Roteiro de Anamnese Infantil

I – Identificação:
Nome:______________________________________________________________________________________________
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Idade:____________________Data de nascimento:_________________________________________________________
Sexo: ______________________________________________________________________________________________
Nome do colégio:_____________________________________________________________________________________
( ) Pública ( ) Particular
Ano:_______________________________________________________________________________________________
Pai: ________________________________________________________________________________________________
Nome: _____________________________________________________________________________________________
Profissão: ___________________________________________________________________________________________
Idade:______________________________________________________________________________________________
Mãe: ______________________________________________________________________________________________
Nome: _____________________________________________________________________________________________
Profissão:___________________________________________________________________________________________
Idade: ______________________________________________________________________________________________
II - Queixa ou motivo da consulta:
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Circunstâncias que precedem a busca de atendimento:
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Tempo de duração do problema atual (queixa):
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III - Situação e contexto atual:
Condição socioeconômica dos cuidadores
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Com quem mora atualmente: (Se a criança não esta vivendo com ambos os pais biológicos, obtenha informações sobre o
paradeiro do pai/mãe não residente, história da separação, visitação, moradia atual, história de institucionalização, etc.).
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Os pais são casados? ______________________________________________________________________
Há quanto tempo?__________________________________________________________________________
Os pais são separados? ______________________________________________________________________
Há quanto tempo?__________________________________________________________________________
Número de irmãos (nome e idade): Identificar se são de pais diferentes
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Histórico psiquiátrico familiar:

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Dinâmica familiar (principais relações, engajamento e disposição da família para o tto, questões religiosas, legais, luto);
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A criança é adotada? ( ) Sim ( ) Não
IV - Antecedentes pessoais:
1 – Concepção e gestação:
Quantas gestações a mãe teve antes do nascimento do avaliado? ___________________________________
Abortos? ( ) Sim ( ) Não
Quantos? _______
A gestação foi planejada/ desejada
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Ocorreram intercorrências durante a gestação do paciente? ( ) Sim ( ) Não
Quais? _________________________________________________________________________________
Ameaça de aborto durante a gravidez do paciente? ( ) Sim ( ) Não
Durante a gestação, utilizou alguma medicação? ( ) Sim ( ) Não
Uso de substâncias
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Circustâncias sociais e emocionais na gestação e período perinatal:

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Brigas no início da gestação
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Abortos, outras gestações;

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O período da gestação durou quantas semanas? _________ (ou meses: __________)

2 - Condição de nascimento:
Natural/cesárea/fórceps;
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Peso ao nascer
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Intercorrências
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3 - Desenvolvimento da criança:
Amamentou no peito?
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Tirou a fralda com quanto tempo?
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Andou com quanto tempo?
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Falou com quanto tempo?
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Dificuldades de fala, visão, audição?
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4 - Desenvolvimento da conduta:
A) Sono
A criança dorme bem?
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Sono agitado?
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Desde quando?
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Alguma alteração de sono?
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Dorme onde?
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B) Alimentação:
Come bem?
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Rejeitou alimentação alguma vez?
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5 - Desenvolvimento neuropsicomotor:
Quando sorriu pela primeira vez?
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Quando engatinhou?
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Quando Sentou?
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Quando Ficou de pé?

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Quando Andou?
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Qual e quando foi a primeira palavra falada?
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Dificuldades na articulação da fala?
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Controle dos esfíncteres:
Anal diurno:
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Anal noturno:
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Vesical diurno:
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Vesical noturno:
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6 - Manipulações e hábitos:
Usou chupeta? Até quando?
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Chupou dedo? Até quando?
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Roeu ou rói as unhas?
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Teve tiques nervosos? Quais?
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7 - Socialização:
Tem amigos?
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Prefere brincar sozinho ou com amigos?
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Faz amigos facilmente?
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Desinteressa-se logo pelos brinquedos?
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Que tipo de brinquedos prefere?
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8 - Escolaridade:
Vai bem na escola?
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Como foi a alfabetização?
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Repetências?
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Relacionamento com professores e relacionamento com colegas?
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Mudanças de escola?
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Tem dificuldade na escrita?
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E na leitura?
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Alguma outra dificuldade?
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9 - Saúde:
Já desmaiou?
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Teve convulsões?
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Foi internada no hospital?
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Foi operada?
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Doenças crônicas?
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Tratamentos prévios (fonoaudiológicos, psicopedagógicos, fisioterápicos, psicoterápicos, etc.)
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Medicações que já utilizou?

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Medicações em uso?
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12 - Descrição do dia a dia da criança:
Um dia na vida da criança (rotina):
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Descreva seu filho para um estranho:
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Eventos importantes:
Separações, mudanças de casa/cidade, trocas de escola, institucionalização
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Situações traumáticas:
A criança já presenciou, se deparou ou viveu algum evento estressante/traumático
em algum momento da sua vida? ( ) Sim ( ) Não
1. ( ) assalto
2. ( ) agressão física
3. ( ) crime violento sofrido pela própria pessoa ou por pessoas afetivamente significativas
4. ( ) sequestro
5. ( ) suicídio de alguém próximo
6. ( ) mutilação provocada por outro indivíduo
7. ( ) terrorismo
8. ( ) guerra

9. ( ) acidentes automobilísticos
10. ( ) acidentes aéreos e/ou aquáticos
11. ( ) desabamentos
12. ( ) incêndios
13. ( ) enchentes
14. ( ) ataques de animais
15. ( ) terremoto
16. ( ) furacão

Descreva:
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Maus-tratos: abuso físico, emocional, testemunho de violência doméstica, negligência, abuso sexual
1. ( ) Abuso físico (infligir ferimentos em uma criança/adolescente por meios não acidentais)
2. ( ) Abuso sexual (qualquer contato ou interação sexual entre uma criança e outro indivíduo em estágio de
desenvolvimento psicossexual mais avançado)
3. ( ) Abuso emocional (frustração extrema e persistente de necessidades emocionais)
4. ( ) Negligência (falha para fornecer cuidados mínimos e a falta de supervisão)
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Risco Atual de maus-tratos:

75 – Possível abuso sexual ou risco: ( ) Sim ( ) Não
76 – Possível abuso físico: ( ) Sim ( ) Não
77 – Possível negligência: ( ) Sim ( ) Não
78 – Possível abuso Psicológico: ( ) Sim ( ) Não
79 – Observações:
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