A nurse is reviewing the dietary intake of an infant who is receiving complementary foods and drinks along with breast milk.

Which of the following foods should the nurse instruct the mother to limit or avoid to prevent dental caries?

Breast milk does not contain enough vitamin D for bone health.Vitamin D is needed to support healthy bone development and to prevent rickets, a condition that causes weak or deformed bones.Breast milk alone does not provide infants with an adequate amount of vitamin D.The Dietary Guidelines for Americans and American Academy of Pediatrics recommend breastfed and partially breastfed infants be supplemented with 400 IU per day of vitamin D beginning in the first few days of life.

Choice B is wrong because breast milk does not interfere with vitamin D absorption from sunlight.However, reducing sun exposure is important for preventing skin cancer, and other factors such as clothing, air pollution, and skin type can also decrease the amount of vitamin D a person can make from sunlight.

Choice C is wrong because breast milk does not increase vitamin D excretion in urine.

Vitamin D is a fat-soluble vitamin that is stored in the body and not easily lost in urine.

Choice D is wrong because breast milk does not inhibit vitamin D synthesis in the liver.Vitamin D is synthesized in the skin from exposure to sunlight, and then activated in the liver and kidneys to its active form.

Breast milk does not affect this process.

The child has frequent temper tantrums.This is because temper tantrums are not a normal part of a 3-year-old child’s development and can indicate emotional or behavioral problems.According to the height and weight chart for children, a 3-year-old child should be able to do the following:

• Speak in three-word sentences

• Copy a circle with a crayon

• Ride a tricycle using pedals

Therefore, choices A, B and C are wrong because they are expected developmental milestones for a 3-year-old child.

A nurse should collect data from the child and the parents to determine the cause and frequency of the temper tantrums and provide appropriate interventions and referrals.