Tiny Teeth · Big Questions Answered

Child Observation Checklist

Child's name

Age

Date

Breathing

During the day

Breathes mostly through the nose Breathes mostly through the mouth Breathes loudly

At night

Sleeps with mouth closed Sleeps with mouth open Snores or breathes noisily during sleep Moves or is restless during sleep

Notes

Mouth Posture at Rest

Lips closed at rest Mouth often open at rest

Notes

Eating & Chewing

Eats a variety of textures Prefers mostly soft foods Chews slowly and comfortably Open-mouth chewing Chews with visible effort in the face

Notes

Habits

Thumb or finger sucking Pacifier use — frequent or prolonged Nail biting Lip biting or sucking Chewing on objects — toys, clothing, pencils, hair

Notes

Sleep

Sleeps calmly through the night Wakes frequently during the night Tosses and turns during sleep

Drooling during sleep Bed wetting Sleepwalking

Notes

Overall observations & questions for the group