FICHA DE ANAMNESE INFANTIL

Identificao
Nome:
Data de nascimento:
Responsvel:
Telefone:
Escola:

Ano:

Motivo da consulta (incio, desenvolvimento, fases de agravamento e melhora do sintoma e atitude familiar ao
motivo da consulta).
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Uso de medicao (eventual e constante).
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Um dia tpico da criana (manh, tarde, noite, fim de semana).
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Ambiente familiar (moradia, relacionamento com pai, me, irmos, bab, etc..).
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Histria do casal.
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Gestao (anteriores e da criana em pauta, reao do casal e da famlia a gestao, acontecimentos relevantes ao
longo do perodo, pr-natal, relacionamento do casal durante a gestao).
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Parto (local, situao, tempo de durao, reao do casal e da famlia, fatos relevantes).
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Alimentao (amamentao, desmame, atual, fatores relevantes e distrbios).

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Sono (qualidade, quantidade, local, distrbios).
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Desenvolvimento psicomotor (marcos do desenvolvimento: sustentar a cabea, rolar, sentar, engatinhar, ficar de p,
andar, etc...).
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Desenvolvimento da linguagem (surgimento e estado atual).
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Controle dos esfncteres (quando, como, com quem, postura dos adultos envolvidos, reao da criana).
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Doenas.
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Antecedentes patolgicos (casos de doenas fsicas e mentais graves nas geraes anteriores).
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Escolaridade (idade inicial, tipo de escola, adaptao, rendimento, relacionamento, mudanas).
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Mudanas e acontecimentos importantes (mortes, doenas graves, acidentes, mudanas de cidade ou moradia,
nascimento de irmos).
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Sexualidade (curiosidade, atividades masturbatrias e/ou jogos sexuais com outras crianas, informaes oferecidas
pelos adultos, reao dos adultos as perguntas e manifestaes).
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Brincadeiras, jogos e sociabilidade ( brincadeiras preferidas, local, horrios, companheiros, frias e lazer).
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Medos, mentiras e fantasias.

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Com quem se parece a criana (opinio de cada um dos responsveis).
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A histria do nome da criana.
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Expectativas em relao ao futuro da criana.
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Prognstico dos pais a respeito do que est acontecendo com a criana.
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