A nurse assisting with the discharge plan of care for a group of children. For which of the following children should the nurse recommend a referral Speech therapy?

A. A toddler who has a new diagnosis of cystic fibrosis: Cystic fibrosis primarily affects the respiratory and gastrointestinal systems due to abnormal chloride transport and thick mucus production. While long-term illness can influence development, speech articulation is not directly impaired by the underlying pathophysiology of cystic fibrosis. B. An infant who is postoperative following a cleft palate repair: A cleft palate alters normal oral cavity structure, affecting resonance, articulation, and proper sound production. Even after surgical repair, children are at risk for speech delays. Early referral to speech therapy supports proper phonation, articulation development, and prevention of compensatory speech patterns. C. A school-age child who has chronic asthma: Asthma is characterized by airway inflammation, bronchoconstriction, and reversible airflow limitation. Although severe episodes may temporarily affect vocal quality, chronic asthma does not structurally impair speech production mechanisms. Management focuses on bronchodilators and anti-inflammatory therapy. D. An adolescent who has juvenile idiopathic arthritis: Juvenile idiopathic arthritis primarily affects synovial joints, leading to inflammation, pain, and reduced mobility. Interdisciplinary care often includes physical and occupational therapy to maintain joint function. Speech production is not compromised unless there is rare temporomandibular joint involvement.