Sarah Cassimiro Marques

Nepneuro
Data: ____/____/____
Numero______________
Anamnese Infantil
Entrevista/Anamnese com a Me (Spreen & Strauss, 1998)

1 Identificao
Nome:______________________________________________________________________________
Idade: ____________________Data de Nascimento: ___________________________________
Sexo:_______________________Escolaridade:_________________________________________
Escola:___________________________________________________________________________
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Pai:_______________________________________________________________________________
Idade:_____________________Profisso:______________________________________________
Me:_______________________________________________________________________________
Idade:_____________________Profisso:______________________________________________
Telefones: ________________________________________________________________________

2 Encaminhamento: ____________________________________________________________

3 Queixa ou motivo da consulta

Queixa principal:_________________________________________________________________
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Outras Queixas:__________________________________________________________________
Atitude frente as queixas:
a) Me:____________________________________________________________________________
b) Pai: __________________________________________________________________________
c) Parentes:_______________________________________________________________________
Medicamentos:______________________________________________________________________
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Paciente sendo acompanhado por outro profissional:_________________________________
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Solicitar exames

4 Antecedentes Pessoais
Concepo
A criana foi desejada?___________________________________________________________
Posio na ordem das gestaes:____________________________________________________
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Abortos:___________________________________________________________________________
Gestao
Fez pr-natal, como foi a evoluo? Lembra como se sentia? Doenas / Sensaes / Quedas /
Medicamentos / Exposio a Rx / Uso de cigarro, lcool e outras drogas.
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Condies do Nascimento
( ) Em casa ( ) Maternidade
Desenvolvimento do parto
( ) Natural ( ) Frceps ( ) Cesariana
Posio do Nascimento
( ) De cabea ( ) Ombro ( ) Ndegas
Desenvolvimento Neuropsicomotor
Primeiras reaes:
( ) Chorou ( ) Vermelho ( ) Roxo
( )Anxia ( ) Ictercia ( ) Precisou de oxignio
( ) Incubadora
Alta hospitalar:__________________________________________________________________
Como foi o clima familiar na recepo da criana?
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Sorriu?___________________ Equilbrio de pescoo?_________________________________
Engatinhou?___________________Sentou?_________________________________________
Andou?______________________Falou as primeiras palavras?__________________________
Falou corretamente?______________Trocou letras?_____________________________
Gaguejou?_________________Dentio ( 1 e 2)________________________________________
Controle dos esfncteres: Anal diurno_____________________
Vesical diurno_____________ noturno_____________________
Estava sob os cuidados de quem? _______________________________________________
Manipulaes
Usou chupeta ________________Chupou o dedo _______________________________________
Roe unhas _____________________ Puxa a orelha ___________________________________
Arranca os cabelos ____________ Morde os lbios ___________________________________
Tques ________________________________________________________________________
Atitude tomada diante desses hbitos __________________________________________
Sono
Dorme bem________________ Pula quando dorme________________________________________
Baba a noite___________________ Sudorese__________________________________________
Acorda vrias vezes durante a noite e torna a dormir_______________________________
Fala dormindo_______________Grita_________________________________________________
Range os dentes________________ Sonmbulo_________________________________________
Pesadelos_________________________________________________________________________
Alimentao
Foi amamentado no peito, atitude no desmame, como so os hbitos alimentares.
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Escolaridade
Vai bem na escola?________________________________________________________
Gosta de estudar_________________________________________________________________
Histrico escolar____________________________________________________________
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Gosta da escola_______________________________________________________________
 Queixas de comportamento ______________________________________________________
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Dificuldade em escrita____________________________________________________________
Dificuldades em clculo ________________________________________________________
Dificuldades em leitura _______________________________________________________
Outras dificuldades ______________________________________________________________
Preferncia lateral _______________________________________________________________
Vida social
Prefere brincar sozinho ou com os amigos, afetividade, famlia, amizades, parentes, crculo de
convivncias.
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Sexualidade
Curiosidades sexual, atitudes dos pais, masturbao, educao sexual.
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Doenas
Febre, convulses, operaes, anestesia, alergias.
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5 - Antecedentes familiares
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6 - Habilidades no-acadmicas
Esportes, bicicleta, joga bola, vdeo-game, leitura, tarefas domsticas, interesse por mecnica,
aparelhos eletrnicos, instrumentos musicais.
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7 - Ambiente familiar
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Observaes
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