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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

Donna Hallas, PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN, comments on the ongoing measles outbreaks and encourages advocation for vaccines and accurate information. 

Measles outbreaks: 223 cases reported in Texas

 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.

Social media data mining may improve STI testing rates and sexual health outreach among young Black males, according to a study presented at the 2025 NAPNAP conference.

Using social media data mining to improve STI testing among young Black males

Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, highlighted key updates on influenza, COVID-19, and RSV vaccines at the 2025 NAPNAP National Conference.

2025 immunization update recap with Mary Koslap-Petraco, DNP

A nurse-led intervention increased HPV vaccination rates among Hispanic adolescents in a rural North Carolina clinic, according to research presented at the 2025 NAPNAP conference.

Improving HPV vaccination rates among Hispanic adolescents

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A mother seeks an evaluation of her 20-month-old son, who has grown slowly and has had leathery dry skin since birth. He also has had multiple skin infections and chronic conjunctivitis, and he has delayed language development.

20-month old boy has had extremely dry skin since birth

**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 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. 

News

Case Studies

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

Mary Koslap-Petraco highlighted the need to address vaccine hesitancy, catch up on immunizations, and build trust with parents at the 2025 NAPNAP National Conference on Pediatric Health Care.

2025 immunization update: addressing vaccine hesitancy and catch-up vaccinations

At the 2025 NAPNAP National Conference on Pediatric Health Care in Chicago, Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, chair of the Scientific Advisory Board for Vaccinate Your Family and clinical assistant professor at Stony Brook University, emphasized the critical need to address vaccine hesitancy and ensure children are caught up on 

"We know that there's a lot of children behind related to the pandemic and hesitancy on the parents' side, and we can't fault the parents. The parents just are looking for good information for their children," Koslap-Petraco explained. She advised healthcare providers to use electronic medical records (EMRs) and other tracking tools to ensure patients return for their immunizations.

The rise in measles outbreaks across the United States further underscores the importance of timely vaccinations, stated Koslap-Petraco.

"If you're in a neighborhood where there are outbreaks of measles, you would certainly want to consider giving children 6 months of age a measles vaccine, but also telling the parent that the child is going to need 2 more doses separated by at least 28 days once the child turns 12 months of age," she said.

Koslap-Petraco acknowledged the complexities of the COVID-19 vaccine schedule but reassured providers that resources are available to help navigate the requirements. 

"COVID vaccine can be very confusing and challenging for providers, but there's really excellent tools available. 

 has excellent tools available, if you can't find things anywhere else, that you can pull up to make sure that you're giving the right formulation, the right dose, and the right number of doses to the various age groups." 

She also highlighted a newly approved 5-valent meningococcal vaccine, though its inclusion in the immunization schedule has been delayed because of the 

cancellation of the Advisory Committee on Immunization Practices (ACIP) 

meeting. "Until it is [included], the insurance companies don't pay for the vaccines," she noted.

Koslap-Petraco stressed the importance of respectful, empathetic communication with parents who are hesitant about vaccines. 

"Be that trusted individual that our patients and their families can come to, and we can give them good information in a conversational way, without being belittling and accepting of that parent's questions, and really giving them the confidence to vaccinate their children."

She recommended a warm and understanding approach: "Greet the parent, be kind, acknowledge their concerns. My big thing is always smile at them so that they know that you genuinely care about them."

She also shared a personal strategy for building trust.

"I always ask, may I have your permission to tell you what I know about this vaccine and why I think it's good for your child? And I also tell them that either I'm vaccinated myself or my grandchildren are vaccinated, which also increases their confidence in the vaccine." 

Koslap-Petraco encouraged healthcare providers to engage in open, informative conversations with parents, emphasizing the shared goal of keeping children safe and healthy. 

"I really want to give this vaccine today, so I know your child is protected," she concluded. Her message reinforced the importance of education, trust, and proactive vaccination efforts to safeguard public health. 

Koslap-Petraco addressed several other areas of vaccination and immunization in pediatric care. Contemporary Pediatrics will have more videos published related to 

There are several more important and timely sessions taking place at the 2025 NAPNAP conference. Be sure to visit ContemporaryPediatrics.com for regular updates and continued coverage from Chicago.

Click here to sign up for our free e-newsletter to receive our top coverage from the conference and in pediatric health care news overall in an email.

 to find all of our NAPNAP coverage throughout the week. 

Pediatric Guidelines

Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, reacts to the recent cancelations of the ACIP and VRBPAC and comments on the potential down stream effects. 

How canceled government agency meetings could impact vaccination schedules, with Mary Koslap-Petraco, DNP

video interview, Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, shared her thoughts on the 

recent cancelations of the CDC's Advisory Committee on Immunization Practices (ACIP)

 and FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC) meetings.

The ACIP meeting was originally slated for February 26, 2025 before being postponed. Then on February 27, 2025, the routine VRBPAC March meeting that was scheduled for the 13th was canceled with no indication that it will be made up.

According to a statement from the FDA published by CNN, the agency reported it "will make public its recommendations to manufacturers in time for updated vaccines to be available for the 2025-2026 influenza season.”

When asked what her reaction to these committee cancelations was, Koslap-Petraco said, "Well, my first reaction is dismay because it puts science behind. My big fear is that we are going to fall behind on the science. That’s what these committees are created for—they have fully vetted scientists who help determine which vaccines should be added to the schedule or whether an existing vaccine’s schedule should be changed. They also determine the strains that go into the influenza vaccine."

Worries are growing among health care providers that a potential result from postponed and canceled meetings could be the delay in receipt of vaccines and delays for the vaccines themselves. 

"I am very disturbed and worried that next year’s 

 vaccine will be delayed due to cancellations of these committee meetings," said Koslap-Petraco. "I have heard that they are supposed to move forward on the strain selection, but I have not yet had that confirmed. It is very distressing to see science being put on the back burner."

Each year, Koslap-Petraco delivers an immunization update at the NAPNAP conference. This year's meeting in Chicago—

—she will have to make changes based on meeting cancelations. 

"This situation is having an impact. What I am planning to do is review the current vaccine schedule, but I will also go over the ACIP agenda—what they were planning to discuss—to make people aware of what was coming if it were able to move forward. I also want to highlight what the science is supporting so that people understand where we are headed." 

 to find all of our NAPNAP coverage throughout the week.

1. Fitch, J. Tina Tan, MD, on ACIP meeting postponement, public vaccine information reports. 

. February 26, 2025. Accessed March 11, 2025. https://www.contemporarypediatrics.com/view/tina-tan-md-on-acip-meeting-postponement-public-vaccine-information-reports 

2. Tirrell M. FDA meeting to choose flu vaccine composition canceled without explanation. CNN. February 27, 2025. Accessed March 11, 2025. https://www.cnn.com/2025/02/26/health/news-fda-meeting-to-choose-flu-vaccine-composition-canceled-without-explanation/index.html 

Chris (Yi) Deng, BS

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