boukydis cry diary.pdf

My Baby's Behavior Diary

Date started: _____ / _____ / _____

My baby’s name: ______________________________________________________

The most pleasant time today with my baby was:

• 6 a.m.

  • Fussing: ________
  • Crying: ________
  • Eating: ________
  • Awake: ________
  • Sleeping: ________

• 2 p.m.

  • Fussing: ________
  • Crying: ________
  • Eating: ________
  • Awake: ________
  • Sleeping: ________

• 10 p.m.

  • Fussing: ________
  • Crying: ________
  • Eating: ________
  • Awake: ________
  • Sleeping: ________

Collaborative Consultation with Parents and Infants in the Perinatal Period by Zack Boukydis

Copyright © 2012 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

• 5 a.m.

  • Fussing: ________
  • Crying: ________
  • Eating: ________
  • Awake: ________
  • Sleeping: ________

• 1 p.m.

  • Fussing: ________
  • Crying: ________
  • Eating: ________
  • Awake: ________
  • Sleeping: ________

• 9 p.m.

  • Fussing: ________
  • Crying: ________
  • Eating: ________
  • Awake: ________
  • Sleeping: ________

Additional Times

• 4 a.m.

  • Fussing: ________
  • Crying: ________
  • Eating: ________
  • Awake: ________
  • Sleeping: ________

• 12 Noon

  • Fussing: ________
  • Crying: ________
  • Eating: ________
  • Awake: ________
  • Sleeping: ________

• 8 p.m.

  • Fussing: ________
  • Crying: ________
  • Eating: ________
  • Awake: ________
  • Sleeping: ________

My Baby’s Behavior Diary: Instructions

This is a diary of what your baby did during a 24-hour day. One complete 24-hour day is indicated by the three horizontal bars (midnight to 8 a.m., 8 a.m. to 4 p.m., and 4 p.m. to midnight). Each box on the bar indicates a 15-minute period (four boxes per hour), and the time of day is indicated along the

How to Fill Out the Form

1. In each box in the diary, mark the letter for the main behavior your baby was showing in each of the 15-minute blocks:

• A = Awake (your baby is awake and alert, looking around or playing)
  • E = Eating (your baby is being fed and is sucking and swallowing)
  • S = Sleeping (your baby is sleeping peacefully)
  • F = Fussing (your baby is agitated and upset and probably moving a lot; your baby may be making fussy sounds but not cries; your baby is awake and uncomfortable)
  • C = Crying (your baby is crying with each breath and is very uncomfortable; it usually takes

Record only one behavior for each block. Sometimes your baby may be doing two behaviors during the 15-minute period. Choose the main (longest, most noticeable) behavior.

ABOUT YOU (write in your specialty and check one field that best applies)

• m Birth to Five
• m K–12
• m Clinical/Medical Personnel
• m 4-year College/Grad.
• m Comm. College/Vocational
• m Association/Foundation
• m Comm. Services