your baby shedding some tears, think about all the good you are doing for them. You are doing this for their well-being - you are not doing anything wrong. Crying is nothing more than protesting, and it's usually very short-lived. Once your baby realizes that you will no longer be putting them to sleep, the protesting and tears will stop, and your baby will be falling asleep on their own. This plan will work, but it takes consistency, patience, and time.