ANAMNESE INFANTIL

Nome do filho(a) _________________________________________________________________

Sexo: ______________ Idade: _______ anos _______ meses_______ Apelido: ______________
Data Nascimento: ____________________ Nacionalidade: __________________________
Escolaridade: ____________________ Srie: _________ Perodo ________________
Escola: _________________________________________________________________________
Endereo (da escola): ______________________________________________
2. Filiao:
Pai: __________________________________________________________ Idade: __________
Profisso: ________________________ Nacionalidade: ___________________
Me: __________________________________________________________ Idade __________
Profisso: ________________________ Nacionalidade: ___________________
Endereo: _____________________________________________________________________
Bairro: ____________________________ Fone Res.: _____________________
Religio: _________________________________________________________
Tratamento(s) anterior(es):
________________________________________________________________________________________
______________________________________________________________________
Antecedentes Pessoais:
a) Concepo:
A criana foi desejada? __________
Observaes:
________________________________________________________________________________________
________________________________________________________________________________________
_____________________________________________________________
b) Gestao:
Como a me estava emocionalmente? _______________________________________________
______________________________________________________________________________
Teve complicaes orgnicas? Em que ms? _________________________________________
Traumatismo? __________________________________________________________________
c) Parto
Como foram s 24 horas anteriores (me) e s 24 horas posteriores (me e criana) no
parto? ________________________________________________________________________
________________________________________________________________________________________
______________________________________________________________________
_______________________________________________________________________________
Condies do parto: normal ( ) cesrea ( )
tempo __________ precoce - quanto meses________ tamanho ________ peso _________

Observaes: ___________________________________________________________________
________________________________________________________________________________________
______________________________________________________________________
d) Desenvolvimento:
1- Alimentao:
lactncia materna? ________________ (caso no) Por que? ________________
________________________________________________________________________________________
______________________________________________________________________
Como aceitou alimentos slidos? ____________________________________________________
Quando nasceram os primeiros dentes? ______________________________________________
Tem problemas de alimentao atualmente? Quais? ____________________________________
______________________________________________________________________________
_______________________________________________________________________________
Qual a atitude da famlia? __________________________________________________________
_______________________________________________________________________________
Observaes: ___________________________________________________________________
________________________________________________________________________________________
______________________________________________________________________
Sono:
Como foi o sono desde pequeno? ___________________________________________________
______________________________________________________________________________
Houve poca em que melhorou ou piorou? ________ Quando?
____________________________
_______________________________________________________________________________
Atualmente, como o sono? ________________________________________________________
_______________________________________________________________________________
Qual a atitude dos pais? ___________________________________________________________
________________________________________________________________________________________
______________________________________________________________________
Observaes: ___________________________________________________________________
________________________________________________________________________________________
______________________________________________________________________Desenvolvimento
motor:
Quando sustentou a cabea? __________________ Sentou? _______________________
Engatinhou? _____________ Ficou em p? _________________ Andou? ___________________
Dificuldades no desenvolvimento: tendncia a cair? ___________ a machucar-se?
____________ golpeava-se? ___________ Dificuldades em manipular objetos?
__________________________
Outras? ___________ Dificuldades atuais: ___________________________________________
______________________________________________________________________________

Qual a atitude dos pais? __________________________________________________________

Lateralidade: ___________________________________________________________________
Observaes: __________________________________________________________________
________________________________________________________________________________________
______________________________________________________________________
6. Controle de esfncteres:
a) Quando deixou as fraldas? _______________________________________________________
_______________________________________________________________________________
b) Aprendizagem do uso de pinico? __________________________________________________
_______________________________________________________________________________
c) Como foi feito? (com facilidade, castigos)?
___________________________________________
_______________________________________________________________________________
Quem fez o controle? ___________________ Com que idade? ____________________________
Vesical diurno? ______________________________ anal diurno? _________________________
Vesical noturno? _______________________ anal noturno? ______________________________
Observaes: ___________________________________________________________________
________________________________________________________________________________________
______________________________________________________________________
7. Linguagem:
Quando falou as primeiras palavras? ______________ Quais foram?
_______________________
_______________________________________________________________________________
Problemas de fala? Quais? _________________________________________________________
_______________________________________________________________________________
Desde quando? __________________________________________________________________
Qual a atitude dos pais? ___________________________________________________________
_______________________________________________________________________________
Observaes:
________________________________________________________________________________________
______________________________________________________________________
- Sociabilidade:
Tem amigos? ___________ Que idade? ___________ Como o relacionamento com eles?
_______________________________________________________________________________
Que tipo de brincadeiras prefere? ____________________________________________________
_______________________________________________________________________________
Como se comporta com adultos? ____________________________________________________
_______________________________________________________________________________
Qual a atitude familiar? ____________________________________________________________
_______________________________________________________________________________

Observaes: ___________________________________________________________________
________________________________________________________________________________________
______________________________________________________________________Escolaridade:
Grau de Instruo: _________________ Escola: _______________________________________
Leitura: ( ) bem ( ) regular ( ) mau Escrita: ( ) bem ( ) regular ( ) mau
Dificuldade de aprendizagem: ________ disciplinas: ____________________________________
J foi reprovado: _____: Quantas vezes: _____ Atitude tomada: __________________________
Que escola(s) frequentou? _________________________________________________________
_______________________________________________________________________________
Com que idade ingressou?_______ Teve problemas em se adaptar escola?
Quais? _________________________________________________________________________
_______________________________________________________________________________
Apresentou dificuldades atualmente, quando ao rendimento escolar?
________________________
________________________________________________________________________________________
______________________________________________________________________
Qual o comportamento? ___________________________________________________________
_______________________________________________________________________________
O que diz a professora? ___________________________________________________________
_______________________________________________________________________________
Qual a atitude dos pais? ___________________________________________________________
_______________________________________________________________________________
Observaes: ___________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
- Sexualidade:
Manifesta curiosidade sexual? __________ Que pergunta faz? ____________________________
_______________________________________________________________________________
Qual a atitude dos pais?___________________________________________________________
______________________________________________________________________________
Teve orientao? Por parte de quem? _______________________________________________
______________________________________________________________________________
Masturba-se? _________ Brincadeiras sexuais com outras crianas?
______________________
Quais? ________________________________________________________________________
Qual a atitude dos pais? __________________________________________________________
_______________________________________________________________________________
- Manipulao e tiques:
Usou chupeta? __________ at quando? _________________ Chupava o dedo? _____________

At quando? _____________ Apresenta outras manipulaes? Quais?

______________________
________________________________________________________________________________________
______________________________________________________________________ Tiques?
________________________________________________________________________
Qual a atitude dos pais? ___________________________________________________________
Observaes: ___________________________________________________________________
________________________________________________________________________________________
______________________________________________________________________Formas

de

Reaes: (s ordens, s proibies, frustraes, relacionamento diante estranhos,

defende-se, etc.)
________________________________________________________________________________________
______________________________________________________________________
Traos de Personalidade: (Tmida, inquieta, hiperativa, retrada, saliente, amvel, etc.)
- Doenas:
Doenas infantis (quais e em que idade)? _____________________________________________
_______________________________________________________________________________
Operaes (quais e em que idade)? __________________________________________________
_______________________________________________________________________________
Traumatismo, quedas (idade)? ______________________________________________________
_______________________________________________________________________________
Desmaios, ausncias (idade) _______________________________________________________
_______________________________________________________________________________
Tem alguma doena atualmente? ________ Qual? ______________________________________
_______________________________________________________________________________
Est sendo tratado? _______________________________________________________________
Observaes: ____________________________________________________________________
________________________________________________________________________________________
______________________________________________________________________Antecedentes
Familiares: _________________________________________________________
________________________________________________________________________________________
______________________________________________________________________
Exame Psquico: ( circunstncia de atendimento, aparncia, psicomotricidade, humor,
pensamento, orientao, memria, vontade, rapport, etc.)
________________________________________________________________________________________
________________________________________________________________________________________
_____________________________________________________________
Relato Espontneo:

________________________________________________________________________________________
________________________________________________________________________________________
_____________________________________________________________

Local e data: _____________________________________________________

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Marcila Melo Alves Lima

Psicopedagoga