The nurse is discussing discharge instructions with the parents of a 6-year-old who had a tonsillectomy. What is the most important thing to stress?

A. Infants with congenital deformities have an increased risk for ear infections: Certain congenital anomalies, such as cleft palate or Down syndrome, can predispose children to recurrent otitis media due to structural or functional impairments of the eustachian tube. While this is clinically relevant, it applies to a specific subset of infants rather than the general mechanism of infection in all children.

B. Ear infections typically increase as the child gets older: The incidence of otitis media actually decreases with age as the child’s immune system matures and the eustachian tube elongates and becomes more vertical, improving drainage. Older children generally have fewer episodes of middle ear infections compared with infants and toddlers.

C. The shorter and wider eustachian tubes of an infant increase the risk: Infants have eustachian tubes that are shorter, wider, and more horizontal than in older children and adults, which allows bacteria and secretions from the nasopharynx to enter the middle ear more easily. This anatomical factor, combined with immature immune responses, significantly contributes to the high incidence of otitis media in infants.

D. Adenoids shrink as the child grows, allowing more bacteria to enter: Adenoids actually tend to hypertrophy in early childhood and regress after age 5–7 years. Enlarged adenoids can contribute to eustachian tube obstruction and recurrent infections, so their shrinkage does not increase bacterial entry; instead, adenoid regression typically reduces infection risk.

A. Holding her breath while pushing during contractions: Prolonged breath-holding increases intrathoracic pressure, reduces venous return, and can decrease uteroplacental perfusion. This may compromise fetal oxygenation and increase maternal fatigue, particularly during repeated pushing efforts.

B. Begin pushing as soon as the cervix has dilated to 8 cm: Initiating pushing before full cervical dilation increases the risk of cervical edema and lacerations. Effective bearing down requires complete dilation to allow fetal descent without maternal or cervical trauma.

C. Push with contractions and rest between them: Coordinating pushing with uterine contractions maximizes expulsive force while rest periods allow maternal recovery and fetal reoxygenation. This pattern supports efficient fetal descent and reduces exhaustion during the second stage of labor.

D. Pant while pushing: Panting is used during the transition phase or when pushing should be delayed, such as with an urge to push before full dilation. During the active second stage, panting interferes with effective bearing-down efforts.