klinikuri praqtikis erovnuli rekomendacia (gaidlaini)medportal.ge/linkedfiles/miscdata/11_36.pdf ·...

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.


• 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


• 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.


• 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.


• 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.


• 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.


• 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.


• 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.


• 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:


• 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.


• 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


• 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.


• 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


• 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.


• 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 àlternativa~

samuSao jgufi:

⇒ Tamar manjaviZe – medicinis doqtori, saqarTvelos Sromis,

janmrTelobisa da socialuri dacvis saministro. pediatrTa

da neontologTa kavSiri àlternativa~-s wevri;

⇒ eka kandelaki – medicinis doqtori, Tbilisis saxelmwifo

samedicino universitetis zogadi pediatriis departamentis

asistent-profesori. pediatrTa da neontologTa kavSiri

àlternativa~-s wevri;

⇒ maia xerxeuliZe – medicinis doqtori, Tbilisis saxelmwifo


asistent-profesori. saqarTvelos Sromis, janmrTelobisa da

socialuri dacvis saministros eqsperti. pediatrTa da

neontologTa kavSiri àlternativa~-s wevri;

28

⇒ nani yavlaSvili – medicinis doqtori, Tbilisis saxelmwifo


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.

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