Pediatric Epworth Sleepiness Scale

The ESS-CHAD (Epworth Sleepiness Scale for Children and Adolescents) is a validated questionnaire adapted from the adult Epworth Sleepiness Scale. It measures how likely a child is to doze off in 8 common everyday situations, producing a score from 0 to 24. It is widely used as a clinical screening tool for excessive daytime sleepiness (EDS) in children and teens.

Each of the 8 situations is rated on a scale from 0 (would never doze) to 3 (high chance of dozing). The scores for all 8 situations are added together to produce a total score ranging from 0 to 24. Higher scores indicate greater levels of daytime sleepiness.

A total score of 0–10 is generally considered normal. Scores of 11–12 suggest mild excessive sleepiness. Scores of 13–15 indicate moderate excessive sleepiness, and scores of 16–24 suggest severe excessive daytime sleepiness. If your child scores above 10, it is advisable to consult a pediatric healthcare provider.

The ESS-CHAD can be completed by the child or adolescent themselves if they are old enough to understand the questions, or by a parent or caregiver who closely observes the child's daily behavior. For younger children, caregiver input is typically more reliable.

The ESS-CHAD is adapted from the adult ESS but modified to include situations more relevant to children and adolescents, such as sitting in a classroom. The scoring method is the same (0–3 per item, 0–24 total), but the normative thresholds may differ slightly from the adult version.

Elevated ESS-CHAD scores in children can be associated with conditions such as obstructive sleep apnea, narcolepsy, idiopathic hypersomnia, restless leg syndrome, insufficient sleep syndrome, or other sleep-related disorders. A high score should always be followed up with a thorough clinical evaluation.

No. The ESS-CHAD is a screening tool only and is not intended to diagnose any sleep disorder. A score above the normal range suggests that further evaluation by a qualified pediatric sleep specialist or healthcare provider is warranted. Diagnosis requires a full clinical assessment and may include a sleep study (polysomnography).

The ESS-CHAD can be used periodically to monitor changes in daytime sleepiness over time, particularly if your child is undergoing treatment for a sleep disorder. Many clinicians administer it at each follow-up visit to track improvement. As a parent, you can use this tool at home to gauge whether your child's sleepiness is worsening or improving.