The American Academy of Pediatrics states that breastfeeding should be avoided for children with congenital heart disease because it requires less energy to suck from a bottle than the breast.

Choice A reason: Mechanical ventilation does not necessarily increase the fluid requirements of a child. Mechanical ventilation is a method of providing artificial breathing support to a child who has respiratory failure or insufficiency. Mechanical ventilation may affect the fluid balance of a child by altering the insensible losses, the renal function, or the hemodynamics. However, the net effect may vary depending on the type, mode, and settings of the ventilator, as well as the underlying condition of the child. Therefore, the fluid requirements of a child on mechanical ventilation should be individualized and monitored closely¹.

Choice B reason: Increased intracranial pressure (ICP) does not increase the fluid requirements of a child. Increased ICP is a condition in which the pressure inside the skull is higher than normal, due to various causes such as head injury, brain tumor, infection, or hydrocephalus. Increased ICP may affect the fluid balance of a child by impairing the cerebral blood flow, the cerebrospinal fluid drainage, or the hypothalamic-pituitary axis. However, the net effect may vary depending on the severity, duration, and cause of the increased ICP, as well as the presence of other complications such as cerebral edema or diabetes insipidus. Therefore, the fluid requirements of a child with increased ICP should be individualized and monitored closely².

Choice C reason: Congestive heart failure does not increase the fluid requirements of a child. Congestive heart failure is a condition in which the heart is unable to pump enough blood to meet the body's needs, due to various causes such as congenital heart defects, cardiomyopathy, or infection. Congestive heart failure may affect the fluid balance of a child by causing fluid retention, edema, or pulmonary congestion. However, the net effect may vary depending on the type, severity, and stage of the heart failure, as well as the presence of other complications such as renal failure or liver failure. Therefore, the fluid requirements of a child with congestive heart failure should be individualized and monitored closely³.

Choice D reason: Fever increases the fluid requirements of a child. Fever is a condition in which the body temperature is higher than normal, due to various causes such as infection, inflammation, or immunization. Fever increases the fluid requirements of a child by increasing the metabolic rate, the insensible losses, and the urine output. The amount of fluid loss due to fever depends on the degree and duration of the fever, as well as the ambient temperature and humidity. A general rule of thumb is that for every degree Celsius increase in body temperature, the fluid requirements increase by 10%⁴. Therefore, the fluid requirements of a child with fever should be adjusted and monitored closely.

Choice A reason: This is not a correct statement, as the American Academy of Pediatrics does not recommend avoiding breastfeeding for children with congenital heart disease. On the contrary, it supports breastfeeding as the optimal source of nutrition for infants, including those with special health care needs¹.

Choice B reason: This is the correct statement, as the American Academy of Pediatrics does not recommend avoiding breastfeeding for children with congenital heart disease. Breastfeeding may have several benefits for these infants, such as enhancing their immune system, reducing their risk of infection, and promoting their growth and development¹². However, breastfeeding may also pose some challenges for these infants, such as increased energy expenditure, poor weight gain, and difficulty coordinating sucking, swallowing, and breathing²³. Therefore, breastfeeding should be individualized and monitored for each infant with congenital heart disease, and supplemented with formula or fortified breast milk if needed²³.