Which parent education should the nurse include to reduce the risk of otitis media in a toddler? (Select all that apply.)

A. Place the child in a supine position immediately after feeding: Placing a toddler flat after feeding promotes reflux of milk into the eustachian tubes due to their shorter, more horizontal anatomy in children. This facilitates fluid accumulation in the middle ear, creating an environment favorable for bacterial growth and increasing the risk of otitis media. B. Encourage frequent pacifier use: Frequent pacifier use is associated with increased incidence of otitis media because repetitive sucking alters middle ear pressure and may introduce pathogens. It can also interfere with proper eustachian tube function, leading to fluid retention and subsequent infection. C. Avoid Q tips in the ear: Using Q tips can push cerumen deeper into the ear canal and cause microtrauma or irritation, disrupting the ear’s natural protective barriers. This may predispose the child to infections and complications, making avoidance an important preventive measure. D. Eliminate exposure to secondhand smoke: Exposure to secondhand smoke causes inflammation of the upper respiratory tract and impairs mucociliary clearance. This leads to eustachian tube dysfunction, increasing fluid retention in the middle ear and significantly raising the risk of recurrent otitis media. E. Avoid bottle-feeding while the child is lying flat: Feeding in a supine position allows milk to enter the eustachian tubes more easily due to gravity and anatomical positioning. This promotes fluid stasis in the middle ear, creating conditions that favor microbial growth and increasing the likelihood of infection.