A nurse is providing teaching to the parent of a newborn who has gastroesophageal reflux (GER). Which of the following instructions should the nurse include?

Choice A reason: Dietary restrictions will not eventually allow the intake of gluten to resume. Gluten is a protein found in wheat, barley, rye, and some oats. It causes damage to the small intestine in people with celiac disease. The only treatment for celiac disease is a lifelong gluten-free diet.

Choice B reason: This condition may cause secondary lactose intolerance. Lactose is a sugar found in milk and dairy products. It is broken down by an enzyme called lactase in the small intestine. People with celiac disease may have reduced levels of lactase due to the damage to the small intestine caused by gluten. This can lead to lactose intolerance, which is the inability to digest lactose properly. Symptoms of lactose intolerance include bloating, gas, diarrhea, and abdominal pain after consuming dairy products.

Choice C reason: Nutritional therapy for this condition does not include limiting proteins and calories. People with celiac disease need adequate amounts of proteins and calories to maintain their health and prevent malnutrition. They also need to ensure that they get enough vitamins, minerals, and fiber from gluten-free sources.

Choice D reason: A normal diet cannot resume after a period of remission. Celiac disease is a chronic autoimmune disorder that does not have a cure. Even if the symptoms improve or disappear, the damage to the small intestine can still occur if gluten is consumed. Therefore, a strict gluten-free diet must be followed for life.

Choice A reason: Hot dog cut in fourths is not an appropriate food choice for toddlers because it is still a choking hazard. Hot dogs are cylindrical and firm, which can block the airway of a child. Hot dogs should be avoided or cut into thin slices and small pieces before offering to toddlers.

Choice B reason: Cooked spaghetti with sauce is an appropriate food choice for toddlers because it is soft, easy to chew, and provides carbohydrates, protein, and vitamins. Cooked spaghetti can be cut into short strands and mixed with sauce to make it more appealing and moist for toddlers.

Choice C reason: Steak cut into small pieces is not an appropriate food choice for toddlers because it is tough, dry, and hard to chew. Steak can cause choking or difficulty swallowing for toddlers who have not developed their molars and chewing skills. Steak should be avoided or minced and moistened before offering to toddlers.

Choice D reason: Caramel popcorn is not an appropriate food choice for toddlers because it is sticky, sweet, and hard. Caramel popcorn can stick to the teeth and gums, causing dental caries and gum infections. Popcorn can also cause choking or aspiration for toddlers who have not mastered their swallowing reflex. Popcorn should be avoided until the child is at least 4 years old.