A nurse is caring for a child who is postoperative following the insertion of a ventriculoperitoneal shunt. The nurse should place the child in which of the following positions?

Following ventriculoperitoneal (VP) shunt insertion, the child should be positioned supine (flat) or with only very slight head elevation, typically on the nonoperative side initially — however, many authoritative pediatric nursing references specify the supine position as the initial post-operative position to prevent too-rapid CSF drainage that could cause subdural hematoma or shunt malfunction. Placing the child flat prevents the siphoning effect that occurs when the head is elevated too high, which could cause overdrainage of cerebrospinal fluid. A 45° head elevation would promote excessive drainage through the shunt and is therefore contraindicated in the immediate postoperative period. The prone position places pressure on the operative site and the shunt hardware and could compromise the incision. Positioning on the nonoperative side may be used at times to avoid pressure on the shunt, but the supine (flat) position is considered the primary correct answer in standard nursing references for the immediate postoperative period because it maintains neutral intracranial pressure dynamics. The critical teaching point for students is that VP shunt surgery patients are kept flat to prevent rapid shifts in cerebrospinal fluid pressure that could precipitate complications such as bleeding or shunt over-drainage.