A nurse is collecting data from a 3-year-old child during a well-child visit.

Which of the following findings should alert the nurse to a possible developmental delay?

All of these conditions would warrant a referral to specialized care for severe diseases or complications related to nutrition and feeding.

Choice A is wrong because phenylketonuria (PKU) in the infant is a genetic disorder that causes an amino acid called phenylalanine to build up in the body.This can lead to intellectual disability, seizures, and other neurological problems if not treated with a special diet that limits phenylalanine.

Choice B is wrong because gestational diabetes mellitus (GDM) in the mother is a condition where the mother has high blood sugar levels during pregnancy.This can increase the risk of complications for both the mother and the baby, such as preeclampsia, macrosomia, birth injuries, and neonatal hypoglycemia.

Choice C is wrong because cleft lip or palate in the infant is a birth defect where the upper lip or roof of the mouth does not form properly.This can affect the infant’s ability to feed, speak, and breathe, and may require surgery and other interventions.

Cover the newborn’s eyes with a mask or shield.This is because phototherapy can cause eye damage and the mask or shield protects the newborn’s eyes from the light.

Some additional explanations are:

• Choice A is wrong because increasing fluid intake by 25% to prevent dehydration is not necessary for a newborn receiving phototherapy.The newborn should be fed on demand or according to a regular schedule and monitored for signs of dehydration such as poor skin turgor, dry mucous membranes, sunken fontanels, and decreased urine output.

• Choice C is wrong because applying lotion or oil to the newborn’s skin to prevent drying is not recommended for a newborn receiving phototherapy.Lotion or oil can increase the absorption of light and cause skin burns.

• Choice D is wrong because turning off the phototherapy lights during feedings is not advised for a newborn receiving phototherapy.The lights should be on continuously to maximize the effectiveness of the treatment and reduce the duration of exposure.