Departamento de Psicologa

Expediente No.

ANAMNESIS INFANTILI. Datos generales

Nombre del nio(a):________________________________________________________

Lugar y fecha de nacimiento: ________________________________________________

Edad: _________________aos __________________ mes(es)_______________ da(s)

Gnero: _____________________ Nacionalidad: ________________________________

Grado escolar: ____ Seccin: ___ Maestro(a) encargado(a): _______________________

Establecimiento Escolar: ____________________________________________________

Nombre de padre: _________________________________________________________Edad: ________ Estado Civil: _______________ Religin: _________________________

Escolaridad: ________________________ Telfono(s):___________________________

Ocupacin: ______________________________________________________________

Nombre de la madre: ______________________________________________________Edad: ________ Estado Civil: _______________ Religin: _________________________

Escolaridad: ________________________ Telfono(s):___________________________

Ocupacin: ______________________________________________________________

Nombre del encargado(a):___________________________________________________

Edad: ________ Estado Civil: _______________ Religin: _________________________

Escolaridad: ________________________ Telfono(s):___________________________

Ocupacin: ______________________________________________________________

II. Motivo de consulta

Padre/Madre/Encargado________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________Establecimiento Escolar: Direccin/Maestro(a)

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III. Historia espontnea

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________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. Historia del problema actual (cuando comenz a manifestarse y que acontecimientos se asocian)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________V. Conducta habitual (comportamiento general del nio antes de presentar el problema)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

VI. Historia personal

a. Historia prenatal

________________________________________________________________________________________________________________________________________________________________________________________________________________________Edad de los padres al embarazo Madre: _______ Padre:______

Duracin del embarazo: _________ Embarazos anteriores: ________________________ Durante el embarazo hubo amenaza de aborto: ________________________________

Reaccin de los padres ante el embarazo (deseado, no deseado, planificado, accidente, etc)________________________________________________________________________________________________________________________________________________

Hubo control prenatal? ____________ Mdico: _________ comadrona: _____________Alimentacin de la madre durante el embarazo: _________________________________

________________________________________________________________________________________________________________________________________________Us algn medicamento? SI NO Cul? _________________________________

Us drogas? SI NO Cul? ____________________________________________

Cigarrillos: SI NO Bebidas alcohlicas: SI NO Frecuencia: _______________

Padeci alguna enfermedad durante el embarazo?______________________________Hubo problemas emocionales? _____________________________________________Actividad cotidiana durante el embarazo: _____________________________________Observaciones

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b. Historia perinatal

________________________________________________________________________________________________________________________________________________________________________________________________________________________Lugar donde fue atendido el parto: ____________________________________________

Quin atendi el parto? ___________________________________________________

Cunto dur la labor? _________________________ Us frceps? SI NO

Hubo llanto inmediato? SI NO Naci amarillo? SI NO Peso al nacer: ________Cunto midi? _____________________Posicin al nacer: _______________________Observaciones (complicaciones, APGAR, diagnstico del mdico al nacer, contacto con la madre)

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c. Historia postnatal

________________________________________________________________________________________________________________________________________________________________________________________________________________________Tiempo que permaneci en el hospital: ________________________________________

Observaciones

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d. Alimentacin

________________________________________________________________________________________________________________________________________________________________________________________________________________________Lactancia Materna ( Mixta ( Artificial ( Duracin ________________Caractersticas del destete: _________________________________________________

Us pepe? SI NO Hubo succin de pulgar? SI NO otros: _______________Responsable de la alimentacin: _____________________________________________Edad que inici a ingerir alimentos slidos: _______ alimentos: _____________________

________________________________________________________________________Preferencias alimenticias: ___________________________________________________________________________________________________________________________Aversiones alimenticias: ____________________________________________________

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Castigos por no comer:_____________________________________________________

________________________________________________________________________Reacciones anorxicas o bulmicas: ___________________________________________

________________________________________________________________________Caractersticas de la primera denticin: ________________________________________

________________________________________________________________________Observaciones

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e. Desarrollo motor

________________________________________________________________________________________________________________________________________________________________________________________________________________________A qu edad alcanz cada una de las siguientes habilidades motoras

Sostuvo la cabeza: ____________________ Gate: _____________________

Volte el cuerpo: _____________________ Se sent: ___________________

Camin: ____________________________ Salt: ______________________

Dibuj garabatos: ____________________ Corri ______________________

Predominio lateral: Izquierdo Derecho Ambas

Sincinesas (Movimiento muscular involuntario y superfluo que acompaa a otro voluntario) ________________________________________________________________________Estereotipias (repeticin constante y automtica de movimientos o palabras) _______________________________________________________________________________

Destreza motora gruesa: ___________________________________________________________

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Destreza motora fina: _____________________________________________________________

_______________________________________________________________________________Estado psicomotriz actual: __________________________________________________Estimulacin temprana: ____________________________________________________Observaciones

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f. Control de esfnteres

________________________________________________________________________________________________________________________________________________________________________________________________________________________Iniciacin del control esfinteriano urinario: ______________________________________

Iniciacin de control esfinteriano anal: _________________________________________

Retencin o juegos con la orina y heces: _______________________________________

Frecuencia de detencin una vez aprendida la retencin: __________________________ Caractersticas generales sobre la educacin de esfnteres: ________________________

________________________________________________________________________Hbitos higinicos: ________________________________________________________

Observaciones

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g. Lenguaje

________________________________________________________________________________________________________________________________________________________________________________________________________________________Indicar a qu edad logr realizar las siguientes actividades:

Balbuceo: ____________________ imitacin de sonidos: ___________________

Slabas: ______________________ Primeras palabras: _____________________

Frases: _______________________oraciones completas: ___________________

Dificultades de lenguaje: ____________________________________________________Idiomas que conoce y utiliza: ________________________________________________Observaciones

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h. Sueo ________________________________________________________________________________________________________________________________________________________________________________________________________________________Cmo fue su sueo durante los primeros aos de vida? __________________________________________________________________________________________________Llanto nocturno: SI NO Especifique: ________________________________________Necesidad de elementos de compaa: Luz, Juguetes ____________________________

Horarios de sueo: __________________________ Siesta: ________________________Pesadillas y sueos:_______________________________________________________

________________________________________________________________________Insomnio: ______________________________________________________________ Hipersomnio: ____________________________________________________________

Observaciones

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i. Antecedentes mdicos

________________________________________________________________________________________________________________________________________________________________________________________________________________________Indicar que vacunas

se han administradoEnfermedades

que ha padecidoEdad

Sarampin Sarampin

Poliomielitis Poliomielitis

DifteriaDifteria

Tos ferinaTos ferina

Ttano Ttano

Rubeola Rubeola

Paperas Paperas

B.C.G.B.C.G.

Tifoidea Tifoidea

Otra: Otra:

Trastornos psicolgicos familiares: ____________________________________________________________________________________________________________________Trastornos psicolgicos anteriores del nio: _____________________________________________________________________________________________________________

Enuresis (miccin repentina): ____________________________________________

Encopresis (perdida voluntaria e involuntaria de heces): ___________________________

Frote ansioso o trueno de manos: _____________________________________

Chupeteo del pulgar u otros dedos: ____________________________________

Chirriar dientes: ___________________________________________________

Tics nerviosos: ____________________________________________________

Antecedentes mdicos (edad, vivencia, tratamiento, hospitalizacin, secuelas): ________________________________________________________________________________________________________________________________________________Antecedentes traumatolgicos: ________________________________________________________________________________________________________________________________________________

Antecedentes quirrgicos: ________________________________________________________________________________________________________________________________________________

Trastornos perceptivos: ____________________________________________________Desmayos: ___________________________________________________

Cefaleas: ____________________________________________________

Convulsiones: _________________________________________________

Trastornos neurolgicos: ___________________________________________________

Actitud del nio frente a la enfermedad y la muerte: ______________________________Actitud de los padres frente a la enfermedad y la muerte: __________________________________________________________________________________________________Observaciones

________________________________________________________________________________________________________________________________________________________________________________________________________________________j. Juegos

________________________________________________________________________________________________________________________________________________________________________________________________________________________Juegos preferidos (solo o en compaa, activos o pasivos, con nios de la misma edad, menores o mayores, gnero) ________________________________________________________________________________________________________________________________________________Rol: ____________________________ Intensidad: ______________________________Horario: _________________________ Deportes: _______________________________Lecturas:________________________ Actividades grupales: ______________________

Observaciones

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k. rea sexual________________________________________________________________________________________________________________________________________________________________________________________________________________________Tocamientos: ____________________________________________________________Masturbacin: ____________________________________________________________

Juegos e investigaciones sexuales: ___________________________________________Nivel de esclarecimiento sexual por parte de los padres. Edad y reacciones del nio y de los padres _______________________________________________________________

________________________________________________________________________

Desarrollo sexual: _________________________________________________________

Actitud de padres ante el tema: ______________________________________________

Educacin sexual en establecimiento escolar: ___________________________________Observaciones

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VII. Historia familiar

Personas con las que vive el nio(a) incluyendo el nombre y calidad de la relacin

Padre:__________________________________________________________________________________________________________________________________________________________________________________________________________________Madre:__________________________________________________________________________________________________________________________________________________________________________________________________________________Abuelo paterno: ___________________________________________________________

________________________________________________________________________________________________________________________________________________Abuela paterna: ___________________________________________________________

________________________________________________________________________________________________________________________________________________Abuelo materno: __________________________________________________________

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Abuela materna: __________________________________________________________________________________________________________________________________________________________________________________________________________

Bisabuelos: ______________________________________________________________

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Hermanos:_______________________________________________________________________________________________________________________________________________________________________________________________________________

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Otros: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Reaccin ante la prdida de seres queridos: ________________________________________________________________________________________________________________________________________________

Reaccin ante las mudanzas: ________________________________________________

________________________________________________________________________Reaccin ante los festejos y regalos: __________________________________________________________________________________________________________________Tiempo dedicado por los padres a la convivencia familiar: _________________________

________________________________________________________________________Conducta del nio(a) en casa: _______________________________________________________________________________________________________________________________________________________________________________________________Aplicacin de premios o castigos: _____________________________________________________________________________________________________________________________________________________________________________________________

VIII. Historia escolar

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Edad y reacciones ante el inicio escolar: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ColegioEdadGrados cursados

Caractersticas especiales de algn colegio o maestros que hayan podido influir en el nio:____________________________________________________________________________________________________________________________________________________________________________________________________________________

Dificultades para el aprendizaje: ______________________________________________________________________________________________________________________Rendimiento escolar general: ________________________________________________________________________________________________________________________Dificultad para alguna(s) materia(s): ___________________________________________________________________________________________________________________Actitud frente a exmenes, presentaciones y estudios en general: ___________________________________________________________________________________________________________________________________________________________________Grados repetidos: _________________________________________________________Actitud de padres ante el rendimiento escolar: ___________________________________

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Actividades extracurriculares: ________________________________________________Conducta escolar: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Observaciones

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IX. Relaciones sociales

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Preferencia de amistades: __________________________________________________

Comportamiento ante adultos: _______________________________________________

Relacin con sus compaeros de clase:________________________________________________________________________________________________________________Relacin con sus maestros: _________________________________________________________________________________________________________________________Preferencias de animales: __________________________________________________Desagrado de animales: ____________________________________________________Observaciones

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X. Observaciones

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Nombre del entrevistador

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Firma del entrevistador

Guatemala, _________________________________de 20___2