A boy aged 4 1/2 years has been having increasingly frequent angry outbursts in preschool. He is aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8-10 weeks. His parents ask the nurse for advice. What is the most appropriate intervention?

Choice A reason: This is not a correct statement, as delaying dental visits until the child's heart defect is fully repaired is not advisable. Dental visits are important for maintaining oral hygiene and preventing dental caries, which can increase the risk of infective endocarditis. The child should have regular dental check-ups and follow the dentist's recommendations for oral care¹.

Choice B reason: This is not a correct statement, as administration of daily prophylactic antibiotics is not recommended for prevention of infective endocarditis. Daily antibiotics can cause adverse effects, such as allergic reactions, diarrhea, or yeast infections. They can also lead to antibiotic resistance, which can make the treatment of infective endocarditis more difficult².

Choice C reason: This is the correct statement, as administration of antibiotics one hour prior to any dental procedure is recommended for prevention of infective endocarditis. Dental procedures can cause bleeding and release bacteria into the bloodstream, which can infect the damaged heart valves or tissues. Antibiotics can help prevent or reduce the bacterial growth and prevent infective endocarditis¹².

Choice D reason: This is not a correct statement, as high dose IV antibiotics for 29 weeks is not a preventive measure, but a treatment option for infective endocarditis. IV antibiotics are given to eradicate the infection and prevent complications, such as heart failure or stroke. The duration of treatment depends on the type and severity of the infection, but it usually ranges from 4 to 6 weeks²³.

Choice A reason: Giving the toddler planned, frequent, and nutritious snacks is a good way to meet her nutritional needs and respect her natural appetite. Toddlers have small stomachs and high energy levels, so they may not eat much at one sitting. They may also be easily distracted or bored by sitting at the table for too long. Snacks can provide additional calories and nutrients that they may miss at mealtimes. However, the snacks should be healthy, such as fruits, vegetables, cheese, yogurt, or whole-grain crackers. They should also be offered at regular times, not on demand, and not too close to mealtimes.

Choice B reason: Explaining to the toddler in a firm manner what is expected of her is not a helpful or realistic strategy to improve her eating habits. Toddlers are naturally curious and independent, and they may not understand or follow the rules that adults set for them. They may also resist or rebel against pressure or coercion to eat. Instead of lecturing or scolding the toddler, the parents should model good eating behaviors, praise her when she tries new foods, and avoid power struggles or arguments over food.

Choice C reason: Avoiding snacks so the toddler is hungry at mealtimes is not a wise or healthy suggestion. This may backfire and cause the toddler to become more fussy, irritable, or tired. It may also lead to overeating, bingeing, or unhealthy food choices later on. Hunger is not the only factor that influences a toddler's appetite. Other factors include mood, activity level, environment, and preferences. The parents should not use hunger as a tool to manipulate the toddler's eating, but rather respect her hunger and fullness cues.

Choice D reason: Offering rewards for eating at mealtimes is not a beneficial or sustainable method to encourage the toddler to eat. Rewards may be material, such as toys or stickers, or edible, such as sweets or desserts. Rewards may work temporarily, but they may also have negative consequences. They may undermine the toddler's intrinsic motivation to eat, or make her associate eating with external rewards rather than internal satisfaction. They may also create an imbalance in the value of different foods, or make the toddler feel guilty or deprived. The parents should not bribe or bargain with the toddler to eat, but rather make eating a pleasant and enjoyable experience.