ANAMNESE INFANTILNome do filho(a) _________________________________________________________________Sexo: ______________ Idade: _______ anos _______ meses_______ Apelido: ______________Data Nascimento: ____________________ Nacionalidade: __________________________Escolaridade: ____________________ Srie: _________ Perodo ________________Escola: _________________________________________________________________________Endereo (da escola): ______________________________________________2. Filiao:Pai: __________________________________________________________ Idade: __________Profisso: ________________________ Nacionalidade: ___________________Me: __________________________________________________________ Idade __________Profisso: ________________________ Nacionalidade: ___________________Endereo: _____________________________________________________________________Bairro: ____________________________ Fone Res.: _____________________Religio: _________________________________________________________Tratamento(s) anterior(es):______________________________________________________________________________________________________________________________________________________________Antecedentes Pessoais:a) Concepo:A criana foi desejada? __________Observaes: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________b) Gestao:Como a me estava emocionalmente? _______________________________________________ ______________________________________________________________________________Teve complicaes orgnicas? Em que ms? _________________________________________Traumatismo? __________________________________________________________________c) PartoComo foram s 24 horas anteriores (me) e s 24 horas posteriores (me e criana) noparto? ________________________________________________________________________ _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Condies do parto: normal ( ) cesrea ( )tempo __________ precoce - quanto meses________ tamanho ________ peso _________Observaes: ___________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________d) Desenvolvimento:1- Alimentao:lactncia materna? ________________ (caso no) Por que? ______________________________________________________________________________________________________________________________________________________________________________Como aceitou alimentos slidos? ____________________________________________________Quando nasceram os primeiros dentes? ______________________________________________Tem problemas de alimentao atualmente? Quais? _________________________________________________________________________________________________________________________________________________________________________________________________Qual a atitude da famlia? _________________________________________________________________________________________________________________________________________Observaes: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________Sono:Como foi o sono desde pequeno? _________________________________________________________________________________________________________________________________Houve poca em que melhorou ou piorou? ________ Quando? ___________________________________________________________________________________________________________Atualmente, como o sono? ________________________________________________________ _______________________________________________________________________________Qual a atitude dos pais? ___________________________________________________________ ______________________________________________________________________________________________________________________________________________________________Observaes: ___________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________Desenvolvimento motor:Quando sustentou a cabea? __________________ Sentou? _______________________Engatinhou? _____________ Ficou em p? _________________ Andou? ___________________Dificuldades no desenvolvimento: tendncia a cair? ___________ a machucar-se?____________ golpeava-se? ___________ Dificuldades em manipular objetos? __________________________Outras? ___________ Dificuldades atuais: _________________________________________________________________________________________________________________________Qual a atitude dos pais? __________________________________________________________Lateralidade: ___________________________________________________________________Observaes: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________6. Controle de esfncteres:a) Quando deixou as fraldas? ______________________________________________________________________________________________________________________________________b) Aprendizagem do uso de pinico? _________________________________________________________________________________________________________________________________c) Como foi feito? (com facilidade, castigos)? __________________________________________________________________________________________________________________________Quem fez o controle? ___________________ Com que idade? ____________________________Vesical diurno? ______________________________ anal diurno? _________________________Vesical noturno? _______________________ anal noturno? ______________________________Observaes: ___________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________7. Linguagem:Quando falou as primeiras palavras? ______________ Quais foram? ______________________________________________________________________________________________________Problemas de fala? Quais? ________________________________________________________________________________________________________________________________________Desde quando? __________________________________________________________________Qual a atitude dos pais? __________________________________________________________________________________________________________________________________________Observaes: ______________________________________________________________________________________________________________________________________________________________ - Sociabilidade:Tem amigos? ___________ Que idade? ___________ Como o relacionamento com eles? _______________________________________________________________________________Que tipo de brincadeiras prefere? ___________________________________________________________________________________________________________________________________Como se comporta com adultos? ___________________________________________________________________________________________________________________________________Qual a atitude familiar? ___________________________________________________________________________________________________________________________________________Observaes: ___________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________Escolaridade:Grau de Instruo: _________________ Escola: _______________________________________Leitura: ( ) bem ( ) regular ( ) mau Escrita: ( ) bem ( ) regular ( ) mauDificuldade de aprendizagem: ________ disciplinas: ____________________________________J foi reprovado: _____: Quantas vezes: _____ Atitude tomada: __________________________Que escola(s) frequentou? ________________________________________________________________________________________________________________________________________Com que idade ingressou?_______ Teve problemas em se adaptar escola?Quais? ________________________________________________________________________________________________________________________________________________________Apresentou dificuldades atualmente, quando ao rendimento escolar? ______________________________________________________________________________________________________________________________________________________________________________________Qual o comportamento? __________________________________________________________________________________________________________________________________________O que diz a professora? __________________________________________________________________________________________________________________________________________Qual a atitude dos pais? __________________________________________________________________________________________________________________________________________Observaes: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________- Sexualidade:Manifesta curiosidade sexual? __________ Que pergunta faz? ___________________________________________________________________________________________________________Qual a atitude dos pais?_________________________________________________________________________________________________________________________________________Teve orientao? Por parte de quem? _____________________________________________________________________________________________________________________________Masturba-se? _________ Brincadeiras sexuais com outras crianas? ______________________Quais? ________________________________________________________________________Qual a atitude dos pais? _________________________________________________________________________________________________________________________________________- Manipulao e tiques:Usou chupeta? __________ at quando? _________________ Chupava o dedo? _____________At quando? _____________ Apresenta outras manipulaes? Quais? ____________________________________________________________________________________________________________________________________________________________________________________ Tiques? ________________________________________________________________________Qual a atitude dos pais? ___________________________________________________________Observaes: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________Formas de Reaes: (s ordens, s proibies, frustraes, relacionamento diante estranhos, defende-se, etc.)______________________________________________________________________________________________________________________________________________________________Traos de Personalidade: (Tmida, inquieta, hiperativa, retrada, saliente, amvel, etc.)- Doenas:Doenas infantis (quais e em que idade)? ____________________________________________________________________________________________________________________________Operaes (quais e em que idade)? _________________________________________________________________________________________________________________________________Traumatismo, quedas (idade)? _____________________________________________________________________________________________________________________________________Desmaios, ausncias (idade) ______________________________________________________________________________________________________________________________________Tem alguma doena atualmente? ________ Qual? _____________________________________________________________________________________________________________________Est sendo tratado? _______________________________________________________________Observaes: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________Antecedentes Familiares: _______________________________________________________________________________________________________________________________________________________________________________________________________________________Exame Psquico: ( circunstncia de atendimento, aparncia, psicomotricidade, humor,pensamento, orientao, memria, vontade, rapport, etc.)_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Relato Espontneo:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Local e data: _________________________________________________________________________________________________Marcila Melo Alves LimaPsicopedagoga