Anamnese Infantil

Concepo
Gravidez planejada? Sim ( ) No ( ) Qual foi a reao a notcia da gravidez? _________
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Idade dos pais na concepo: me______ pai ____________
Gestaes anteriores? S N Quantas? ______________
Ordem de nascimento: _______________
Gestao
Quanto tempo de relacionamento o casal j tinha? __________________________
Pr-natal? S N a partir de que ms _________ Onde __________
Gravidez de risco? S N Por qu? _________________________________________
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Condies fsicas (inchao, vmitos) _____________________________________
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Condies psicolgicas (ansiedade, depresso) _______________________________
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Parto
Tipo: Cesria ( ) Normal ( ) prematuro? S N Idade gestacional_________ peso ______
Complicaes? S N Quais? ________________________________________________
Encubaroda? S N quantos dias de UTIN? _______________________
Ps- parto
Primeiros meses
Alimentao: seio S N tempo: ___________ Mamadeira S N tempo: __________
Problemas alimentares: ___________________________________________________
Problemas alimentares atualmente: __________________________________________
Sono: agitado S N
noite toda S N
Dorme: sozinho ( ) com os pais ( ) se sozinho, desde quando? __________________
Sono atualmente:________________________________________________________
Desenvolvimento motor
Idade que: engatinhou ____________ andou_______________________
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Linguagem
Idade que: falou ____________________________________________
Problemas nessa rea S N Quais? ________________________________________
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Social
Como : Interao com os pais/cuidadores:____________________________________

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Interao com irmos: ___________________________________________________
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Interao com outras pessoas (crianas/adolescentes/adultos):_____________________
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Atitude diante de estranhos: ______________________________________________
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Hbitos de lazer
Costuma passear? _______________________________________________________
Lazer com os pais: tempo disponvel: ________________________________________
Como ? _______________________________________________________________
Tipos de brincadeiras/passatempos preferidos:_________________________________
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Tem alguma mania? Qual? ________________________________________________
Dados Escolares
Escola:
Freqenta escola? S N
Idade de incio? _______________________________
Como foi adaptao: _____________________________________________________
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Escolas: _______________________________________________________________
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Atendimento especializado: S N Quais? ____________________________________
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Problemas escolares? S N Que tipo? _________________________________________
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Quando comearam os problemas?__________________________________________
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Sade fsica
Doenas infantis: ________________________________________________________

Cirurgias e internaes: ___________________________________________________

Tratamentos: ___________________________________________________________
Uso de medicamentos? S N Quais? __________________________________________
Antecedentes familiares: __________________________________________________
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Outras informaes relevantes:____________________________________________
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