A 16-month-old child is attending a well-child visit at a pediatric clinic.
Which assessment would indicate the biggest cause for concern?

Choice A rationale:

Decreasing fluid intake after the evening meal is a helpful intervention for a child with enuresis. Enuresis, commonly known as bedwetting, is often related to the child's ability to control their bladder at night. Limiting fluid intake in the evening can reduce the chances of overloading the bladder and minimize the likelihood of nighttime bedwetting. It is a proactive approach to managing this common issue in children.

Choice B rationale:

Increasing dietary fiber intake is not directly related to managing enuresis. While a balanced diet is essential for overall health, it is not a primary intervention for addressing bedwetting. Enuresis is primarily related to bladder control and nighttime habits, and dietary fiber intake does not play a significant role in this context.

Choice C rationale:

Applying an electric pad that gently shocks the child is not a recommended intervention for enuresis. This approach is not only ineffective but can also be potentially harmful and traumatic for the child. It is essential to choose interventions that are safe, non-invasive, and respectful of the child's well-being.

Choice D rationale:

Waking the child several times during the night to urinate is not a sustainable or effective intervention for enuresis. Interrupting a child's sleep repeatedly can be disruptive and may not lead to long-term improvement. The primary goal is to help the child develop bladder control during sleep, and waking them up at night does not address this core issue.

Choice A rationale:

The ability to communicate that he or she is wet is a good sign but not the primary indicator of toilet training readiness. While communication is essential, it's not the sole factor. A child should also display other signs of readiness, such as curiosity about using the potty and the ability to control their bladder and bowels.

Choice B rationale:

Being dry in the daytime for 4-hour periods is a strong sign of toilet training readiness. However, it's not the only behavior that identifies readiness. A child should also show interest in using the potty and display curiosity about bathroom activities.

Choice C rationale:

Curiosity about bathroom activities is a key indicator of toilet training readiness. When a child starts showing interest in what goes on in the bathroom and demonstrates a desire to imitate the actions of adults using the toilet, it's a positive sign that they may be ready to begin toilet training. This curiosity can make the training process more engaging and effective.

Choice D rationale:

Willingness to sit on the potty for 15 to 20 minutes is a positive sign of toilet training readiness. This behavior suggests that the child is willing to participate in the process and may be ready to start learning how to use the toilet. However, it should be considered alongside other signs of readiness, such as curiosity about bathroom activities and the ability to communicate their needs.