Anamnese Infantil

Nome__________________________________________________________________________________
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Data de Nascimento___________________________ Data da entrevista ___________________
Escola___________________________________ Nome da professora__________________________
Nome do Pai_______________________________________________________________ idade______
profisso_______________________________________________________________________________
Nome do me___________________________________________________________ idade_________
profisso_______________________________________________________________________________
Quem compareceu a entrevista psicolgica_____________________________________________
A criana filha nico ( ) Primognito ( ) 2 Filho ( ) 3 ( ) Gmeos ( )
Adotado ( ) Sobre a adoo __________________________________________________________
Irmos
Nome______________________________________________________________________Idade_______
escola______________________________________________ srie ______________________________
Nome______________________________________________________________________Idade_______
escola______________________________________________ srie ______________________________
A criana reside com__________________________________________________________________
Queixa principal_______________________________________________________________________
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Quem identificou o problema__________________________________________________________
Quem encaminhou ____________________________________________________________________
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Histrico
Gestao/sade da
Me/nascimento____________________________________________________
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Desenvolvimento
Fala:Idade/dificuldades_______________________________________________________________
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Engatinhou/rastejou/andou___________________________________________________________
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Enurese/feses__________________________________________________________________________
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Toma banho sozinho____________________________________________________
Toma atitudes de auto cuidados (quando se fere)___________________________
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Hbitos alimentares
A criana tem horrios para se alimentar_________________________________
Respeita esses horrios_____________________
A criana faz as refeies junto com outros
familiares_____________________________________________________________________________
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Recusa-se a alimentar__________________________________________________
Como alimentao da criana_________________________________________
Apresenta dificuldade em relao ao peso excesso ou abaixo _________________
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Sono
Dorme sozinha_________________________________________________________
Tem seu prprio quarto__________________________________________________
Durante a noite levanta-se e vai para cama dos pais______________________
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Tem pesadelos__________________________________________________________
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Qualidade do sono______________________________________________________

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Dorme rapidamente/ouve estrias antes de dormir_________________________
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Acorda irritado_________________________________________________________
Sade Geral
Doenas/Medicao/Cirurgias/Traumas/Desmaios/Convulses_____________
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Tratamentos
Fonoaudiologia ( ) / Terapia Ocupacional ( ) / Fisioterapia ( ) / Psicoterapia ( ) /
Psicopedagoga ( ) / Psiquiatria ( ) / Outros ( )
Motivo/Houve melhoras________________________________________________
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Vida Acadmica
Com que idade iniciou a vida escolar/resistncia/chorou____________________
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Reprovou/Motivo/srie_________________________________________________________________
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Qual a principal dificuldade/Matria___________________________________
Qual o comportamento da criana em fazer as tarefas_____________________
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Quem vai s reunies escolares___________________________________________
A viso da criana em relao ao futuro/profisso_________________________
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Qual a atitude dos pais________________________________________________
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Dinmica Familiar
O principal cuidador____________________________________________________
Com quem a criana se relaciona melhor_________________________________
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Quem brinca mais_____________________________________________________
Que tipos de brincadeiras________________________________________________
Relacionamento com irmos_____________________________________________
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Quais as outras pessoas que a criana se relaciona/mais velhos/mais
novos/adultos__________________________________________________________
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A famlia tem hbitos de sair juntos_____________________________________
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Os pais conhecem os amigos/pais dos colegas da criana_____________________
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Personalidade da Criana
Distrada______________________________________________________________________________
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Esquece os compromissos_________________________________________________
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Perde os brinquedos_____________________________________________________
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Respeita as regras/limites/formas de driblar as regras_______________________________
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Comportamento de Birras/desafiador/submisso_______________________________________
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Qual a atitude dos pais________________________________________________________________
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Habilidades sociais
Criana tem amigos___________________________________________________________________
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Relaciona com criana mais velhas/novas/adultos/idosos/parentes__________________
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Briga com as outras crianas/lder____________________________________________________
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Tem noo de perigo/fere-se____________________________________________________________
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Passatempos preferidos________________________________________________________________
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Prtica algum esporte_________________________________________________________________
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Antecedentes familiares Psiquitricos e Neurolgicos
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Observaes:___________________________________________________________________________
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Sinop. MT

Data:______________________________

Nome:__________________________________________________________________________________