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. He joined the brand in March of 2023 as an editor before being promoted to senior editor in January 2024. Fitch graduated from Youngstown State University in Youngstown, Ohio in 2020 with a degree in telecommunications and journalism. He started his career as a news and sports videographer before becoming an on-air sports anchor at the NBC-affiliated news station in Youngstown. Fitch briefly worked as a national content writer for a Chicago-based national television station before joining the 

team. He can be reached at: jfitch@mjhlifesciences.com.

Articles

Can you diagnose this patient in our most recent puzzler poll? 

Puzzler poll: Urticarial rash in a 9-hours-old male 

Sanjiv Harpavat, MD, PhD, FAAP, lead author of a clinical report recently released by the AAP on identifying infants with biliary atresia, joined to discuss the report and guidance for primary care.

Identifying biliary atresia in primary care with Sanjiv Harpavat, MD, PhD, FAAP

 and joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio before joining 

 You can reach her at mpetronelli@mjhlifesciences.com.

The FDA has accepted PTC Therapeutics' NDA for vatiquinone, a potential treatment for Friedreich's ataxia, with a decision expected by August 19, 2025. 

FDA accepts new drug application for vatiquinone to treat Friedreich's ataxia

In a recent study, the rate of infant deaths was increased by 5.6% in US states implementing abortion bans. 

Infant mortality rises after implementing abortion bans, study finds

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Understand how to naviate the current shortage of pediatric ADHD medications.

Navigating the current shortages of pediatric ADHD medications

**Editor's Note** Please note that starting January 1, 2025, we will be switching to an online-exclusive publication process. This will allow us to publish case submissions quicker without having to deal with the variables that come along with print publication. All cases will still be eligible for print publication consideration, but publication in our print magazine is not guaranteed and will be up to the editor's discretion. 

Do you have a puzzling pediatric case that you’d like to share with the readers of 

We are looking for intriguing diagnoses that have stumped the experts—a diagnostic “Puzzler”—to help our physicians enhance their day-to-day practices. If you have such a story to tell, tell us.

Here’s what to do: Before you begin, we suggest that first you review the Puzzler 

https://www.contemporarypediatrics.com/case-studies

. Please note the specific style required for writing Puzzler manuscripts.

Next, prepare a draft of your case, including a summary of the presenting symptoms, a case overview, a 

table of the differential diagnosis (MANDATORY)

, and the special aspects of your case that qualify it as a Puzzler, and send it to us. Please note that the differential diagnosis table should also be discussed in the body text. We’ll review your draft and let you know what you need to add or revise before we send the manuscript to peer review for evaluation.

Puzzlers vary in length, and we suggest a minimum of 1,200 words up to a maximum of 2,000 words, but that is because of the complexity of some cases and whether some patients returned for many assessments before their diagnoses were determined. Also, some authors describe the pathophysiology of the differentials in great detail. Please also note no more than 3 authors are allowed per article.

What's most important is to show us the process that you used to analyze the case, including:

Why you decided to order certain tests and why you did not order others.

Peer consultations or why you elected to contact other specialists.

Lab values including vital signs or blood tests.

Labs and values if your patient was attended to in the emergency department or other hospital departments such as radiology or neurology.

Discussion related to the possible diagnoses.

Final diagnosis, treatment, prognosis, and follow-up.

Remember to indicate numbered citations within the body of the text and include a complete list of corresponding literature/references at the end of the manuscript. (Do not use any citation management programs or unlink them.) 

Limit references to 25. No references (unless it is a seminal study) can be older than 10 years.

We prefer primary research as references, but some cases are so obscure that authors will need to pull from a variety of sources. However, 

. Be advised that peer reviewers are adamant that the disease/disorder you describe was actually diagnosed and not determined by index of suspicion on the basis of ruling out various differentials. We use AMA11 as our publication style, which uses superscript citation numbers and a corresponding numbered reference list. Please create your citations and references in this style.  Check this recent article posted online at 

https://www.contemporarypediatrics.com/view/the-rx-of-adhd

 for examples of reference style. IMPORTANT NOTE WITH AMA 11TH EDITION: PLEASE PUT DOI OR WEBSITES/URLS AT THE END OF THE REFERENCE LINE.

When you send your draft manuscript, also 

. These image files must be high-resolution jpg or tiff files (minimum of 300 dpi) and as large in size as possible. We suggest a minimum of 7 horizontal inches. The images must be original photos with clear permissions to use, not images from copyrighted sources. Send as separate attachments with your e-mail submission; do not embed images into your manuscript document.

After we receive your manuscript, our editors and peer reviewers will review your draft and let you know if we accept your submission for publication. 

Puzzler is one of the departments for which we receive the most submissions, so it may be several months after submission before you receive feedback from us.

If we do accept your submission for publication, we will contact you with further instructions.

Send your submissions in Microsoft Word format to 

, via e-mail to mpetronelli@mjhlifesciences.com

Guidelines for PUZZLER, Contemporary Pediatrics

 poll. Take a look at the following case below. After reading through the description, choose a multiple choice answer and try to guess the correct patient diagnosis.

on Monday, January 6 at 12:00 PM ET for the full case presentation, differential diagnoses, and the correct patient diagnosis. 

This case was provided by Amar Davé, MD, FAAP and Pahroul Davé, APRN

A boy aged 10 years presented to the outpatient office with a history of painful nodules on the plantar surface of his bilateral feet 8 to 10 hours after spending time in a hot tub. He was unable to bear weight or put on socks and shoes due to his pain. The photos were taken soon after the painful and red papules appeared. The lesions affected the whole plantar aspect of both feet. Over the following 4 days, the nodules became less painful and red. 

Medical advice was sought on the fifth day of symptoms, and by this time, the child was improving clinically. He was stable with subcutaneous, mildly painful, fleshy nodules mostly populating the medial arch of the foot. His remaining clinical examination results were within a normal range. Further questioning of the child’s mother revealed that other children exposed to the hot tub experienced painful feet but without lesions. 

Due to the patient’s improving symptoms and the self-limiting nature of the illness, no tests or labs were ordered as the child was not acutely ill. No peer consultations or specialists were utilized.

Click here for the full case presentation, differential diagnoses, and the correct patient diagnosis, in a separate article.

The photos in this case were taken soon after the painful and red papules appeared.

News

Case Studies

Can you diagnose this boy with painful nodules on his feet?

 poll. Take a look at the following case below. After reading through the description, choose a multiple choice answer and try to guess the correct patient diagnosis. 

 on Wednesday, January 29 at 12:00 PM ET for the full case presentation, differential diagnoses, and the correct patient diagnosis. 

This case was provided by Nicholas W. Kieran, MS and Annuradha Goel, MD.

A 14-year-old girl presented to her primary care office with 2 weeks of vomiting that began when she tried to eat breakfast. She said she was feeling well up until that point, but then developed sudden onset vomiting and constant, 7/10, non-radiating chest pain centrally located at about the level of the second rib that remained unchanged since onset and slightly worsened when trying to eat. 

She was able to take in liquids but vomited all food, despite having an appetite. She denied feeling the food get stuck in her throat and endorsed continued vomiting of meals within 2 minutes of eating. She denied blood in the vomit and denied any abdominal pain. 

Urination was unchanged, and stools, although infrequent because of a lack of eating, continued to have their normal consistency and color. The patient did endorse some mild shortness of breath. This started around the same time as the other symptoms, but did not find it very bothersome. Her last sexual encounter was 3 months prior to this visit, just prior to Nexplanon (etonogestrel implant) insertion. Her last menstrual period was 2months prior to the visit.

On review of systems, she did not endorse palpitations, syncope, lightheadedness. She had increased her vape use recently but did not disclose when she started or how much she vaped. She had no recent travel and had not identified any extremity swelling. She was unsure if she had lost weight but had not been trying to lose any.

website on Wednesday, January 29, 2025, at 12:00 PM ET or later for an article featuring the full case presentation, differential diagnosis, and correct patient diagnosis.

The patient had increased her vape use recently, but did not disclose when she started, or how much she vaped. 

14-year-old girl presents with chest pain, 2-week history of vomiting

Genetic research is revealing that up to 35% of cerebral palsy cases have an identifiable genetic cause, leading to earlier diagnoses and potential precision medicine treatments.

Michael Kruer, MD explains genetic testing and cerebral palsy

A recent meta-analysis, co-authored by Michael C. Kruer, MD, pediatric neurologist and human geneticist at Phoenix Children's Hospital, sheds new light on the genetic underpinnings of cerebral palsy (CP) and the implications for diagnosis and treatment. 

Kruer and his team have been investigating the genetic basis of CP for over a decade.

“This study really has kind of built upon the work that my laboratory has been doing for the last 10 years or so,” he explained. Initially, their research aimed to answer a fundamental question: 

Can cerebral palsy sometimes have a genetic basis?

“I think we now know that the answer to that question is a firm yes,” said Kruer. “We know, in fact, that about around 25 to 35% of individuals with cerebral palsy will have a genetic cause for their symptoms at this point in time that we can detect." 

in December of 2024, systematically reviewed genetic findings in CP cases. Among 1,841 patients who underwent exome sequencing, 27% had pathogenic or likely pathogenic variants related to their CP phenotype. Additionally, 8% of individuals had genetic findings classified as actionable, meaning the results could lead to changes in clinical management, such as targeted therapies or preventative strategies.

Kruer emphasized that understanding the genetic origins of CP is crucial for affected families and medical professionals alike. 

“So, what difference does that make to families and individuals with CP? What difference does that make to the clinicians, the therapists, the physicians that care for them?” he asked. “We now know that we can reliably diagnose CP in at-risk infants as early as 6 months of age, or in the right context, even 3 to 4 months of age,” Kruer noted. This early detection can facilitate timely interventions, potentially improving long-term outcomes.

Advancements in genetic testing technology have made it more accessible and less invasive. 

“We now have the ability to do whole exome or whole genome sequencing… instead of looking at one of the 20,000 or so genes in the human body at a time, [this] looks at at least the coding regions of all of those genes all at once,” said Kruer. 

Notably, genetic testing can now be performed using a simple blood test or even a painless mouth swab, making it more feasible for routine clinical use.

“The interpretation of the test is actually becoming increasingly complicated,” he said. “So there may be some general pediatricians that are comfortable with that, but I think increasingly they’re relying on their sub-specialist colleagues.” 

Lewis SA, Chopra M, Cohen JS, et al. Clinical actionability of genetic findings in cerebral palsy: a systematic review and meta-analysis. 

 2025;179(2):137-144. doi:10.1001/jamapediatrics.2024.5059

Peter S. Jensen, MD, comments on the challenges primary health care providers may face when it comes to mental health treatment in pediatrics, and provides screening tools to consider to combat these challenges. 

Mental health treatment challenges in primary care

Peter S. Jensen, MD, child and adolescent psychiatrist and founder and board chair of The REACH Institute, highlights the critical challenges in pediatric mental health care and the practical tools available to primary care providers. With a growing demand for mental health services, Jensen emphasizes the need for better training, screening tools, and reimbursement structures to support pediatricians in addressing conditions such as ADHD, anxiety, and depression.

Through The REACH Institute, Jensen and his team have trained more than 8,000 pediatricians and family practitioners over the past 15 years. Despite this progress, significant barriers remain.

“The biggest challenge is finding the time and space in a busy practice to actually introduce the topic and follow up on the topic,” Jensen says. “Another major issue is that primary care physicians don’t get enough training during residency, so they often lack hands-on experience in treating conditions like depression or anxiety."

To help bridge this gap, Jensen points to a variety of freely available, evidence-based screening tools that can be easily implemented in primary care settings. “The good news is that there are now a handful of free, effective screening checklists available to primary care providers, that are kind of like checklists,” he explains. These include the M-CHAT for autism spectrum disorder, the Vanderbilt rating scale for ADHD, and the PSC-17, an improved version of the Pediatric Symptom Checklist.

“PSC 17 lets you separate out the child who might have more attention problems, or might anxiety or depression problems or maybe other kinds of behavioral difficulties,” Jensen notes. “There’s a parent version and a teen version. So these can be transformative.”

Beyond screening, Jensen stresses the importance of reimbursement for these tools, which can make their adoption more feasible for busy pediatric practices. "Many insurance companies, including Medicaid, provide reimbursement for these screening tools, making them more accessible for primary care practices," Jensen says. "They take just a minute or two but offer valuable insights that save time and guide treatment decisions."

He also highlights other widely used assessments, such as the PHQ-9 for depression and the SCARED tool for anxiety screening. By integrating these tools into electronic health records and practice workflows, pediatricians can take a significant step toward improving mental health care for children and adolescents.

The FDA has approved meningococcal ABCWY (MenABCWY, Penmenvy; GSK) vaccine for use in individuals aged 10 to 25 years, according to an announcement from GSK.

The vaccine targets 5 groups of the bacteria 

 (A,B,C,W, AND Y) that cause the most invasive meningococcal disease cases (IMD) globally. The vaccine combines antigenic components of the meningococcal group B vaccine (Bexsero) and meningococcal groups A, C, Y, and W-135 Oligosaccharide Diphtheria CRM197 Conjugate Vaccine (Menveo).

“We are excited about the opportunities ahead to help improve meningococcal vaccination coverage in the United States, especially for IMD caused by serogroup B," said Tony Wood, chief scientific officer, GSK. "Building on our global leadership in meningococcal vaccination and our longstanding commitment to address unmet need in disease prevention, we aim to help protect more teens and young adults at a life stage when they are at an increased risk.”

The biologics license application (BLA) submission and acceptance was based on data from a randomized, controlled, observer-blind, multi-country phase 3 trial (NCT04502693) that evaluated safety, tolerability, and immunogenicity of the vaccine candidate.

 Reacting to the meningococcal ABCWY vaccine approval with Donna Hallas, PhD, PPCNP-BC

Approximately 3650 participants aged 10 to 25 years from 7 countries, including the United States and Canada, were enrolled in the study. The trial’s main objective was to assess immunological vaccine effectiveness against a panel of 110 MenB strains and to demonstrate non-inferiority of the immune responses of participants who received 2 doses of meningococcal ABCWY 6 months apart. These results were compared to responses of individuals who received 2 doses of meningococcal group B vaccine and 1 does of meningococcal groups A, C, Y, and W vaccine.

The trial met all primary endpoints and was "well tolerated with a safety profile consistent with both vaccines,” GSK stated when the BLA was accepted by the FDA.

The combination vaccine targets 5 groups of the bacteria Neisseria meningitidis (A,B,C,W, AND Y) that cause the most invasive meningococcal disease cases (IMD) globally.

Bailey Smith, PharmD

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