ANAMNESE PARA DISFONIA INFANTIL

Data: __/__/__
Identificao
Nome: _______________________________________________________________
Data de nascimento:__/__/__ Idade: _________________
Naturalidade: ___________________________
Nacionalidade: ___________________________
Sexo:Masc ( ) Fem ( )
Endereo:
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Telefone: ____________________________________
Filiao:
Pai: _____________________________________________
Grau de Instruo:_____________________________________________
Profisso: _____________________________________________
Me: _____________________________________________
Grau de Instruo:_____________________________________________
Profisso: _____________________________________________
Informante: _____________________________________________
Encaminhado por: _____________________________________________
Motivo da consulta (Queixa e durao)
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Gestao - Parto - Aleitamento
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Desenvolvimento Neuropsicomotor
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Desenvolvimento Escolar
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Histria do Distrbio Vocal

- Houve um motivo desencadeante aparente? ( ) No ( ) Sim
- Descrever
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- O incio da alterao foi sbito ou progressivo?
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- H perodos de melhora e piora da voz? ( ) No ( ) Sim
- A voz se altera com as emoes? ( ) No ( ) Sim
- A criana j esteve afnica? ( ) No ( ) Sim
Quando? _______________________________
Por quanto tempo? _________________________
- No que a voz mudou?
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- A criana se queixa de cansao ou dor para falar?
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- H esforo aparente ao falar? - Em que regio do corpo?
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- Foram feitos comentrios sobre a alterao da voz?
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- Como a criana reagiu?
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- Outros dados?
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 Abusos Vocais
- A criana fala muito ( ) No ( ) Sim
Onde? _______________________________________
- Com quem? ____________________________________________________
- A criana grita ( ) No ( ) Sim
Com que freqncia? ______________________________________
Em que situao? _________________________________________
- Chora muito? __________________________________________
Qual o motivo? __________________________________________
- Costuma imitar outras vozes?__________________________
Rudos? _________________________________
Animais? _________________________________
- A criana canta? _________________________________
Que tipo de msica? _________________________________
- H alguma situao ou horrio de maior excitabilidade?
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- A criana fala rpido? _______________________________________
Os adultos entendem o que ela diz? ___________________________________
Competio Vocal
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Sade
- Estado Geral
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- Distrbios mais freqentes:
( ) laringite ( ) rinite ( ) faringite ( ) otite ( ) sinusite ( ) asma ( ) bronquite ( ) tosse ( )
amigdalite
( ) outros - Quais? _________________________
- Tratamentos realizados _______________________________________________
- Cirurgias realizadas ( ) No ( ) Sim
Quais? ______________________________________________
- Sensibilidade alimentos ( ) No ( ) Sim

Quais e como se manifesta? _______________________________________________

- Sensibilidade mudana de temperatura ( ) No ( ) Sim
Como se manifesta? ________________________________________________________
Dados da criana:
Voc considera a criana
( ) agitada ( ) ansiosa ( ) manhosa ( ) tranqila ( ) curiosa ( ) explosiva ( ) sensvel ( )
preguiosa ( ) alegre
( ) extrovertida ( ) lenta ( ) tmida ( ) outros:
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Actividades preferidas (esportivas, ldicas e culturais, outras)
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Dados da dinmica familiar:
- Ambiente familiar
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- Pessoas que vivem com a criana
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- Rotina diria
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Antecedentes familiares
- Membro da famlia com alterao vocal
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- Alergias _________________________________________________________
- Outras patologias (alcoolismo, retardo, etc.)
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Grau de conscincia do problema e motivao para a terapia
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Tratamentos anteriores
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Laudo do Otorrinolaringologista
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Outros exames
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Concluso:
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Fonte: http://www.profala.com/frameset.htm

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