ANAMNESE PARA FUNO ALIMENTAR

*Sugerida pela Fg Patrcia Ferret Siman

CRFa. 1836
Data:___ /___ /_____
Identificao
Nome: _________________________________________________
Data de nascimento:___ /___ / ___ Idade: __________
Naturalidade:___________________________
Nacionalidade: _________________________
Sexo: ___________________
Endereo: __________________________________________________________
Bairro: ______________________Cidade:____________________ UF: ____
Telefone: __________________________________
Grau de Instruo:___________________________
Religio: __________________________________________
Filiao:
Pai: _____________________________________________________
Grau de Instruo:_________________________________________
Profisso: ________________________________________________
Me: ____________________________________________________
Grau de Instruo:_________________________________________
Profisso: ________________________________________________
Telefone: ________________________________
Irmos:
Nome ___________________________________ Idade_____
Nome ___________________________________ Idade_____
Nome ___________________________________ Idade_____
Informante: _______________________________

Queixa:
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1. Foi amamentada no seio?
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2. poca da primeira amamentao:
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3. Sugava bem?
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4. Havia escoamento de leite? Pela boca ou pelo nariz?
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5. At quando mamou no seio?
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6. Quando foi introduzida a mamadeira?
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7. Tem (ou tinha) o hbito de suco de dedo, de chupeta, etc.?
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8. Qual a mamadeira e o bico utilizados?
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9. Como (era) o furo da mamadeira?
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10. Qual a posio durante a alimentao?
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11. At quando usou a mamadeira?
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12. poca de introduo da colher:

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13. Tipo de colher e quantidade de alimento colocada na mesma:
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14. Quando iniciou a alimentao pastosa?
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15. Quando iniciou a alimentao pastosa com pedaos semi-slidos?
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16. Havia muitos engasgos?
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17. Quando iniciou a alimentao slida?
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18. Havia engasgos e/ou movimentos associados?
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19. Foi observado se a criana realmente mastigava?
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20. Mastigava com a boca aberta?
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21. Tem dificuldades na deglutio de lquidos?
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22. poca de introduo do copo:
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23. Consegue tomar lquido utilizando canudo?
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24. Alimentao atual:

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25. Preferncia alimentar:
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26. Irrita-se com lquidos gasosos?
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Concluses:
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Fonte: http://www.profala.com/frameset.htm

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