The nurse is examining a 12-month-old who was brought to the clinic for persistent, painful diaper rash after being treated for otitis media with antibiotics. The nurse finds red perianal inflammation with satellite lesions. This is most likely caused by:

Choice A reason: Informing the family that supplemental feeding through an N/G tube will probably be needed is not a correct feeding instruction for a newborn with cleft lip and palate. An N/G tube is a nasogastric tube that is inserted through the nose into the stomach to provide nutrition. It is usually used for infants who have severe feeding difficulties or other medical conditions that require tube feeding. However, most infants with cleft lip and palate can be fed orally with proper techniques and equipment, and do not need an N/G tube.

Choice B reason: Demonstrating feeding the infant using the squeeze bottle and ESSR method of feeding is a correct and helpful feeding instruction for a newborn with cleft lip and palate. A squeeze bottle is a special bottle that has a soft nipple and a valve that allows the caregiver to control the flow of milk by squeezing the bottle. The ESSR method stands for Enlarge nipple opening, Stimulate the suck reflex, Swallow, and Rest. It is a technique that helps the infant to suck and swallow effectively, and to prevent choking or aspiration. The nurse should show the family how to use the squeeze bottle and the ESSR method, and let them practice under supervision.

Choice C reason: Instructing the parents to add rice cereal to the formula is not a necessary or advisable feeding instruction for a newborn with cleft lip and palate. Rice cereal is sometimes added to the formula to thicken it and reduce the risk of reflux or regurgitation. However, it is not recommended for infants younger than four months, as it may cause constipation, overfeeding, or allergic reactions. It may also interfere with the absorption of iron and other nutrients. Rice cereal is not a substitute for proper feeding techniques and equipment for infants with cleft lip and palate.

Choice D reason: Infants with cleft lip and palate usually have an easy time breastfeeding is a false and misleading feeding instruction for a newborn with cleft lip and palate. Breastfeeding is the ideal way of feeding a newborn, as it provides optimal nutrition, immunity, and bonding. However, breastfeeding can be challenging for infants with cleft lip and palate, as they may have difficulty creating a seal, latching on, or sucking effectively. Some infants may be able to breastfeed with the help of a nipple shield, a breast pump, or a supplemental nursing system. However, others may need to be fed with a bottle or a cup. The nurse should support the mother's choice of feeding method, and provide education and resources to help her succeed.

Choice A reason: Clear liquids are not the best intervention for acute diarrhea and dehydration in children. Clear liquids are fluids that are transparent or translucent, such as water, broth, tea, or juice. They may provide some hydration, but they do not contain enough electrolytes (sodium, potassium, chloride) to replace the losses from diarrhea. They may also worsen diarrhea by increasing the osmotic load in the gut.

Choice B reason: Absorbents such as kaolin and pectin are not recommended for acute diarrhea and dehydration in children. Absorbents are substances that bind to toxins, bacteria, or water in the gut, and are supposed to reduce the frequency and volume of stools. However, there is no evidence that they are effective or safe for children with diarrhea. They may also interfere with the absorption of other medications or nutrients.

Choice C reason: Oral rehydration solution (ORS) is the preferred intervention for acute diarrhea and dehydration in children. ORS is a specially formulated solution that contains water, glucose, and electrolytes in the right proportions to replenish the losses from diarrhea. ORS can prevent or treat dehydration, and can also reduce the duration and severity of diarrhea. ORS is widely available, inexpensive, and easy to use. It should be given to children with diarrhea as soon as possible, and continued until the diarrhea stops.

Choice D reason: Antidiarrheal medications are not advised for acute diarrhea and dehydration in children. Antidiarrheal medications are drugs that slow down the movement of the gut, reduce the secretion of fluids, or kill the bacteria that cause diarrhea. However, they are not effective for viral diarrhea, which is the most common cause of diarrhea in children. They may also have serious side effects, such as constipation, abdominal pain, drowsiness, or allergic reactions. They may also mask the symptoms of more serious conditions, such as appendicitis or bowel obstruction.