A nurse finds a 3-year-old child unresponsive and not breathing. The nurse begins CPR while a bystander calls EMS (emergency medical services). Another person trained in CPR arrives. What is the next appropriate action?

Rationale:

• Nutrition: Millie’s intake of 5–6 cups of low-fat milk per day significantly exceeds the recommended 2 cups for toddlers. High milk intake suppresses appetite for nutrient-dense foods, worsening her picky eating and risking iron-deficiency anemia. Because it directly affects growth and development, nutrition becomes the priority teaching need.
• Excessive milk intake: Drinking this much milk can displace iron-rich solids, creating micronutrient deficits and contributing to poor weight progression if continued. Excess milk can also cause constipation and limit overall diet variety in young children. This factor presents the most immediate risk and therefore requires primary intervention.
• Language: Millie’s use of two-word phrases is developmentally appropriate for age 2, even though she is not yet forming full sentences. Sentence formation typically matures between ages 2½ and 3, making this delay mild and expected in many toddlers.
• Not using complete sentences: Toddlers commonly have uneven language development, and sentence construction often emerges later in the third year. This pattern does not impair Millie’s daily functioning or pose a health threat. Because the concern is mild and age-appropriate, it does not outweigh the need to address excessive milk intake.
• Motor skills: Millie walks, runs, kicks a ball, and climbs stairs with help—all well within expected developmental ranges for a 2-year-old. Fine motor tasks such as switching from a palmar grasp to a mature tripod grasp do not emerge until closer to age 3. These findings do not require urgent correction.
• Holding pencil in fist and needing help to walk up stairs: A fist grasp is the normal toddler way of holding writing tools, and alternating feet on stairs often develops after age 3. These abilities reflect early-stage coordination that continues to mature gradually. They do not signal a developmental risk.
• Behavior: Saying “no,” imitating adults, and having 2–3 tantrums per week are classic expressions of toddler autonomy. These behaviors demonstrate normal emotional development and do not indicate dysregulation that threatens health or safety.
• Having a tantrum 2–3 times per week: Tantrums at this frequency fall squarely within expected toddler patterns as they manage frustration and communication limits. They usually decrease as language improves and routines stabilize. Because they represent normal development, they are not the primary concern.

Rationale:

A. Tachypnea and diaphoresis with feeding, poor weight gain, and irritability: Tachypnea and sweating during feeds indicate increased cardiac workload, poor weight gain reflects inadequate nutrition due to fatigue, and irritability can result from decreased perfusion and hypoxia. Caregivers should be able to identify these signs promptly.

B. Cough, edema, and irregular heart rate: While cough and edema may occur in older children or adults with heart failure, they are less specific in infants. Irregular heart rate can indicate arrhythmia but is not the most sensitive early marker of heart failure worsening in this age group.

C. Abdominal pain, poor appetite, and cough: Poor appetite may be present, but abdominal pain is not a typical early sign of infant heart failure. Cough is more often associated with respiratory infections rather than early heart failure.

D. Bradycardia, rapid weight gain, and irritability: Bradycardia is not an early sign of worsening heart failure in infants; it may indicate severe hypoxia or advanced decompensation. Rapid weight gain could suggest fluid retention, but in combination with bradycardia, it reflects a more severe state rather than an early warning.