In providing anticipatory guidance to the mother of a two-month old breast-fed infant, which of the following should the nurse include:

Choice A reason: This is not a good choice. Delaying dental visits until the child's heart defect is fully repaired is not a recommended practice. Dental hygiene is important for preventing oral infections that can spread to the bloodstream and cause infective endocarditis. The child should have regular dental check-ups and cleanings, as well as good oral care at home.

Choice B reason: This is the correct choice. Administration of antibiotics one hour prior to all dental procedures is a critical teaching point to emphasize for parents of a child with a complex congenital heart defect. Dental procedures can cause bleeding and bacteria to enter the bloodstream, which can infect the damaged or abnormal heart valves and cause infective endocarditis. Antibiotics can prevent or reduce the risk of this complication by killing the bacteria before they reach the heart.

Choice C reason: This is not a good choice. Administration of daily prophylactic antibiotics is not a necessary or effective measure for preventing infective endocarditis in a child with a complex congenital heart defect. Daily antibiotics can cause side effects, such as allergic reactions, diarrhea, or yeast infections. They can also lead to antibiotic resistance, which can make the bacteria harder to treat if they do cause an infection.

Choice D reason: This is not a good choice. High dose IV antibiotics for 2-8 weeks is not a preventive strategy for infective endocarditis, but a treatment option for an established infection. IV antibiotics are given to eradicate the bacteria from the bloodstream and the heart valves and prevent further damage or complications. However, IV antibiotics are not always effective and may have serious side effects, such as kidney damage, hearing loss, or allergic reactions. Therefore, prevention is better than cure.

Choice A reason: This statement is incorrect, as letting the child feed herself finger foods is not a risk factor for aspiration, but a way to promote self-feeding skills, independence, and appetite. The nurse should encourage the parents to offer the child a variety of soft, bite-sized, and nutritious foods, such as cooked vegetables, fruits, cheese, or bread, and to supervise the child during meals.

Choice B reason: This statement is correct, as giving whole milk is recommended for children between 1 and 2 years old, as it provides adequate fat, protein, calcium, and vitamin D for their growth and development. The nurse should advise the parents to give the child about 16 to 24 ounces of whole milk per day, and to avoid low-fat or skim milk until the child is 2 years old.

Choice C reason: This statement is incorrect, as delaying the introduction of foods which may cause allergies is not necessary or beneficial for the prevention of food allergies in children. The nurse should inform the parents that there is no evidence that avoiding certain foods, such as eggs, peanuts, or fish, can reduce the risk of food allergies, and that introducing these foods early, around 6 months of age, may actually prevent or reduce the severity of food allergies.

Choice D reason: This statement is incorrect, as transitioning to 1% milk is not advisable for children under 2 years old, as it does not provide enough fat and calories for their growth and development. The nurse should explain to the parents that low-fat or skim milk is not suitable for young children, as they need more fat for their brain and nervous system development, and that switching to 1% milk should only be done after consulting with the doctor.