Sarah Cassimiro Marques

Incantato Psicologia
Data: ____/____/____
Numero______________
Anamnese Infantil
Entrevista/Anamnese com a Mãe (Spreen & Strauss, 1998)

1 – Identificação
Nome:_____________________________________________________________________________________________________
Idade: ____________________Data de Nascimento: _________________________________________________________
Sexo:_______________________Escolaridade:_________________________________________________________________
Escola:____________________________________________________________________________________________________
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Pai:_______________________________________________________________________________________________________
Idade:_____________________Profissão:______________________________________________________________________
Mãe:______________________________________________________________________________________________________
Idade:_____________________Profissão:_____________________________________________________________________
Telefones: _________________________________________________________________________________________________

2 – Encaminhamento (solicitar encaminhamento, caso houver):

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3 – Queixa ou motivo da consulta

Queixa principal - História de Doença Atual/HDA (Sintomas, início do quadro, duração dos sintomas, evolução, formas de

intervenção já realizadas):

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Outras Queixas:___________________________________________________________________________________________
Atitude frente as queixas:
a) Mãe:____________________________________________________________________________________________________
b) Pai: ____________________________________________________________________________________________________
c) Parentes:______________________________________________________________________________________________
Medicamentos:_______________________________________________________________________________________________
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Paciente sendo acompanhado por outro
profissional:_______________________________________________________________________________________________
Fez tratamento fonoaudiológico?________________________________________________________________________
Fez tratamento psicológico?______________________________________________________________________________
Fez tratamento psiquiatrico?____________________________________________________________________________

Solicitar exames

4 – Antecedentes Pessoais
Concepção
Com quantos meses ou semanas descobriu que estava grávida? _________________________________________
A criança foi desejada?/Como você se sentiu quando descobriu que estava grávida?
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Posição na ordem das
gestações:___________________________________________________________________________________________________
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Abortos (foi
espontâneo?):_____________________________________________________________________________________________

Gestação
Fez pré-natal, como foi a evolução? Lembra como se sentia? Doenças / Sensações / Quedas / Medicamentos / Exposição a Rx / Uso
de cigarro, álcool e outras drogas.
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Nasceu de quantas semanas?_____________________________________________________________________________

Condições do Nascimento
( ) Em casa ( ) Maternidade
Desenvolvimento do parto
( ) Natural ( ) Fórceps ( ) Cesariana
Posição do Nascimento
( ) De cabeça ( ) Ombro ( ) Nádegas
Desenvolvimento Neuropsicomotor
Primeiras reações:
( ) Chorou ( ) Vermelho ( ) Roxo
( )Anóxia ( ) Icterícia ( ) Precisou de oxigênio
( ) Incubadora
APGAR: _________________________________________________________________________________________________
Alta hospitalar:__________________________________________________________________________________________

Como foi o clima familiar na recepção da criança?

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Sorriu?___________________ Equilíbrio de pescoço?_________________________________________________________
Engatinhou?___________________Sentou?__________________________________________________________________
Andou?______________________Falou as primeiras palavras?_____________________________________________
Quais palavras: __________________________________________________________________________________________
Falou corretamente?______________Trocou letras?________________________________________________________
Gaguejou?_________________Dentição ( 1 e 2)______________________________________________________________
Controle dos esfíncteres: Anal diurno_____________________________________________
Vesical diurno_____________ noturno_____________________
Estava sob os cuidados de quem? ________________________________________________________________________
Aconteceu algum evento que configurou maus-tratos? __________________________________________________
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Manipulações (quantos anos?)

Tem alguma mania, um comportamento que se repete com frequência? ________________________________
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Usou chupeta _________________Chupou o dedo ___________________________________________________________
Roí unhas _____________________ Puxa a orelha __________________________________________________________
Arranca os cabelos ____________ Morde os lábios _________________________________________________________
Balança o corpo _______________________________ Mexe com as pernas ____________________________________
Tíques ____________________________________________________________________________________________________
Atitude tomada diante desses hábitos ___________________________________________________________________
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Sono
Dorme bem________________ Pula quando dorme___________________ Horário: ____________________________
Baba a noite___________________ Sudorese_________________________________________________________________
Acorda várias vezes durante a noite e torna a dormir_________________________________________________
Fala dormindo_______________Grita_______________________________________________________________________
Range os dentes________________ Sonâmbulo______________________________________________________________
Pesadelos_________________________________________________________________________________________________
Atualmente, dorme no próprio quarto? Dorme com quem? _____________________________________________
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Alimentação
Foi amamentado no peito, usou mamadeira, atitude no desmame, como são os hábitos alimentares atualmente, restrições.
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Escolaridade
Vai bem na escola?_______________________________________________________________________________________
Gosta de estudar_________________________________________________________________________________________
Histórico escolar (quando começou a estudar, quais escolas, reprovação)
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Gosta da escola___________________________________________________________________________________________
Queixas de comportamento_______________________________________________________________________________
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Dificuldade em escrita___________________________________________________________________________________
Dificuldades em cálculo __________________________________________________________________________________
Dificuldades em leitura _________________________________________________________________________________
Organização com materiais escolares ___________________________________________________________________
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Outras dificuldades ______________________________________________________________________________________
Preferência lateral ______________________________________________________________________________________

Vida social
Prefere brincar sozinho ou com os amigos, afetividade, família, amizades, parentes, círculo de convivências.
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Sexualidade
Curiosidades sexual, atitudes dos pais, masturbação, educação sexual.
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Doenças
Febre, convulsões, operações, anestesia, alergias, acidentes, quedas.
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5 - Antecedentes familiares (pais tiveram dificuldades escolares?)

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6 - Habilidades não-acadêmicas
Esportes, bicicleta, joga bola, vídeo-game, leitura, tarefas domésticas, interesse por mecânica, aparelhos eletrônicos, instrumentos
musicais, esportes.
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7 – Rotina (o que costuma fazer durante a semana)

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8 - Ambiente familiar
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9. O que faz sozinho? Toma banho sozinho?

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Veste roupa sozinho? Come sozinho?

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Observações
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