A nurse is providing anticipatory guidance to the parents of a newborn about feeding skills. Place the following feeding skills in the order the newborn should develop them. (Move the steps into the box on the right, placing them in the selected order of performance. Use all of the steps.)

The correct answer is Choice D: Contraction lasting 85 seconds.

Choice A rationale: A contraction resting period of 35 seconds is normal and expected during labor. The resting period allows the uterine muscle to relax and replenish its oxygen supply, which is essential for fetal well-being. The resting period also gives the client a chance to rest and cope with the pain of labor. A normal resting period ranges from 30 to 90 seconds, depending on the stage and phase of labor¹².

Choice B rationale: A heart rate of 100/min for a 10-min period is within the normal range for an adult. The normal resting heart rate for an adult is 60 to 100 beats per minute (bpm)³. During labor, the heart rate may increase due to factors such as pain, anxiety, dehydration, fever, or infection. However, a heart rate of 100/min is not considered a sign of distress or complication, unless it is accompanied by other symptoms such as chest pain, shortness of breath, or palpitations⁴⁵.

Choice C rationale: Four contractions in a 10-min period is a normal frequency for labor contractions. The frequency of contractions refers to how often they occur, measured from the beginning of one contraction to the beginning of the next. The normal frequency of contractions varies depending on the stage and phase of labor, but generally ranges from two to five contractions in 10 minutes¹².

Choice D rationale: A contraction lasting 85 seconds is too long and should be reported to the provider. The duration of contractions refers to how long they last, measured from the beginning to the end of one contraction. The normal duration of contractions ranges from 30 to 70 seconds, depending on the stage and phase of labor¹². A contraction lasting longer than 90 seconds is considered a prolonged contraction, which can reduce the blood flow and oxygen supply to the placenta and the fetus, leading to fetal hypoxia and acidosis. Prolonged contractions can also cause uterine rupture, placental abruption, or maternal hemorrhage .

Choice A rationale: Eight months is too early to transition to whole milk. At this age, infants still need the complete nutrition provided by breast milk or formula.
Choice B rationale: Ten months is still too early for transitioning to whole milk. Breast milk or formula should be the primary source of nutrition until around 12 months of age.
Choice C rationale: At 6 months of age, infants are usually just starting to introduce solid foods, but breast milk or formula remains the primary source of nutrition. Transitioning to whole milk at this age is not recommended.
Choice D rationale: The American Academy of Pediatrics (AAP) recommends transitioning from breast milk or formula to whole cow's milk at around 12 months of age. Before that age, breast milk or formula provides essential nutrients for the baby's growth and development.