A nurse is providing teaching about toilet training to the caregiver of a 2-year-old client who has a history of vesicoureteral reflux. Which of the following recommendations should the nurse make to help the caregiver decrease the risk of UTI development? (Select All that Apply.)

A. "It is caused primarily by a combination of genetic factors and maternal environmental exposures during early pregnancy, such as smoking, certain medications, and infections.": Cleft lip results from incomplete fusion of the maxillary and medial nasal processes during early embryonic development,. Both genetic predisposition and environmental exposures, including maternal smoking, alcohol use, certain medications and infections, increase the risk.

B. "A cleft lip is due to an abnormal autoimmune response.": Autoimmune responses are not considered a primary cause of cleft lip. The defect occurs during early facial development, not as a result of immune-mediated processes.

C. "Intrauterine hypoxia causing tissue necrosis of the lip during the third trimester.": Tissue necrosis in the third trimester cannot cause a cleft lip, as the structural fusion occurs much earlier in embryogenesis.

D. "Postnatal trauma to the upper lip during delivery.": Cleft lip is a congenital malformation present at birth, not a result of trauma during delivery. Postnatal injury cannot create this congenital defect.

A. "Formula feeding is easier and will let you get more rest, so it's definitely the better option now.": This statement introduces personal judgment and implies superiority of one feeding method over another. It may invalidate the mother’s autonomy and oversimplifies infant feeding decisions. Nursing communication should remain neutral and supportive rather than directive or comparative.

B. "I can help you learn how to properly prepare and safely store formula to ensure your infant receives safe nutrition.": This response respects the mother’s informed choice while prioritizing infant safety and adequate nutrition. Teaching correct formula preparation, dilution, and storage reduces the risk of infection, electrolyte imbalance, and inadequate caloric intake. It reflects patient-centered, nonjudgmental nursing care.

C. "Since formula feeding is not as beneficial as breastfeeding, you should only use it as a last resort.": This statement is judgmental and may increase parental guilt or distress. While breastfeeding has immunologic benefits, formula feeding can fully support normal growth when used correctly. Nursing support should focus on safe feeding practices rather than persuasion.

D. "Breastfeeding provides better immunity, so I strongly recommend you reconsider and continue breastfeeding.": This response disregards the mother’s decision and undermines autonomy. Pressuring the parent may damage trust and does not address the immediate need for education on formula use. Supportive counseling should align with the family’s chosen feeding method.