A 7-year-old child is diagnosed with head lice.
In addition to applying a pediculicide, which instruction should the nurse provide to the parents?

Choice A rationale

Blank staring for prolonged periods is not a typical sign of otitis media. While changes in behavior can occur with illness, this specific symptom is more indicative of neurological issues like absence seizures rather than an ear infection. Neurological assessments would be necessary to evaluate this finding, which is outside the typical presentation of otitis media.

Choice B rationale

Rubbing or pulling at the affected ear is a common behavioral manifestation of otitis media in young children. The inflammation and pressure within the middle ear cause pain and discomfort, leading the child to touch or tug at their ear in an attempt to alleviate the sensation. This localized physical sign strongly suggests an issue within the ear itself.

Choice C rationale

Hyperactivity is not a primary indicator of otitis media. While a child experiencing discomfort might be irritable or restless, true hyperactivity is a distinct behavioral pattern often associated with other conditions like attention-deficit/hyperactivity disorder (ADHD) and is not directly linked to a middle ear infection.

Choice D rationale

Excessive sleepiness is not a typical presenting symptom of otitis media. While a child might be slightly more tired due to the general discomfort of an infection, excessive somnolence would be more concerning for a systemic illness or a neurological issue, rather than a localized ear infection.

Choice A rationale

Irritability after feedings can be a common symptom of GER due to stomach acid refluxing into the esophagus and causing discomfort. While it should be reported, it is not necessarily an immediate sign of a serious complication.

Choice B rationale

A slight decrease in appetite can occur with GER due to discomfort or a learned aversion to feeding. While it warrants monitoring, it is not typically an immediate red flag for severe complications.

Choice C rationale

Coughing or wheezing during sleep can indicate aspiration of gastric contents into the airway due to severe GER. Aspiration can lead to respiratory complications such as pneumonia, making this a serious sign that requires immediate medical attention.

Choice D rationale

Occasional spitting up after feedings is a common manifestation of GER in infants and is often physiological. While frequent or forceful spitting up should be monitored, occasional spitting up in a 9-month-old with known GER is not necessarily a sign of a serious complication requiring immediate reporting.