Anamnese Infantil

Nome________________________________________________________________________________________________________________________________________________________

Data de Nascimento___________________________ Data da entrevista ___________________Escola___________________________________ Nome da professora__________________________Nome do Pai_______________________________________________________________ idade______ profissão_______________________________________________________________________________Nome do mãe___________________________________________________________ idade_________ profissão_______________________________________________________________________________Quem compareceu a entrevista psicológica_____________________________________________A criança é filha único ( ) Primogênito ( ) 2º Filho ( ) 3º ( ) Gêmeos ( )

Adotado ( ) Sobre a adoção __________________________________________________________

Irmãos

Nome______________________________________________________________________Idade_______escola______________________________________________ série ______________________________

Nome______________________________________________________________________Idade_______escola______________________________________________ série ______________________________

A criança reside com__________________________________________________________________Queixa principal_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Quem identificou o problema__________________________________________________________Quem encaminhou ____________________________________________________________________________________________________________________________________________________________

Histórico

Gestação/saúde da Mãe/nascimento____________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

DesenvolvimentoFala:Idade/dificuldades_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Engatinhou/rastejou/andou___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Enurese/feses________________________________________________________________________________________________________________________________Toma banho sozinho____________________________________________________Toma atitudes de auto cuidados (quando se fere)_________________________________________________________________________________________________

Hábitos alimentaresA criança tem horários para se alimentar_________________________________ Respeita esses horários_____________________A criança faz as refeições junto com outros familiares_________________________________________________________________________________________________________________________Recusa-se a alimentar__________________________________________________Como é alimentação da criança_________________________________________Apresenta dificuldade em relação ao peso excesso ou abaixo _____________________________________________________________________________________________________________________________________________________________

Sono

Dorme sozinha_________________________________________________________Tem seu próprio quarto__________________________________________________Durante a noite levanta-se e vai para cama dos pais________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Tem pesadelos________________________________________________________________________________________________________________________________Qualidade do sono________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Dorme rapidamente/ouve estórias antes de dormir_____________________________________________________________________________________________________________________________________________________________________Acorda irritado_________________________________________________________

Saúde GeralDoenças/Medicação/Cirurgias/Traumas/Desmaios/Convulsões_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

TratamentosFonoaudiologia ( ) / Terapia Ocupacional ( ) / Fisioterapia ( ) / Psicoterapia ( ) / Psicopedagoga ( ) / Psiquiatria ( ) / Outros ( )

Motivo/Houve melhoras__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Vida AcadêmicaCom que idade iniciou a vida escolar/resistência/chorou________________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________Reprovou/Motivo/série_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Qual a principal dificuldade/Matéria___________________________________Qual o comportamento da criança em fazer as tarefas_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________Quem vai às reuniões escolares___________________________________________A visão da criança em relação ao futuro/profissão_____________________________________________________________________________________________________________________________________________________________________Qual a atitude dos pais____________________________________________________________________________________________________________________________________________________________________________________________

Dinâmica FamiliarO principal cuidador____________________________________________________Com quem a criança se relaciona melhor_____________________________________________________________________________________________________________________________________________________________________________Quem brinca mais_____________________________________________________Que tipos de brincadeiras________________________________________________Relacionamento com irmãos_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Quais as outras pessoas que a criança se relaciona/mais velhos/mais novos/adultos__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

A família tem hábitos de sair juntos_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Os pais conhecem os amigos/pais dos colegas da criança_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Personalidade da CriançaDistraída____________________________________________________________________________________________________________________________________Esquece os compromissos_______________________________________________________________________________________________________________________Perde os brinquedos_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________Respeita as regras/limites/formas de driblar as regras_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Comportamento de Birras/desafiador/submisso_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Qual a atitude dos pais________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Habilidades sociais

Criança tem amigos___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Relaciona com criança mais velhas/novas/adultos/idosos/parentes__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Briga com as outras crianças/líder____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Tem noção de perigo/fere-se____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Passatempos preferidos________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Prática algum esporte_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Antecedentes familiares Psiquiátricos e Neurológicos__________________________________________________________________________________________________________________________________________________________________________________________________________________

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Observações:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Sinop. MT Data:______________________________

Nome:__________________________________________________________________________________