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1
mSoblis konsultireba bavSvis
movlisa da ganviTarebis
sakiTxebze
ZiriTadi principebi
klinikuri praqtikis erovnuli rekomendacia
(gaidlaini)
2
klinikuri praqtikis erovnuli rekomendacia (gaidlaini)
`mSoblis konsultireba bavSvis movlisa da ganviTarebis
sakiTxebze – ZiriTadi principebi~ miRebulia klinikuri
praqtikis erovnuli rekomendaciebis (gaidlainebi) da
daavadebaTa marTvis saxelmwifo standartebis (protokolebi)
SemuSavebis, Sefasebis da danergvis erovnuli sabWos 2008 wlis 5
noembris #1 sxdomaze da damtkicebulia saqarTvelos Sromis,
janmrTelobisa da socialuri dacvis ministris 2009 wlis 14
aprilis # 151/o brZanebiT.
3
mSobelis konsultireba bavSvis movlisa da ganviTarebis sakiTxebze
ZiriTadi principebi definicia
konsultireba dinamiuri procesia, romlis drosac konsultanti
informacias awvdis erTi an ramdenime adamians da exmareba mas/maT swori
gadawyvetilebis miRebaSi.
gaidlaini gankuTvnilia
⇒ pirveladi jandacvis rgolis samedicino personalisTvis - ojaxis
eqimi, eqimi-pediatri, eqTani.
gaidlainis samizne jgufi:
⇒ 0-15 wlis asakis bavSvebi da maTi mSoblebi.
D
mSobelTa konsultirebis principebi 1, 2, 3
mSoblebis konsultireba bavSvis janmrTelobisa da ganviTarebis
sakiTxebze jandacvis pirveladi rgolis erT-erTi mniSvnelovani funqciaa
da eqimis/eqTnis bavSvTan vizitis aucilebel komponents warmoadgens.
dadgenilia, rom bavSvebi ukeT viTardebian, Tu maTi garemo aRsavsea
zrunviT, yuradRebiTa da siyvaruliT. racionaluri kveba da higiena,
janmrTelobaze meTvalyureoba, imunizacia, gonebrivi ganviTarebis
xelSewyoba, TamaSi da usafrTxo garemo is safuZvelia, rac xels uwyobs
janmrTeli da harmoniulad ganviTarebuli adamianis Camoyalibebas.
Tu bavSvis mSobeli/aRmzrdeli flobs srulfasovan informacias bavSvis
yvela saWiroebis, misi ganviTarebis xelSewyobis, ufrosis bavSvTan
damokidebulebis aucilebeli principebis Sesaxeb, igi advilad SeZlebs
uzrunvelyos Sesabamisi pirobebi da keTilganwyobili garemo, bavSvis
cxovrebis saukeTeso dasawyisisTvis.
specialisti, romelic atarebs Kkonsultirebas unda flobdes iseT unar-
Cvevebs, romlebic erTi mxriv uzrunvelyofs mSoblisTvis aucilebeli
informaciis miwodebas da meore mxriv specialists miscems SesaZleblobas,
Seafasos mSoblis unari, ramdenad SeuZlia mas bavSvis movla da misTvis
aucilebeli saWiroebebis dakmayofileba4,.31.
4
komunikaciis meTodebi 6, 7 M
konsultirebis efeqturoba damokidebulia specialistis (eqimi/eqTani)
komunikaciis (urTierTobis xerxi) unar-Cvevebze; Kkomunikacia erT-erTi
umniSvnelovanesi pirobaa mSobelTan ndobaze damyarebuli urTierTobis
CamoyalibebisTvis;
araverbaluri komunikacia – ,,sxeulis ena’’, romelic saSualebas aZlevs
specialists sityvebis gareSe gamoiCinos yuradReba mSoblis/aRmzrdelis
mimarT. araverbaluri komunikaciis principebis dacvis mizniT specialistma
unda SearCios Sesabamisi poza, distancia, mimika, Jestikulacia da mzera. P
• poza – Tavisufali, odnav win gadaxrili;
• distancia – aranakleb 50 santimetrisa da araumetes 2 m-sa, sivrce,
barierisgan Tavisufali
• mimika – TanagrZnobisa da yuradRebis gamomxatveli, Rimili
Sesaferis momentebSi;
• Jestikulacia – zomieri, aramkveTri;
• mzera – specialistma unda uyuros mosaubres TvalebSi, Tumca mzera
ar unda iyos Semawuxebeli da daJinebuli, ar aris mizanSewonili
mzeris gadatana mis ukan ganlagebul sagnebze, saaTze daxedva.
verbaluri komunikacia – saubris warmarTvis teqnika, romelic saSualebas
aZlevs specialists gamoiCinos yuradReba Tanamosaubris mimarT.
• xma – rbili, intonacia Tematikis Sesasabamisi;
• sityvebi - martivi, gasagebi;
• gamoTqma – mkafio;
• saubari – damajerebeli, riTmuli, Sesabamis momentebSi riTmis cvla.
saubris dros specialistma unda gamoxatos Tanamosaubris mimarT dadebiTi
emocia, gamoiyenos pauzebi, raTa msmenelma ukeT aiTvisos miRebuli
informacia. A
ar aris rekomendebuli erTdroulad Warbi informaciis miwodeba, vinaidan
msmenels uWirs misi aRqma.
ndobaze damyarebuli komunikacia da aqtiuri mosmena:
konsultirebis drosAucilebelia, specialistis mxridan TanagrZnobis
gamoxatva, msmenelma unda igrZnos, rom misi yvela problema gaTavisebulia.
es xels uwyobs sapasuxo keTilganwyobas da uzrunvelyofs
urTierTgagebas. saubari ise unda warimarTos, rom saboloo
gadawyvetileba msmenelma Tavad miiRos. konsultantma unda gamoiyenos
aqtiuri mosmenis xerxi, rac SesaZleblobas aZlevs specialists mosaubris
mimarT gamoxatos maqsimaluri yuradReba da moipovos misi ndoba.
konsultantma unda waaxalisos da Seaqos mSobeli imisTvis, rasac kargad
akeTebs da gaiziaros mSoblis gancdebi, miawodis informacia martivi da
misTvis gasagebi eniT, rCevis da ara brZanebis formiT. ar aris
5
rekomendebuli SeniSvnebs da iseTi sityvebis gamoyeneba, romlebic
adanaSaulebs mSobels.
aqtiuri mosmenis dros gamoiyeneba
• perifrazireba – mosaubris mier gamoTqmuli, zogierTi sityvis
gameoreba arwmunebs mas, rom misi yvela sityva mosmenili da kargad
aRqmulia;
• msmenelis diskusiaSi CarTva –sakuTari azris gamoxatvis xelSewyoba;
• mimikiT da frazebiT miniSneba, rom specialisti usmens mSobels.
• SekiTxvis dasma - Sinaarsis mixedviT SekiTxva SeiZleba iyos:
hipoTezuri, gansjiTi, mxardamWeri, azris gamoTqmis wamaxalisebeli,
kvleviTi, Semajamebeli, SemaTanxmebeli. saubris dros aucilebelia
adeqvaturi, mizanmimarTuli SekiTxvebis gamoyeneba, raTa specialisti
srulad Cawvdes problemis arss. Aarsebobs ,,daxuruli’’ da ,,Ria’’
SekiTxvebi.
_ ,,daxuruli’’ SekiTxva – moiTxovs erTmniSvnelovan pasuxs ,,diax’’ an
,,ara’’ da ar iZleva srulyofili informaciis miRebis
SesaZleblobas;
_ ,,Ria’’ SekiTxva – iwyeba kiTxviTi sityvebiT: sad, rogor, rodis da
sxv. orientirebulia mosaubris axsna-ganmartebiT pasuxze da
iZleva srulyofili informaciis miRebis SesaZleblobas.
konsultantma unda gaiTvaliswinos, rom ar aris sasurveli mimarTulebis
mimcemi SekiTxvis dasma; erTdroulad ramdenime SekiTxvis micema da
SekiTxvis dawyeba kiTxviTi sityviT “ratom”, romelic iwvevs mosaubris
daZabvas, uRvivebs danaSaulis grZnobas da aferxebs urTierTobis process.
konsultantma unda gamoiCinos moTmineba da ar Seawyvetinos saubari
mSobels.
konsultirebis procesSi aucilebelia Tanamosaubris kulturuli
Taviseburebebis da erovnuli tradiciebis pativiscema.
bavSvze meTvalyureobis vizitebis ZiriTadi sakonsultacio sakiTxebi
• vizitis mniSvneloba, ufaso vizitebis raodenoba da moculoba;
• Casaxvis sawinaaRmdego meTodebi;
• drouli imunizacia da imunizaciis kalendari;
• kveba, ZuZuTi kveba da racionaluri kvebis xelSewyoba;
• bavSvis movlis principebi;
• dRis reJimi da Zili;
• uecari sikvdilis sindromi;
• bavSis ganviTarebis (motoruli, emociuri, socialuri da kognituri)
xelSewyoba;
• TamaSi da misi mniSvneloba;
• tirili;
6
• disciplina (3 wlis krizisi);
• tualetis treningi;
• usafrTxo garemo da dazianebebis prevencia;
• daavadebis saSiSroebis niSnebi;
• jansaRi cxovrebis wesi.
yvela vizitis dros konsultirebis Tematika unda dafqsirdes
bavSvis ganviTarebis istoriaSi (rekomedacia D); konsultirebis procesSi mSobelTa uzrunvelyofa nabeWdi
sainformacio masaliT, xels uwyobs konsultirebis efeqturobis
xarisxis gazrdas (mtkicebulebis done - I) 4,5; vizitis dros
mSoblisTvis, mxolod nabeWdi sainformacio masalis miwodeba
konsultirebis gareSe, ar aris rekomendebuli5. (rekomedacia A).
vizitis mniSvneloba da moculoba 7,8,9
specialistma mSobels unda miawodos informacia Semdeg sakiTxebze:
• janmrTel bavSvze regulari meTvalyureobis mniSvneloba bavSvis
janmrTelobis SenarCunebisa da ganviTarebis xelSewyobisTvis;
• eqimisa da eqTnis vizitebis vadebi;
• vizitis periodSi dagegmili yvela aqtivoba (gasinjva, Sefaseba,
skrinigi).
gasinjva – mSobelma unda icodes, rom gasinjva aucilebelia bavSvis
janmrTelobis mdgomareobis Sesafaseblad da bavSvis sruli gasinjva
ganxorcieldeba yvela vizitze
mSobels unda miawodon informacia, rom bavSvi unda iyos
gaxdili, raTa eqimma srulfasovnad SeZlos misi daTvaliereba
da gasinjva;
umjobesia gasinjva Catardes dRis Suqze.
Sefaseba – mSobelma unda icodes, rom yvela vizitze eqimi Seafasebs
bavSvis ganviTarebas, 5 wlamde asakis bavSvebSi yvela savaldebulo
vizitze tardeba bavSvis mxedvelobis, smenis da displaziis skriningi;
Tu viziti igegmeba binaze eqimma/eqTanma unda urCios mSobels moamzados
Tbili oTaxi da saWiroebis SemTxvevaSi moxerxebuli magida bavSvis
gasasinjad.
• mSobeli mzad unda iyos, daxmareba gauwios specialists vizitis
procesSi bavSTan urTierTobis damyarebaSi;
• mniSvnelovania viziti daigegmos dRis iseT monakveTSi, roca bavSvs
ar Zinavs;
• vizitis dasrulebis Semdgom mSobeli informirebuli unda iyos
Semdegi vizitis zusti TariRis Taobaze.
D
I
A
7
Tu gamovlindeba bavSvis janmrTelobasTan dakavSirebuli problema,
bavSvis ganviTarebis Seferxebis an daavadebaTa saSiSroebis niSnebi,
mSobeli ar unda daelodos Semdeg vizits da dauyovnebliv mimarTos eqims.
specialistma unda Seadginos calkeuli vizitis konsultirebis
gegma, Sesabamisi Tematikis gaTvaliswinebiT (rekomedacia D); bavSvis individualuri Taviseburebebidan gamomdinare, specialisti ar unda
Semoifarglos mxolod gegmiT gaTvaliswinebuli sakonsultacio
TemebiT (rekomedacia D).
Casaxvis sawinaaRmdego meTodebi
adreul postnatalur vizitze specialistma aucileblad unda
Cautaros dedas konsultireba Casaxvis sawinaaRmdego meTodebze
(rekomendacia D). misces ganmarteba, ramdenad didi mniSvneloba
eniWeba mSobiarobebs Soris aranakleb 2 wliani intervalis dacvas4.
Tu bavSvi dedis rZiT ikvebeba, deda unda iyos informirebuli
laqtaciuri amenoreis meTodis Sesaxeb, aseve Casaxvis sawinaaRmdego
sxva usafrTxo meTodebis Sesaxeb.
dedasTan konsultirebis sakvanZo sakiTxebi
• laqtaciuri amenoreis meTodi – xSiri ZuZuTi kveba, 24 saaTSi 8-jer
da metad, Ramis kveba, eqskluziuri ZuZuTi kveba 6 Tvemde asakSi icavs
qals xelaxali daorsulebisagan;
• Tu bavSvi xelovnur kvebazea an ZuZuTi ikvebeba da 6 Tveze meti
asakisaa, aucilebelia mSoblis informireba usafrTxo Casaxvis
sawinaaRmdego meTodebze.
imunizacia da imunizaciis kalendri
specialistma unda miawodos mSoblebs informacia imunizaciis
mniSvnelobisa da im daavadebTa saSiSroebis niSnebze, romelTaA Tavidan
acilebac SeiZleba vaqcinaciis drouli CatarebiT.
mSobeli unda iyos informirebuli saqarTveloSi moqmedi acrebis
kalendris da im savaldebulo vizitebis Taobaze, romlebic emTxveva
vaqcinacias. ucilebelia, mSoblis konsultireba acris Semdgomi periodis,
acris Semdgomi reaqciis da SesaZlo garTulebebis Sesaxeb.
dedasTan konsultirebis sakvanZo sakiTxebi
• imunizacia icavs bavSvs sicocxlisTvis saSiSi daavadebebisgan,
romlebic seriozuli garTulebebs iwvevs aramarto bavSvTa, aramed
zrdasrul asakSic;
D
D
8
• imunizaciis efeqturobisTvis didi mniSveneloba aqvs mis droulad
Catarebas.
ZuZuTi kveba da racionaluri kvebis xelSewyoba
mSoblis konsultireba bavSvis racionaluri da adekvaturi kvebis
sakiTxebze sapatronaJo vizitebis erT-erTi aucilebeli komponentia.
specialistma unda SeZlos mSoblis darwmuneba, rom bavSvis kveba erT-erTi
umniSvnelovanesi faqtoria adreuli asakis bavSvis ganviTarebisa da
janmrTelobis xelSewyobisaTvis. vizitebis dros specialisti atarebs
konsultacias ZuZuTi kvebis, damatebiTi kvebis, xelovnuri kvebis, avadmyofi
bavSvis kvebis principebze.
ZuZuTi kvebis sakiTxebze konsultireba unda daiwyos antenatalur
periodSi da gagrZeldes pirveli postnataluri vizitebis dros
(rekomendacia C)10. antenatalur periodSi konsultirebis ZiriTad
mizans dedis motivireba warmoadgens, bavSvis kvebis Sesaxeb swori
gadawyvetilebis misaRebad. patronaJis vizitebis dros
konsultirebis ZiraTadi mizania meZuZuri dedis daxmareba, raTa
man efeqturad ganaxorcielos axalSobili da Cvili bavSvis ZuZuTi
kveba.
ZuZuTi kveba
• mSobelTa konsultirebasTan erTad maTi uzrunvelyofa
nabeWdi sainfarmacio masaliT bunebrivi kvebis sakiTxebze
xels uwyobs ZuZuTi kvebis sixSiris 5-10%-iT zrdas
(mtkicebulebis done - I) 5,
• ojaxis sxva wevrebis CarTva ganaTlebis procesSi xels
uwyobs ZuZuTi kvebis xangrZlivobis gazrdas
(mtkicebulebis done - II). 11
• konsultireba ZuZuTi kvebis sakiTxebze unda daiwyos antenatalur
periodSi, gagrZeldes samSobiaro saxlSi da patronaJis vizitebis
dros. 5
dedasTan konsultirebis sakvanZo sakiTxebi
• ZuZuTi kveba amcirebs bavSvTa avadobisa da sikvdilobis
risks. (mtkicebulebis done I, rekomendaciis xarisxi B). 12, 13,14
• ZuZuTi kveba amcirebs dedis avadobis da sikvdilobis
risks (mtkicebulebis done II) 15,16,17
• qalis rZe saukeTeso sakvebia bavSvisaTvis.
• pirveli rZe, xseni akmayofilebs axalSobilis
moTxovnilebas da icavs mas mravali daavadebisagan.
(rekomendacia A ) 18,19,20
II
I
A
I, B
II
C
9
• 6 Tvemde bavSvi unda imyofebodes eqskluziur ZuZuTi
kvebaze.
• ZuZuTi kvebis gagrZeleba bavSvis an dedis avadmyofobisa
da hospitalizaciis dros aumjobesebs, rogorc dedis,
ise bavSvis janmrTelobis xarisxs (mtkicebulebis done
II)15,21
• rZis produqcia damokidebulia wovis sixSireze da
gamwvelili rZis raodenobaze. (mtkicebulebis done I)14,
21,23
• ZuZuTi kveba unda ganxorcieldes moTxovnilebis
mixedviT. aucilebelia Ramis kveba (rekomendacia- D) • bunebrivi kvebis gagrZeleba 2 wlis asakamde
(rekomendacia D) 24,25,26; • gaxangrZlivebuli ZuZuTi kveba xels uwyobs bavSvis
gonebriv ganviTarebas15,27 da amcirebs mozrdil asakSi
qronikuli daavadebebisa da simsuqnis ganviTarebis
risks25,26 • ZuZuTi kvebis teqnikis dacva xels uwyobs laqtacias
(swori moWideba da pozicia) (mtkicebulebis done II)
28.29.30 • meZuZuri dedis kveba - meZuZurma qalma unda miiRos
mravalferovani sakvebi da siTxeebi moTxovnilebis
mixedviT (rekomendacia A). dedis mier Warbi siTxis
miReba ar axdens gavlenas rZis produqciaze.
(mtkicebulebis done I). 23
damatebiTi kveba da bavSvis kveba 1 wlis Semdeg
pirveli 6 Tvis ganmavlobaSi qalis rZe srulad akmayofilebs janmrTeli
axalSobilisa da Cvilis moTxovnilebas sakvebsa da siTxeze. intensiur
zrdasTan erTad izrdeba misi kvebiTi da energetikuli moTxovnileba, ris
gamoc 6 Tvis Semdeg aucilebelia damatebiTi sakvebis miwodeba kvebiTi
racionis mikroelementebiTa da vitaminebiT Sesavsebad.
dedasTan konsultirebis sakvanZo sakiTxebi
• damatebiTi sakvebis daniSvnis saukeTeso periodia 6 Tve 24,25,26,32
• droulad dawyebuli da sworad SerCeuli damatebiTi kveba bavSvis
janmrTelobis, fizikuri da gonebrivi ganviTarebis safuZvelia. (ix.
bunebrivi kvebis gaidlaini);
• pirveli wlis Semdeg bavSvis kveba ojaxis magididan, mravalferovani
sakvebi da misi mniSvneloba;
• bavSvis kvebis procesi da masze zrunva kvebis dros bavSvis swavlis,
masTan Tbili urTierTobis da pirispir kontaqtis damyarebis
saukeTeso periodia.32,33
D
II
II
D
A,I
I
10
Tu samedicino Cvenebis gamo bavSvi xelovnur kvebazea dedam unda icodes4
• xelovnuri kvebis dros aucielbelia saaTobrivi reJimis
dacva, Ramis intervaliT. sakvebi unda momzaddes yvela
kvebis win higienis wesebis dacviT. (mtkicebulebis done
IV);4
• xelovnuri kvebis dros dedam bavSvi iseT poziciSi unda daiWiros,
rogorc ZuZuTi kvebis dros;
• Tu bavSvi ikvebeba qarxnuli wesiT momzadebuli qalis rZis
Semcvleli xelovnuri nareviT, sakvebi unda momzaddes arsebuli
etiketis instruqciis Tanaxmad; • dauSvebelia sakvebis gacxeleba mikrotalRovan RumelSi
(mtkicebulebis done III)4
bavSvis movlis principebi 9, 34,50,51,
mSoblis informireba bavSvis movlis principebis Sesaxeb postanataluri
vizitebis konsultaciis mniSvnelovan komponents Seadgens.
• mSobelma unda icodes ramdenad mniSvnelovania bavSvis
janmrTelobisTvis higienis dacva;
• unda hqondes informacia sxvadasxva proceduris sixSiris, vadebisa da
teqnikis Sesaxeb;
• specialistma saWiroebis SemTxvevaSi praqtikuli daxmareba unda
gauwios mSobels ama Tu im proceduris teqnikis dauflebis sakiTxSi.
dedasTan konsultirebis sakvanZo sakiTxebi
• axalSobil da Cvil bavSvs esaWiroeba yoveldRiuri tualeti -
Tvalis, yuris, cxviris gawmenda, xel-piris dabana, Cabana, banaoba,
wylis temperatura, sapnis gamoyeneba, kanis damuSaveba, Wipis
damuSaveba;
• Cacma - dauSvebelia axalSobilis gaxveva Zilis dros. bavSvi
Tavisuflad unda izrdebodes. bavSvis samosi naturaluri
qsovilisgan unda iyos damzadebuli. rogorc saxlSi, ise seirnobis
dros sezonis Sesabamisad unda iyos Cacmuli. ar aris rekomendebuli
bavSvis gadaxureba;
• kbilebis amoWris problemebis marTva, piris Rrus da kbilebis
tualeti asakis gaTvaliswinebiT. erTi wlis Semdeg saWiroa
stomatologis konsultacia 6 TveSi erTxel. kariesis ganviTarebis
xelSemwyobi faqtorebia - tkbileulis xSiri miReba, sawovariani
boTlis da satyuaras xangrZlivi droiT gamoyeneba. es ukanaskneli
xels uwyobs Tankbilvis darRvevasac;
• bavSvs piradi higienis dacvis damoukidebeli Cvevebis gamomuSavebis
xelSewyoba asakis gaTvaliswinebiT;
IV
III
11
• pubertatul peridSi konsultireba Sesabamisi higienuri wesebis
Sesaxeb.
dRis reJimi da Zili 35, 36
mSobels unda gaewios konsultireba dRis reJimis mniSvnelobisa da dRis
reJimis swori principebis dacvis xelSewyobis Taobaze. mSobelma unda
icodes, rom bavSvs uWirs erTi da igive saqmianobis didxans Sesruleba,
specialisti unda daexmaros mas fizikuri aqtivobis, dasvenebisa da haerze
seirnobis periodebis daregulirebaSi.
erT-erT mniSvnelovan sakonsultacio Temas warmoadgens mSoblis
informireba bavSvis Zilis Taobaze, bavSvis asakTan mimarTebaSi Zilis
xangrZlivobisa da Zilis dros sxeulis poziciis Sesaxeb.
dedasTan konsultirebis sakvanZo sakiTxebi
• bavSvis sxvadasxva aqtivobis racionalurad ganawileba dRis
ganmavlobaSi (kveba, Zili, dasveneba, TamaSi, fizikuri datvirTva,
haerze sernoba);
• Zilis dros bavSvi Tavisuflad unda grZnobdes Tavs, aucilebelia
Sesabamisi tansacmlisa da sabnis SerCeva;
• mniSvnelovania bavSvi SeeCvios erTsa da imave dros Zils da Zilis
win erTsa da imave situacias;
• Zilis xangrZlivoba unda Seesabamebodes asaks;
• mSobeli unda daukvirdes rogor sZinavs bavSvs; xom ar aRiniSneba
SfoTva, Ramis ,,koSmari’’, yvirili, moulodneli gamoRviZeba tiriliT
da koordinaciis darRveva, xom ar axlavs Ramis SiSebs da koSmarebs
enurezi.
uecari sikvdilis sindromi, 37,38,39,52
uecari sikvdilis sindromi ZiriTadad 1 wlamde, gansakuTrebiT xSirad ki 1-
dan 4 Tvemde asakSi vlindeba. konkretuli mizezi dadgenili ar aris, Tumca
SesaZlebeli gaxda faqtorebis identificireba, romlebic xels uwyobs
uecari sikvdilis sindromis sixSiris zrdas, mSobels unda gaewios
konsultacia imis Taobaze, rogor Seuwyos xeli uecari sikvdilis
sindromis riskis Semcirebas.
dedasTan konsultirebis sakvanZo sakiTxebi
• Zilis poziciis SerCeva. ar aris rekomendebuli bavSvis mucelze
daZineba, vinaidan aseT SemTxvevaSi izrdeba bavSvis uecari sikvdilis
sindromis riski. Uumjebesia bavSvs eZinos zurgze;
• Zilis dros bavSvs saxeze ar unda efaros safeni an sabani, ar aris
rekomendebuli didi da rbili baliSis da sabniss gamoyeneba;
12
• dauSvebelia bavSvis boTliT daZineba;
• garemoSi, sadac bavSvi imyofeba dauSvebelia moweva;
• ZuZuTi kveba amcirebs uecari sikvdilis sindromis gaviTarebis risks;
• dauSvebelia bavSvis marto datoveba;
• mSobeli unda iyos informirebuli usafrTxoebis yvela wesis Sesaxeb.
bavSvis ganviTarebis xelSewyoba 40,41,42,43
aRniSnul sakiTxebze konsultirebis dros specialistma unda ganumartos
mSoblebs, rom adreuli asaki bavSvis ganviTarebis xelSewyobis saukeTeso
periodia. am periodSi bavSvis fizikur ganviTarebasTan erTad sakmaod
intensiurad mimdinareobs gonebrivi ganviTareba da sxvadasxva unar-Cvevebis
Camoyalibeba. mSobeli unda iyos informirebuli imis Sesaxeb, rom ZiriTadi
roli bavSvis ganviTarebis xelSewyobis sakiTxSi swored mSoblebs, bavSvis
pirveli rigis aRmzrdelebs ekisrebaT. procesis keTilsaimedo
mimdinareobas gansazRvravs mSoblis damokidebuleba bavSvis mimarT, da
bavSvis sxvadasxva unaris ganviTarebis stimulireba ufrosis mier.
dedasTan konsultirebis sakvanZo sakiTxebi
• bavSvis srulfasovani da mravalmxrivi ganviTarebisTvis aRmrzdelma
unda uzrunvelyos saWiro garemo-pirobebis Seqmna;
• bavSvis ganviTareba mravalkomponentiania da moicavs fizikuri,
motoruli, emociuri, socialur da kognituri sferos ganviTarebis
xelSewyobas:
• TiToeuli sferos ganviTarebis done moqmedebs sxva sferoebzec;
• sxvadasxva bavSvs ganviTarebis procesi gansxvaveulad mimdinareobs,
amitom mas SeiZleba ganviTarebis konkretul etapze konkretul
sferoSi gansxavebuli miRwevebi hqondes vidre sxva sferoSi.
• aRmzrdeli unda daakvirdes bavSvs da individualurad SeurCios is
aqtivobebi, romlebic xels Seuwyobs bavSvis konkretuli asakisTvis
Sesabamisi Sedegebis miRwevas.
• aucilebelia bavSvis pirovnuli Tvisebebis pativiscema da misi azris
gaTvaliwineba;
• mSobelma unda agrZnobinos bavSvs, rom is uyvars, xSirad moeferos,
miularesos, saubris dros SearCios Sesabamisi intonacia da
Jestikulacia;
• bavSvTan urTierTobis dros aucilebelia bavSvis SesaZleblobebis,
metyvelebis donisa da aRqmis unaris gaTvaliswineba;
• mSobelma unda gaiTvaliswinos da droulad daakmayofilos bavSvis
moTxovnileba;
• aucilebelia bavSvis Seqeba kargi qcevisTvis.
13
kognituri - SemecnebiTi ganviTareba
bavSvis unari aRiqvas, analizi gaukeTos, daimaxsovros, miiRos
gadawyvetileba da SeZlos problemis gadaWra. konsultirebis mizania
specialistma ganumartos mSoblebs, rom bavSvis kognituri ganviTareba
yvelaze intensiurad adreul asakSi mimdinareobs, rasac samyaros aRqma,
azrovneba, mexsiereba, warmosaxva da metyveleba uwyobs xels. aRniSnuli
unarebis ganviTarebis xelSewyoba mTlianad ufroszea damokidebuli.
kognitur sferos ganviTareba, amave dros ganapirobebs saskolo mzaobas.
metyvelebisa da smenis ganviTarebis xelSewyoba:
miawodeT informacia mSobels, imis Taobaze, rom sicocxlis pireveli weli
kritikuli periodia metyvelebis CamoyalibebisTvis,Aam periodSi viTaredeba
bavSvis unari erTis mxriv gamoTqvas Tavisi Sexedulebebi da fiqrebi.
meores mxriv moisminos da aRiqvas garSemomyofebis naTqvami. Sesabamisad
aucilebelia bavSvis saubris da masTan urTierTobis waxaliseba.
aRmzrdelma aucileblad unda icodes, rom yuris xSirma infeqciebma
SesaZloa bavSvis metyvelebis ganviTarebis Seferxeba gamoiwvios.
dedasTan sakonsoltacio sakiTxebi
• mSobeli bavSvs dabadebidanve xSirad unda esaubros, mouyves zRaprebi
da moTxrobebi, moasmeninos musika, waukiTxos wigni; mizanSewonilia
dasuraTebuli wignebis gamoyeneba • bavSvTan saubari unda iyos neli, mSvidi, intonaciebiT mdidari da
alersiani;
• bavSvi laparaks mibaZviT swavlobs. amitom mozrdili mas unda
esaubros sworad da gamarTulad, unda gamoiyenos martivi ena da
saineterso sasaubro Temebi da misces bavSvs dro azris
CamoyalibebisTvis;
• mSoblema unda yuradReba miaqcios iseT saSiSroebis niSnebs,
romlebic SeiZleba sxvadasxva daavadebis mizezi iyos – bavSvi ar
brundeba xmauris mimarTulebiT, xSirad ifarebs/idebs yurze xels.
aseT SemTxvevebSi saWiroa eqimTan viziti.
motoruli ganviTarebis xelSewyoba
motoruli ganviTareba bavSvis unaria, sxvadasxva jgufis kunTebis
saSualebiT Seasrulos esa Tu is moZraoba. motoruli ganviTareba moicavs
msxvil anu uxeS, wvril anu natif motorikasa da sensomotorul anu
mgZnobelobiT-moZraobiT unarebs. motoruli sferos ganviTarebis
xelSewyobisTvis saWiroa sxvadasxva moZraobiTi aqtivobis ganxorcieleba.
aRmzrdelma unda icodes, rom calkeuli aqtivoba ara mxolod erTi
damoukidebeli mimarTulebis ganviTarebas uwyobs xels, aramed moqmedebs
erTdroulad ramdenime unaris Camoyalibebaze.
14
aRmzrdelTan konsultirebis sakvanZo sakiTxebi
• bavSvs unda mieces sxvadasxva fizikuri aqtivobis da gaSlil
sivrceSi moZraobis SesaZlebloba.
• msxvili motorikis ganviTarebisTvis mSobelma unda misces bavSvs
cocvis, xoxvis, siarulis, sirbilis, aZromis da sxv. saSualeba.
natifi motorikis ganviTarebisTvis ki – xatvis, weris, plasteliniT
(comiT), kubebiT da sxv. TamaSis saSualeba.
• asakis Sesabamisad aRmzrdelma unda SesTavazos sxvadasxva sagani da
saTamaSo, raTa xeli Seuwyos misi moZarobebis waxalisebas.
• gansakuTrebiT mniSvnelovania, rom mSobelma bavSvTan erTad
Seasrulos sxvadasxva aqtivoba. Aam dros mSobeli unda esaubros mas,
ganumartos Tu ras akeTeben, rac Tavis mxriv xels uwyobs bavSvs
iswavlos sxvadasxva moqmedebisa da sagnebis dasaxeleba.
motoruli sferos ganviTarebisa da TviTmomsaxureobis Cvevis
CamoyalibebisTvis gansakuTrebuli mniSvneloba eniWeba iseT aqtivobebs,
romlebic moiTxovs xelis mtevnebisa da TiTebis, xelebisa da fexebis,
aqtiur moqmedebas, aseve Tvalis koordinacias. maT Soris yvelaze
mniSvnelovania: Cacma, banaoba, saWmlis momzadeba, Wama, xatva, Zerwva, wera,
sxvadsxva TamaSi, xoxva, cocva, sirbili, xtunva.
mxedevloba, ynosva, smena, gemovneba, Sexeba da sensomotoruli Cvevebi
bavSvis grZnobaTa organoebis ganviTareba jer kidev orsulobis periodSi
iwyeba, igi dabadebis pirveli wuTebidanve iwyebs samyaros aRqmas, xedavs,
esmis, SeigrZnobs suns, gemos, Sexebas. UaRmzrdelma dabadebidanve unda
daiwyos bavSvis grZnobaTa organoebisa da sensomotoruli Cvevebis
ganviTarebis xelSewyoba da asakis gaTvaliswinebiT Tanmimdevrulad
SesTavazos mas sxvadasxva aqtivobebi.
aRmzrdelTan konsultirebis sakvanZo sakiTxebi
• mSobelma unda icodes, rom axalSobili yvelaze ukeT 20-25
santimetris manZilze xedavs. ufrosma unda waaxalisos bavSvis
mxedvelobis ganviTareba xelSemwyobi garemo pirobebis SeqmniT –
Camoukidos sxvadasxva feris da formis saTamaSo, daaTvalierebinos
dasuraTebuli wignebi da garemo da sxv. Mmas unda hqondes
informacia, rom aucilebelia bavSvis mxedvelobisa da smenis
perioduli Sefaseba specialistis mier.
• Sexeba axalSobilisTvis garesamyaros Sesaxeb inforaciis miRebis
erT-erT ZiriTad wyaros warmoadgens. mSobeli xSirad unda Seexos
bavSvs, moeferos aiyvanos xelSi. ar SeiZleba bavSvis uxeSad
SenjRreva, rasac SeiZleba moyves sxvadasxva saxis dazianeba.
• axalSobili gansakuTrebul interess adamianis xmis mimarT iCens.
amitom mSobeli xSirad unda esaubros, waukiTxos bavSvs.
15
socialuri da emociuri sfero socialur-emociuri sfero gansazRvravs bavSvis pirovnuli Tvisebebis
Camoyalibebas da adamianebTan urTierTobas. igi moicavs bavSvis unars
SeZlos sakuTari grZnobebis gageba da gamoxatva, sxvaTa grZnobebis gageba
(TanagrZnoba) da Sesaferisad reagireba.
mSobelma unda icodes, rom bavSvTan dabadebidanve unda daamyaros
Sesabamisi urTierToba, riTac Tavad unda Seuwyos xeli, misi socialuri
Cvevebis ganviTarebis swavlebas da emociebis regulirebas. bavSvis emociuri
samyaro sruliad damokidebulia ojaxis wevrebs Soris arsebul
urTierTobebze, Tu ojaxis wevrebi gamoxataven erTmaneTis mimarT siTbos
da siyvaruls bavSvic bednieria da piriqiT Tu ojaxSi daZabulobaa, bavSvs
xSirad uwevs sxvadasxva problemis gamo Cxubis da gabrazebuli mSoblebis
yureba igi ubeduri, gulCaTxrobili da karCaketilia.
konsultirebis sakvanZo sakiTxebi
• mniSvnelovania bavSvisTvis mSvidi da wynari garemos uzrunvelyofa,
rac xels uwyobs maTi emociebis daregulirebas, gansakuTrebiT iseT
patarebTan, romlebic zedmetad morcxvebi da agznebulebi arian.
• mSobelma xeli unda Seuwyos bavSvs sxvebTan urTierTobis
damyarebaSi (aRmzrdeli, ojaxis sxva wevrebi, maswavlebeli.);
• bavSvs unda mieces SesaZlebloba gamoikvlios garemo. Seexos
sxvadasxva nivTebs, Sinaur cxovelebs. Tu mSobels eSinia mwerebis,
am dros man Tavi unda Seikavos sakuTari emociebis gamoxatvisgan;
• xangamoSvebiT aucilebelia bavSvis marto datoveba, raTa man SeZlos
sakuTar TavTan TamaSi da mieCvios marto yofnas. es xels uwyobs
damoukideblobisa da sakuTar TavSi rwmenis Camoyalibebas. sakuTar
TavTan TamaSis Semdeg, bavSvi SeaqeT da daasaCuqreT.
• ufrosma Tavad unda Seuwyos xeli bavSvis socialur urTierTobebs
sxva bavSvebTan, Seaqos da daasaCuqros, roca bavSvi erTveba sxvebTan
TamaSSi, gamoxatavs sxva bavSvebis mimarT keTilganwyobas, esmis maTi
emociebi.
• Tu bavSvi agresiulia sxva bavSvebis mimarT, utyams, uyviris,
aucilebelia mis mimarT sayveduris gamoTqma.’ Tu bavSi Zalian
gabrazebulia Tavis megobrebze da ar Cerdeba, ufrosma unda
moacilos maT. mogvianebiT unda aswavlos sxvadasxva gza, rogor
gamovides arasasurveli situaciidan. Mmag. sTxovos daxmareba
ufross, an Sewyvitos TamaSi Tu mas ar moswons. Tu romelime
saTamaSoa usiamovnebis mizezi, ufrosma droebiT unda gamoarTvas
bavSvebs igi, roca cota xanSi daubrunebs, bavSvebi ukve mzad arian
Secvalon TavianTi damokidebuleba mis mimarT.
16
• ar SeiZleba ufrosma daartyas, uCqmitos, Tmebi moqaCos da a.S.,
imisTvis, rom aswavlos mas ramdenad cudia aseTi saqcieli da ras
grZnoben am dros is bavSvebi, romelsac patara urtyams. umjobesia,
roca bavSvi dawynarebulia, hkiTxon mas ,,Sen vinmem xom ar dagartya,
ra igrZeni am dros, getkina?’’, ,,rogor fiqrob Sens megobarsac ase
etkina Sen rom daartyi?’’
• mizanSewonilia roluri TamaSis gamoyeneba, imisTvis rom aswavlon
bavSvs sxvadasxva socialuri Cveva, mag. rodis Tqvas ,,gamarjoba’’ da
,,naxvamdis’’ megobrebs an ufrosebs, romlebic modian masTan stumrad.
• ufrosma bavSvTan unda isaubros grZnobebis Sesaxeb, daexmaros mas
gaigos im sityvebis mniSvneloba, romlebic emociebs gamoxatavs.
daaxasiaTos sakuTari, an bavSvis ganwyoba ,,gaxarebuli xar?’’
,,bednieri xar?’’ ,,mowyenili xar?’’
• Tu bavSvi mSiSaraa da ,,dedis kalTas’’ ar scildeba, aucilebelia
masTan muSaoba, imisTvis rom igi SeeCvios dedisgan gancalkevebas.
bavSvs unda agrZnobinon, rom is kargad iqneba, maSinac, roca
mSoblebisgan gancalkevebulia. ,,Sen dRes Zalian kargi dRe geqneba,
Zalian kargad iqnebi uCemoT.’’ Uufrosma yovelTvis unda uTxras
bavSvs, rodis dabrundeba masTan da es daukavSiros misTvis advilad
gasageb movlenas: ,,me davbrundebi sauzmis Semdeg”, aseTi
damokidebuleba xels uwyobs bavSvs drois SegrZnebis ganviTarebaSi.
• socialuri urTierTobebis Camoyalibebis procesSi mniSvnelovania
mSoblebma kargi magaliTi aCvenon bavSvs rogorc erTmaneTTan, ise
ojaxis sxva wevrebTan da Tavis megobrebTan urTierTobaSi.
• pubertatul periodSi gansakTrbuli yuradReba unda daeTmos
bavSvis sqeobriv momwifebasTn dakavSirebul sakixTebs. sxeulis
fizikuri ganviTrbis Tavseburebebs. Aam periodSi bavSvis asakobriv
cvlilbebs, aseve mSoblisa da bavSvis damokidebulebas.
TamaSi 36,41
konsultirebis mizania mSobels ganemartos, rom bavSvisTvis TamaSi
mxolod garToba ar aris, TamaSi misi gonebrivi, motoruli ganviTarebisa
da samyaros Secnobis auclebeli pirobaa. mSobelma unda icodes, ra
principebiT isargeblos bavSvis TamaSis xelSewyobisTvis.
dedasTan konsultirebis sakvanZo sakiTxebi
• mSobelma unda uzrunvelyos bavSvi saTamaSoebiT;
• saTamaSoebi da TamaSis sxvadasxva saxeoba unda SeirCes asakis
gaTvaliswinebiT;
• saTamaSo unda iyos usafrTxo;
• bavSvi Riziandeba Tu erTdroulad bevr saTamaSos miawvdian;
• erTi da igive saTamaSo bavSvisTvis mosabezrebelia;
17
• maRalteqnologiuri saTamaSoebi abnevs mcire asakis bavSvs da
zRudavs misi warmosaxvis unars;
• bavSvisTvis mniSvneloba ara aqvs saTamaSos Rirebulebas, igi kargad
erToba TviTnakeTi saTamaSoebiTac;
• bavSvi usafrTxo garemoSi unda TamaSobdes;
• sasurvelia ufrosi CaerTos bavSTan TamaSis proceSi, MTumca ar unda
Seasrulos lideris roli.
tirili 36,44
axalSobili da Cvili bavSvebi Tavis moTxovnilebebs mxolod tiriliT
gamoxataven, amitom xSirad tirian da es sakiTxi gansakuTrebiT ainteresebT
mSobelbs. mSobelma unda icides, rom bavSvis tirils sxvadasxva mizezi da
gansxvavebuli xasiaTi aqvs. dakvirvebul mSobels advilad SeuZlia bavSvis
tirilis mizezis dadgena. specialistma unda urCios mSobels rogor
moiqces bavSvis tirilis dros:
dedasTan konsultirebis sakvanZo sakiTxebi
• 6 Tvemde bavSvis tirilze ufross meyseuli reaqcia unda hqondes;
• mSobelma unda gamoarkvios bavSvis tirilis mizezi da daakmayofilos
misi moTxvna (Tu Sia aWamos, Tu Casvelebulia gamoucvalos, Tu
ufrosTan urTierToba surs aiyvanos, moeferos da daamSvidos);
• ufosi bavSvs xSirad unda moeferos, maSinac ki, roca bavSi ar tiris,
raTa bavSvis tirili ufrosTan urTierTobis erTaderT xerxad ar
gadaiqces;
• mSobelma unda icodes, rom 1-3 Tvis asakSi zogierTi bavSvis tirilis
xSiri mizezia ,,kolika”- xangrZlivi tirili, dRis erTi da igive
monakveTSi, romelic muclis tkivilis STabeWdilebas tovebs, Tumca
kolikis namdvili mizezi dadgenili ar aris.
disciplina 9,36
bavSvis disciplinis Camoyalibebaze zrunva jer kidev adreul asakSi,
daaxloebiT, 18 Tvidan unda daiwyos. MmSobelma unda icodes, rom am
asakamde bavSvs ar SeuZlia cudad moqceva, radgan man jer kidev ar icis
cudi da kargi saqcielis garCeva. specialistma konsultireba unda gauwios
mSobels im meTodebis Sesaxeb, romelic daexmareba maT adreuli asakidan
bavSvis disciplinis CamoyalibebaSi.
dedasTan konsultirebis sakvanZo sakiTxebi
• bavSvis disciplinis Camoyalibeba or ZiriTad fenomens efuZneba -
,,mibaZva” da ,,magaliTi’’;
18
• bavSvi baZavs ufrosis qcevas, imisTvis rom xeli Seuwyon bavSvis
disciplinis Camoyalibebas, mas yovelTvis kargi magaliTi unda
miscen;
• bavSvi kargi saqcielis mibaZviT ukeT swavlobs, vidre SegonebiT;
• ar aris rekomendebuli bavSvis fizikuri dasja da Seuracxyofa,
aseTi damokidebuleba xels uwyobs bavSvis agresias da sakuTari
TavSi Caketvas;
• mSobelma unda gaiTvaliswinos, rom bavSvis fizikurma dasjam
SesaZloa seriozuli ziani miayenos bavSvis janmrTelobas;
• rekomendebulia bavSvisTvsis gasagebi, minimaluri akrZalvebis
daweseba;
• 1-5 wlamde asakis bavSvis dasjis efeqturi meTodia ,,taim-auti”- bavSvi
xanmokle periodis ganmavlobaSi erT adgilze mSvidad unda ijdes an
idges garemosagan izolirebuli. mas aravin ar unda elaparakebodes.
taim-auti grZeldeba imdeni wuTi, ramdeni wlisac aris bavSvi;
• mozardis mSobelma unda gaiTvaliswinos asakisTvis damaxasiaTebeli
xasiaTobrivi cvlilebebi da gamoyos dro bavSvTan urTierTobisTvis.
tualetis Cveva 36,45
mizanSewonilia specialistma Seafasos tualetis Cvevis arseboba 18
Tvidan. hkiTxos mSobels akontrolebs Tu ara bavSvi dRis an Ramis
ganmavlobaSi defekacias da Sardvas.
D
dedasTan konsultirebis sakvanZo sakiTxebi
• 8-9 Tvis asakSi gadayenebas meqanikuri xasiaTi aqvs. bavSvi ver grZnobs
Sardis buStis sisavses da ver agebinebs ufross, rodis unda
gadayeneba;
• defekaciis da Sardvis kontrolis unaris Camoyalibeba 18-24 Tvidan
iwyeba da bavSvi mzad aris gadayenebisTvis Tu:
misi safeni 2-3 saaTi mSralia;
ar siamovnebs WuWyiani safenis danaxva;
asrulebs ufrosis martiv moTxovnebs mag. ,,modi’’, ,,aiRe’’,
,,momeci’’;
• aRniSnuli periodi mniSvnolavania imisTvis, rom bavSvi miaCvion
qoTnis gamoyenebas;
• bavSvi qoTanze unda dasvan yvela Wamisa da gaRviZebis Semdeg, aseve
daZinebis win;
• ar aris rekomendebuli qoTanze bavSvis didxans gaCereba;
• ufrosma unda gaiTvaliswinos, rom yvela bavSvi individualuria,
zogi advilad swavlobs qoTnis gamoyenebas, zogi Znelad;
• iSviaTi “marcxi” dasaSvebia 5 wlamde, gansakuTrebiT Tu bavSvma bevri
siTxe dalia, an Zalian gaerTo TamaSiT;
19
• Tu uneblie Sardva aRiniSneba 5 wlis Semdeg, saSualod kviraSi
orjer mSobelma unda mimarTos specialists;
• dauSvebelia bavSvis dasja da Seuracxofa.
3 wlis krizisi 36
2-3 wlamde asakSi bavSvis qcevaSi mSoblebi seriozul sirTuleebs
awydebian. Mmanamde mSvidi, wynari da damjeri bavSvi uecrad jiut da
Wirveul arsebad iqceva. bavSvi seriozul winaaRmdegobas uwevs ufrosis
moTxovnebs da sakuTari survilebis dakmayofilebas yvelanairad cdilobs.
am peridSi ojaxs gansakuTrebuli yradReba esaWiroeba. specialistis
konsultirebis mizania ganumartos mSobels, rom bavSvis aseTi cvlileba am
asakisTvis damaxasiaTebelia, igi ukavSirdeba bavSvis pirovnebis formirebis
process, damoukideblobisken swrafvas da TviTdamkvidrebis survils. es
periodi ,,3 wlis krizis” saxeliT aris cnobili da male gaivlis.
pirovnebis formirebis procesSi did rols asrulebs bavSvis emocia,
romelic am periodSi SesaZloa bavSvis SiSebis safuZveli gaxdes.
specialistma unda ganumartos mSobels, rom problemebis gadalaxva
SesaZlebelia, Tu aRmzrdeli seriozul moTminebas da taqts gamoiCens.
dedasTan konsultirebis sakvanZo sakiTxebi
• bavSvs unda hqondes damoukidebeli moqmedebis SesaZlebloba, riTac
igi swavlobs pirveli dabrkolebebis gadalaxvas da rac exmareba mas
nebisyofis gamomuSavebaSi;
• Tu bavSvi damoukideblad ver axerxebs dabrkolebis daZlevas,
ufrosi unda daexmaros mas;
• gaumarTlebelia bavSvisTvis gaugebari da xSiri akrZalvebis daweseba;
• am asakSi bavSvis arasasurveli qcevis aRkveTis saukeTeso gza misi
yuradRebis sxva rameze gadarTvaa;
• ucilebelia SeniSvnis drouli micema, raTa bavSvma saqcieli da
SeniSvna erTmaneTs daukavSiros;
• aucilebelia 2-3 martivi akrZalvis daweseba da ojaxis wevrebis
SeTanxmeba akrZalvis wesebze;
• araswori saqcielis gamo bavSvs SeniSvna nebismierma ufrosma unda
misces.
usafrTxo garemo, travmebis da dazianebis prevencia 46,47,48,47,50
mSobeli aucileblad unda iyos informirebuli imis Taoabze, rom bavSvs
ganviTarebisTvis usafrTxo garemo esaWiroeba. bavSvis banaobis, Zilis,
TamaSisa da manqaniT mgzavrobis dros ufrosma unda daicvas usafrTxoebis
wesebi, raTa xeli Seuwyos bavSvis usafrTxoebas da daicvas igi
dazianebisgan. MmSobelma unda gaiTvaliswinos, rom bavSvs asakis matebasTan
erTad meti yuradReba esaWiroeba. usafrTxoebis wesebis dacva travmebis da
sxva dazianebis Tavidan acilebis saukeTeso saSualebaa.
20
dedasTan konsultirebis sakvanZo sakiTxebi
• bavSvis sawoli unda iyos usafrTxo;
• wlamde ar SeiZleba baliSis gamoyeneba;
• banaobis dros unda gaizomos wylis temperatura;
• abazanaSi ar SeiZleba bavSvis marto datoveba;
• wamlebi, eleqtromowyobiloba, basri da wvrili nivTebi, qimiuri
saSualebebi bavSvisTvis xelmiuwvdomeli unda iyos;
• ar SeiZleba bavSvis marto datoveba Sinaur cxovelebTan da mcire
asakis da-ZmasTan;
• bavSvis kvebamde unda Semowmdes sakvebis temperatura;
• manqaniT mgzavrobisas saWiroa specialuri skamis gamoyeneba, ar
SeiZleba manqanaSi bavSvis umeTvalyureod datoveba;
• ar aris rekomendebuli bavSvis mzeze didxans gaCereba, seirnobisas
umeTvalyureod datoveba da sxva.
jansaRi cxovrebis wesi
mozardebi xSirad dgebian mavne Cvevebis saSiSroebis winaSe - Tambaqo,
alkoholi.
dedasTan konsultirebis sakvanZo sakiTxebi
• jer kidev adreuli asakidan mSobeli unda ecados bavSvs Tavad ar
misces mavne Cvevis magaliTi, winaaRmdeg SemTxvevaSi mozardisTvis
gaugebaria, ratom uSlis misTvis samagaliTo adamiani mas Tambaqos
mowevas an alkoholis gamoyenebas;
• bavSvTan saubarsisas mSobeli unda moeridos mis Seuracyofas da
fizikur dasjas, es mxolod sapirispiro Sedegs moitans.
• ucilebelia mavne Cvevebis uaryofiT Sedegebze yuradRebis
gamaxvileba, kargia dadebiTi magaliTebis moyvana mSoblis piradi
cxovrebidan;
• mniSvnelovania bavSvis CarTva sportSi da misTvis saintereso
sazogadoebriv aqtivobebSi.
• mavne Cvevis (mag. frCxilebis kvneta) dros saWiroa bavSvis
yuradRebis gadarTva misTvis saWiro saqmianobaze
sqesobrivi gziT gadamdebi daavadebebi (sggi)
mozardebi sqesobrivad gadamdebi daavadebebis riskis qveS imyofebian. am
periodSi maT ukve unda miawodon informacia sggi-s gavrcelebis, maTi
gamovlenis niSnebisa da Tavdacvis saSualebebis Sesaxeb. aRniSnuli
21
informaciis misawodeblad mniSvnelovania nabeWdi sainformacio masalis
gamoyeneba.
saSiSroebis niSnebi, roca aucilebelia eqimiTan dauyovnebeli viziti
• bavSvi cudad svams an uars ambobs siTxeebis miRebaze;
• agznebuli an mivardnilia;
• sxeulis temperatura > 38,5 -39oC;
• sxeulis temparatura < 36oC;
• aReniSneba xSiri Rebineba;
• ganavalSi moimata wylis Semcvelobam an aReniSneba sisxli;
• gamoixata sunTqvis gaZneleba (xmauriani sunTqva);
• gamoixata sunTqvis gaxSireba (2 Tvemde - 60 da meti; 2 Tvidan 1
wlamde - 50 da meti; 1 wlis zemoT - 40 da meti);
• aqvs an hqonda krunCxva;
• mkurnalobis miuxedavad mdgomareoba ar umjobesdeba.
gaidlainis gadasinjvisa da ganaxlebis vada _ 4 weli
22
gaidlainis miRebis xerxi/wyaro
gaidlainis SemuSavebis meTodologia
• bavSvis janmrTelobaze da ganviTarebis sakiTxebze konsultirebis
principebis Sesaxeb arsebobs samecniero mtkicebulebis safuZvelze
Seqmnil rekomendaciaTa sakmaod mcire raodenoba. mocemuli
gaidlainis Seqmnis procesSi samuSao jgufis gadawyvetilebiT
moZiebuli da Sefasebuli iqna ukve arsebuli praqtikuli
rekomendaciebi. moxda arsebuli rekomendaciebis adaptirebuli
variantis SemuSaveba, romelic erTis mxriv pasuxobs saerTaSoriso
moTxovnebs, xolo meore mxriv iTvaliswinebs saqarTvelos samedicino
dawesebulebaTa rogorc adamianur, ise teqnikur resursebs.
• rekomendaciaTa moZieba xorcieldeboda klinikuri rekomendaciebis
saerTaSoriso reestrebSi eleqtronuli monacemTa bazebis
gamoyenebiT internetSi.
qveyana da resursis
dasaxeleba
internet-misamarTi
aSS
US National Guideline Clearinghouse (NGC)
http://www.guideline.gov
Centers for Disease Control and Prevention (CDC)
http://www.phppo.cdc.gov/CDCRecommends/AdvSearchV.asp
Agency for Healthcare Research and Quality (AHRQ)
http://www.ahrq.gov/clinic/cpgsix.htm
Health Services Technology Assessment Text (HSTAT) and National Library of Medicine (NLM)
http://hstat.nlm.nih.gov
Institute of Clinical Systems Improvement (ICSI)
http://www.icsi.org
American Medical Association http://www.ama-assn.org
Canadian Medical Association (CMA)
http://mdm.ca/cpgsnew/cpgs/index.asp
Health Canada – Population and Public Health Branch (PPHB)
http://www.hc-sc.gc.ca/pphb-dgspsp/dpg_e.html
didi britaneTi National Institute for Clinical Excellence (NICE)
http://www.nice.org.uk
Sheffield Evidence for Effectiveness and Knowledge
http://www.shef.ac.uk/seek/guidelines.htm
23
(SEEK)
National electronic Library for Health (NeLH)
http://www.nelh.nhs.uk/guidelinesfinder
PRODIGY Clinical Guidance http://www.prodigy.nhs.uk/ClinicalGuidance
Scottish Intercollegiate Guidelines Network (SIGN)
http://www.sign.ac.uk
German Guideline Information Service (GERGIS)
http://www.leitlinien.de/english/english/view;
avstralia Australian National Health and Medical Research Council (NHMRC)
http://www.health.gov.au/hfs/nhmrc/publicat/cp-home.htm
axali zelandia
New Zealand Guidelines Group (NZGG)
http://www.nzgg.org.nz/library.cfm
mtkicebiTi medicinis
specialistTa
regionTaSorisi
sazogadoeba
http://www.osdm.org
klinikuri rekomendaciebis da mtkicebulebebis moZiebis damatebiTi
wyaroebi da meTodebi
• koxreinis biblioTeka - The Cochrane Library 2006, Issue 2, • amerikis samedicino biblioTekis mier Seqmnil eleqtronul
bibliografiul monacemTa baza - medlaini – MEDLINE • janmrTelobis dacvis msoflio organizacia
publikaciebis CarTvis/gamoricxvis kriteriumebi
• kvlevebi Semdegi dizainiT: randomizirebuli sakontrolo
kvlevebi, sistematuri mimoxilvebi da meta-analizi, erTmomentiani,
kohortuli kvlevebi
• rekomendaciis momzadebisas ZiriTadad dadgenili iyo drois 12
wliani SezRudva. Tumca zogjer gamoyenebuli iyo ufro adreuli
publikaciebi, romlebic dResac aqtualuria da safuZvlad udevs
sxva Tanamedrove mtkicebulebebs.
• dadgenili iyo enobrivi SezRudvebi, radganac samuSao jgufs
SesaZlebloba hqonda literaturis wyaroebi Seeswavla mxolod
inglisur da rusul enebze.
24
moZiebuli klinikuri rekomendaciebisa da mtkicebulebebis analizi
• samuSao jgufis mier tardeboda moZiebuli wyaroebis analizi.
Catarebuli Ziebis Sedegad miRebuli iyo ramdenime klinikuri
meToduri rekomendacia bavSvis janmrTelobisa da ganviTarebis
xelSewyobis konsultirebis sakiTxebze, romlebic Seicavda jgufis
miznis Sesaferis saWiro informacias. am rekomendaciebis Sefasebisas
gamoyenebuli iyo rekomendaciaTa atestaciisa da eqspertizis kiTxvari
- AGREE (94,96-98). Sefasebis Sedegad amorCeuli iyo qvemoT CamoTvlili
organizaciebis gaidlainebi:
⇒ janmrTelobis msoflo organizacia
⇒ nelsonis saxelmZRvanelo “pediatria”
⇒ amerikis pediatrTa akademiia
• rekomendaciebis mtkicebulebaTa doneebis gansazRvrisas gamoyenebuli
iyo saqarTvelos Sromis janmrTelobisa da socialuri dacvis
saministros mier mowodebuli mtkicebulebebis donisa da
rekomendaciebis xarisxis sqema.
mtkicebulebaTa doneebisa da rekomendaciebis xarisxis sqema
done mtkicebulebis siZlieris
done (Muir Gray) xarisxi rekomendaciis xarisxi
(Cook et al) I Zlieri mtkicebuleba,
eyrdnoba minimum erT
sistemur mimoxilvas,
romelic efuZneba swori
dizainis mqone
randomizebul
kontrolirebad kvleva
A eyrdnoba I donis
mtkicebulebas da
Sesabamisad mtkiced
rekomendebulia
II Zlieri mtkicebuleba,
eyrdnoba minimum erTi
swori dizainis mqone
randomizebul
kontrolirebad kvleva
B eyrdnoba II donis
mtkicebulebas da
Sesabamisad mtkiced
rekomendebulia
III klinikuri kvleva
randomizaciis gareSe,
kohortuli da SemTxveva-
kontrolis kvlevebi
C eyrdnoba III donis
mtkicebulebas SeiZleba
CaiTvalos Sesabamisad
IV araeqsperimentuli
multicentruli kvlevebi
D eyrdnoba IV da V donis
mtkicebulebas saWiroebs
konsesuss
Va avtoritetul
profesionalTa mosazreba
Vb klinikuri gamocdileba,
aRwerilobiTi kvlevebi an
eqspertTa angariSi
25
alternatiuli gaidlaini ar arsebobs
gamoyenebuli literatura
1. Zuckerman B, Parker S Preventive pediatrics new models of providing needed health services. Pediatrics 1995; 95:758-762 [Medline]
2. Gielen AC, McDonald EM, Forrest CB, Harvilchuck JD, Wissow L Injury prevention counseling in an urban pediatric clinic. Arch Pediatr Adolesc Med 1997; 151:146-151
3. Goldstein EN, Dworkin PH, Berstein B Anticipatory guidance in pediatric practice: are we doing more or less? Ambulatory Child Health 1997; 3:159
4. http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4089101&chk=Kuk%2BDw
5. Singapur Ministry of Health. Management of breastfeeding for healthy full term infants. 2002.
6. Triggs EG, Perrin E Listening carefully. Improving communication about behavior and development. Recognizing parental concerns. Clin Pediatr 1989; 28:185-192 [Medline]
7. Young KT, David K, Schoen C Listening to parents. A national survey of parents with young children. Arch Pediatr Adolesc Med 1998; 152:255-262
8. Dodds M, Nicholson L, Muse B, Osborn LM Group health supervision visits more effective than individual visits in delivering health care information. Pediatrics 1993; 91:668-670 [Medline]
9. Green, Morris (ed). Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents. Arlington, VA: National Center for Education in Maternal and Child Health; 1994
10. Nutrition Assessment – pediatrics.JPEN2002 jan-feb;26(1suppl):13 SA-17SA. 11. Guiding Principles for Complementary Feeding of the Breastfeed Child. WHO Global
Consultation on Complementary Feeding, December 10-13, 2001. 12. International Laqtation consultant assotiation (ILCA).Clinikal Gudelines for the
establishment of exkluzive breastfeeding June 2005 Mary L. Overfield 13. World Health Organization. (2002) Infant and Young Child Nutrition: Global Strategy on
Infant and YoungChild Feeding. WHO, Fifty-fifth World Health Assembly. April. 14. Lawrence RA, Lawrence RM. Breastfeeding: A Guide for the Medical Profession, 5th ed. St.
Louis: Mosby, 1999. 15. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of
human milk. Pediatrics 2005;115(2):496-506. 16. Ferber SG, Makhoul IR. The effect of skin-to-skin contact (kangaroo care) shortly after birth
on the neurobehavioral responses of the term newborn: arandomized, controlled trial. Pediatrics 2004; 113(4):858-65.
17. Metaj M, Laroia N, Lawrence RA, Ryan RM. Comparison of breast- and formula-fed normal newborns in time to first stool and urine. J Perinatol 2003;23(8):624-8.
18. Barros FC, Victora CG, Semer TC, et al. Use of pacifiers is associated with decreased breastfeedingduration.Pediatrics 1995;95:497-499.
19. Casiday RE, Wright CM, Panter-Brick C, Parkinson KN. Do early infant feeding patterns relate to breastfeeding continuation and weight gain? Data from alongitudinal cohort study. Eur J Clin Nutr 2004;58(9):1290-6.
20. Hill PD, Humenick SS, Brennan ML, Woolley D. Does early supplementation affect long-term breastfeeding? Clin Pediatr (Phila) 1997;36(6):345-50.
21. Blomquist HK, Jonsbo F, Serenius F, Persson LA. Supplementary feeding in the maternity ward shortens the duration of breast feeding. Acta Paediatr 1994;83(11):1122-6.
26
22. Howard CR, Howard FM. Management of breastfeeding when the mother s ill. Clin Obstet Gynecol 2004;47(3):683-95.
23. Dusdieker LB, Stumbo PJ, Booth BM, Wilmoth RN.Prolonged maternal fluid supplementation in breastfeeding. Pediatrics 1990;86(5):737-40.
24. World Health Organization. Global strategy for infant and young child feeding. Geneva: 2003.
25. World Health Organization. Global strategy: breastfeeding critical for child survival—UNICEF and WHO call for increased commitment to appropriate feeding practices for all infants and young children. Indian J Med Sci 2004;58(3):138-9.
26. World Health Organization. The World Health Organization multinational study of breast-feeding and lactational amenorrhea. III. Pregnancy during breast-feeding. World Health Organization Task Force on Methods for the Natural Regulation of Fertility. Fertil Steril 1999;72(3):431-40.
27. Dewey KG, Peerson JM, Brown KH, Krebs NF, Michaelsen KF, Persson LA, et al. Growth of breastfed infants deviates from current reference data: a pooled analysis of US, Canadian, and European data sets. World Health Organization Working Group on Infant Growth. Pediatrics 1995;96(3 Pt 1):495-503.
28. Ingram J, Johnson D, Greenwood R. Breastfeeding in Bristol: teaching good positioning, and support from fathers and families. Midwifery 2002;18(2):87-101.
29. Righard L, Alade MO. Sucking technique and its effect on success of breastfeeding. Birth 1992;19(4): 185-9.
30. Morton JA. Ineffective suckling: a possible consequence of obstructive positioning. J Hum Lact 1992;8(2):83-5.
31. Alkon, A., Farrer, J., & Bernzweig, J. (2004). Child care health consultants’ roles and responsibilities: Focus group fidings. Pediatric Nursing 30(4), 315-321.
32. Guiding Principles for Complementary Feeding of the Breastfeed Child. WHO Global Consultation on Complementary Feeding, December 10-13, 2001.
33. .Pelto G, Levitt E, Thairu L. Improving feeding practices: current patterns, common constraints, and the design of interventions. Food Nutr Bull,in press.
34. American Academy of Pediatrics, American Public Health Association, & National Resource Center for Health and Safety in Child Care. (2002). Caring for our children: National health and safety performance standards:
35. Wolfson A, Lacks P, Futterman A Effects of parent training on infant sleeping patterns, parents' stress, and perceived parental competence. J Consult Clin Psychol 1992; 60:41-48
36. m. xerxeuliZe, T. manjaviZe, es saocari adreuli asaki 2003, 86; 57-58 37. Willinger M, James LS, Catz C. Defining the sudden infant death syndrome (SIDS):
deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Pediatr Pathol. 1991;11:677-684
38. Hale CM, Polder JA. The ABC's of Safe and Healthy Child Care: A Handbook for Child Care Providers. Atlanta, Ga: Centers for Disease Control and Prevention; 1997.
39. American Academy of Pediatrics Task Force on Infant Feeding and SIDS. Changing concepts of sudden infant death syndrome: implications for infant sleeping environment and sleep position. Pediatrics. 2000;105(3);650-656.
40. Ulione, M.S., & Crowley, A.A. (1997). Nurses as child care health consultants. Healthy Child Care America,1(2), 1,4-5.
41. Bredekamp, S., & C. Copple, eds. 1997. Developmentally appropriate practice in early childhood programs. Rev.ed Washington, D.C.:NAEYC.
27
42. Eggbeer L, Littman CL, Jones M. Zero To Three's developmental specialist in pediatric practice project: an important support for parents and young children. In: Zero To Three. Washington, DC: Zero to Three; 1997:3-24
43. Zenni EA, Robinson TN Effects of structured encounter forms on pediatric house staff knowledge, parent satisfaction, and quality of care. Arch Pediatr Adolesc Med 1996; 150:975
44. Wolke D, Gray P, Meyer R Excessive infant crying: a controlled study of mothers helping mothers. Pediatrics 1994; 94:322-332
45. Brazelton TB, Christophersen ER, Frauman AC, Instruction, timeliness, and medical influences affecting toilet training. Pediatrics 1999; 103:1353-1358
46. Clamp M, Kendrick D A randomized controlled trial of general practitioner safety advice for families with children under 5 years. BMJ 1998; 316:1576-1579
47. Bass JL, Mehta KA, Ostrovsky M Childhood injury prevention in a suburban Massachusetts population. Public Health Rep 1991; 106:437-442 [Medline]
48. Miller PA, Binns HJ, Christoffel KK Children's bicycle helmet attitudes and use. Arch Pediatr Adolesc Med 1996; 150:1259-1264
49. Mackinin ML, Gustafson C, Gassman J, Barich D Office education by pediatricians to increase seat belt use. Am J Dis Child 1987; 141:1305-1307
50. American Academy of Pediatrics. The Pediatrician’s Role in Promoting Health and Safety in Child Care. American Academy of Pediatrics, Johnson & Johnson Pediatric Institute, 1999 www.aap.org;
51. American Public Health Association, American Academy of Pediatrics and National Resource Center for Health and Safety in Child Care. Caring for Our Children, National Health and Safety Performance Standards-guidelines for Out-of Home Child Care Programs, Second Edition. 2002 http://nrc.uchsc.edu;
52. American Academy of Pediatrics. AAP revises recommendations on reducing the risk of SIDS.[online] 2005. Available from URL: http://www.aap.org/ncepr/sids.htm
avtorTa jgufi
pediatrTa da neontologTa kavSiri `alternativa~
samuSao jgufi:
⇒ Tamar manjaviZe – medicinis doqtori, saqarTvelos Sromis,
janmrTelobisa da socialuri dacvis saministro. pediatrTa
da neontologTa kavSiri `alternativa~-s wevri;
⇒ eka kandelaki – medicinis doqtori, Tbilisis saxelmwifo
samedicino universitetis zogadi pediatriis departamentis
asistent-profesori. pediatrTa da neontologTa kavSiri
`alternativa~-s wevri;
⇒ maia xerxeuliZe – medicinis doqtori, Tbilisis saxelmwifo
samedicino universitetis zogadi pediatriis departamentis
asistent-profesori. saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministros eqsperti. pediatrTa da
neontologTa kavSiri `alternativa~-s wevri;
28
⇒ nani yavlaSvili – medicinis doqtori, Tbilisis saxelmwifo
samedicino universitetis zogadi pediatriis departamentis
asistent-profesori. saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministros eqsperti. pediatrTa da
neontologTa kavSiri `alternativa~-s wevri.
eqspertebi:
⇒ medea zarnaZe _ Sps #10 poliklinikis direqtori;
⇒ medea beleSaZe _ medicinis doqtori, bavSvis uflebaTa dacvis
asociacia “klaritasi XXI” prezidenti;
⇒ lela woworia _ saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministros jandacvis departamenti;
⇒ Tea TavidaSvili _ saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministros jandacvis departamenti.