Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on which statement?

Choice A reason: This is the correct statement, as the knee-chest position can help reduce the cyanosis and hypoxia in infants with tetralogy of Fallot. This position increases the systemic vascular resistance and decreases the right-to-left shunting of blood, improving the pulmonary blood flow and oxygenation¹².

Choice B reason: This is not a correct statement, as the Trendelenburg position can worsen the cyanosis and hypoxia in infants with tetralogy of Fallot. This position decreases the systemic vascular resistance and increases the right-to-left shunting of blood, reducing the pulmonary blood flow and oxygenation¹².

Choice C reason: This is not a correct statement, as feeding the infant every 2 hours around the clock can cause overfeeding and fatigue in infants with tetralogy of Fallot. These infants may have poor appetite and weight gain due to their cardiac condition, and they may need frequent rest periods during feeding. Feeding the infant on demand or every 3 to 4 hours may be more appropriate¹³.

Choice D reason: This is not a correct statement, as adding rice cereal to the formula can increase the risk of aspiration and choking in infants with tetralogy of Fallot. These infants may have difficulty swallowing and coordinating their breathing, and they may need a thin and easily digestible formula. Adding rice cereal to the formula may also increase the caloric density and volume, which can cause overfeeding and fatigue¹³.

Choice A reason: Giving the toddler planned, frequent, and nutritious snacks is a good way to meet her nutritional needs and respect her natural appetite. Toddlers have small stomachs and high energy levels, so they may not eat much at one sitting. They may also be easily distracted or bored by sitting at the table for too long. Snacks can provide additional calories and nutrients that they may miss at mealtimes. However, the snacks should be healthy, such as fruits, vegetables, cheese, yogurt, or whole-grain crackers. They should also be offered at regular times, not on demand, and not too close to mealtimes.

Choice B reason: Explaining to the toddler in a firm manner what is expected of her is not a helpful or realistic strategy to improve her eating habits. Toddlers are naturally curious and independent, and they may not understand or follow the rules that adults set for them. They may also resist or rebel against pressure or coercion to eat. Instead of lecturing or scolding the toddler, the parents should model good eating behaviors, praise her when she tries new foods, and avoid power struggles or arguments over food.

Choice C reason: Avoiding snacks so the toddler is hungry at mealtimes is not a wise or healthy suggestion. This may backfire and cause the toddler to become more fussy, irritable, or tired. It may also lead to overeating, bingeing, or unhealthy food choices later on. Hunger is not the only factor that influences a toddler's appetite. Other factors include mood, activity level, environment, and preferences. The parents should not use hunger as a tool to manipulate the toddler's eating, but rather respect her hunger and fullness cues.

Choice D reason: Offering rewards for eating at mealtimes is not a beneficial or sustainable method to encourage the toddler to eat. Rewards may be material, such as toys or stickers, or edible, such as sweets or desserts. Rewards may work temporarily, but they may also have negative consequences. They may undermine the toddler's intrinsic motivation to eat, or make her associate eating with external rewards rather than internal satisfaction. They may also create an imbalance in the value of different foods, or make the toddler feel guilty or deprived. The parents should not bribe or bargain with the toddler to eat, but rather make eating a pleasant and enjoyable experience.