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Meet the Editors

. 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

The higher dose regimen of nusinersen comprises a more rapid loading regimen, two 50 mg doses 14 days apart, and higher maintenance regimen, 28 mg, every 4 months.

FDA accepts sNDA for higher regimen nusinersen for spinal muscular atrophy

Based on recent reports, norovirus outbreaks in the 2024-2025 seasonal year is above the range reported from the 2012-2020 and 2021-2024 seasonal years.

Tina Tan, MD discusses the increased outbreaks of norovirus this year

Already approved in those aged 18 and older in the United States, Valneva has submitted label extension applications to the FDA for IXCHIQ use in adolescents aged 12 to 17 years. 

IXCHIQ chikungunya vaccine meets phase 2 endpoint in children

Detectable TTE in children's urine were 'significantly higher' in homes with reported in-home cannabis smoking. 

Detectable THC biomarkers among children via in-home, second-hand cannabis smoke

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A 6-year-old boy presented to his pediatrician with clear drainage from his left eye for 1 to 2 days. He denied itchiness, pain, vision changes, nasal congestion, or history of allergies. What's the diagnosis?

Six-year-old male with acute eye swelling and drainage

**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

Robert Frenck, MD, offers several practical tips to use when discussing pediatric vaccination among vaccine-hesitant parents. 

Discussing pediatric vaccination with vaccine-hesitant parents

Robert Frenck, MD, Professor of Pediatrics in the Division of Infectious Diseases and Director of Vaccine Research at Cincinnati Children’s Hospital, recently addressed the challenges surrounding pediatric COVID-19 vaccination rates. Frenck highlighted the efficacy of vaccines and the critical role healthcare providers play in promoting vaccination among children.

“One of the frustrating things is that I've worked doing COVID vaccines for a couple years... and we have very effective COVID-19 vaccines that just aren't being used,” said Frenck. He emphasized the misconception that COVID-19 poses little risk to children.

“If you look at the incidence of hospitalization for COVID, the two highest groups are kids 0 to 4 years of age and 85 years of age and above. And so that if we're going to immunize anyone, and I think we should immunize everyone, but if we're going to immunize anyone, you want to really focus on that 0 to 4 and 85 and above," he said.

Frenck stressed the importance of using a strong, prescriptive approach when discussing vaccines with parents.

“The most important thing you can do is to have a very strong message," such as, "'I highly recommend you vaccinate your family.' If you go in with that presumptive approach that vaccines are the normative choice, a lot of research has shown that 80-85% of parents will say 'okay.'” 

He contrasted this with a more open-ended approach, which often leads to greater parental hesitancy. 

Frenck also underscored the need for healthcare providers to actively listen to parents’ concerns. “'Tell me what worries you, tell me what concerns you, tell me what information you need to have to make sure you understand,'” he advised. By understanding the root of parental hesitancy, providers can tailor their responses effectively.

Despite the challenges, Frenck reminded providers of their pivotal role in guiding families. 

“We have to remember as healthcare providers is that people are coming to us because they trust us.” He encouraged empathy and patience when addressing vaccine hesitancy, adding, “It may be that today you're not ready to say yes yet, and that's okay. Rather than make people feel guilty, say, 'okay, I can see you're not ready today. Go home, think about it. Let’s talk about it next time.'”

Robert Frenck, MD, offers several practical tips to use when discussing pediatric vaccination among vaccine-hesitant parents.

News

Principal investigator Lewis Romer, MD, of Johns Hopkins Medicine joined us to discuss the actively-recruiting MoD PAH trial, and explains the role the pediatrician can play in care and recruitment. 

Pediatric pulmonary arterial hypertension and the pediatrician

Lewis Romer, MD, professor of Anesthesiology and Critical Care Medicine at Johns Hopkins Medicine and principal investigator of the Mono vs. Dual Therapy for Pediatric Pulmonary Arterial Hypertension (MoD PAH) trial, recently discussed the vital role of pediatricians in identifying and managing pulmonary arterial hypertension (PAH) in children. This progressive and rare disease can present with nonspecific symptoms, making early recognition critical. 

“When one is a general pediatrician, one is never sure who's going to walk into one's office,” Romer said. “Some disease processes kind of sneak up on people slowly over time, and they don’t even realize... this is a child who can’t climb up into a chair in the doctor’s office.” These subtle signs, such as fatigue or not keeping up with peers on the playground, Romer used as an example, can be early indicators of PAH, emphasizing the need for vigilance among primary care providers. 

The MoD PAH trial, a Phase 3 study, is evaluating the safety and efficacy of sildenafil monotherapy versus combination therapy with sildenafil and bosentan in children newly diagnosed with PAH. Currently recruiting participants, the trial includes 15 centers across the United States to ensure accessibility. The goal is to determine the best first-line treatment for children with World Health Organization functional class II or III symptoms.

Click here for more information on the MoD PAH trial, as explained by Romer in a previous 

Romer highlighted the importance of referral to specialized centers for accurate diagnosis and care. “If [pediatricians] are suspicious of pulmonary hypertension, referral to a pulmonary hypertension center, if feasible, is the very best thing to do as quickly as possible,” he explained. These centers are equipped to make precise diagnoses efficiently and safely, providing the foundation for effective treatment planning, stated Romer.

Despite a child’s participation in a specialized trial, the pediatrician remains a cornerstone of their care team. Romer emphasized the significance of ongoing collaboration: “The pediatrician continues to be the first contact for things that are not right, for things that are unusual.” 

The MoD PAH trial also integrates routine follow-up, including monthly calls and quarterly visits, to foster a supportive relationship with families. However, Romer reiterated that pediatricians are the consistent presence in a child’s life, offering continuity of care and a trusted partnership in navigating this challenging disease.

Fitch, J. Investigating mono vs dual therapy for pediatric pulmonary arterial hypertension. 

. January 13, 2024. Accessed January 20, 2025. https://mjh.sanity.studio/contpeds/structure/article;edb2ab89-ff82-480b-84eb-0646387bb76c

 Susan Carnell, PhD, highlights the nuanced relationship between social media use and binge eating in adolescents, emphasizing the importance of addressing addictive behaviors and seeking professional support when needed.

 Addictive behaviors surrounding social media could lead to binge eating

Susan Carnell, PhD, Associate Professor in the Division of Child and Adolescent Psychiatry at Johns Hopkins University School of Medicine, recently shared findings from her study examining social media’s impact on adolescent mental health, particularly binge eating behaviors. The study, published in 

, highlights the complex relationship between social media usage and disordered eating in youth. 

, Carnell explained details of the study.

“The reason we did this study is because we were interested to understand more about the effects on social media,” Carnell said. “We were particularly interested in eating disorders because we know that there is potential for social media to impact mental health, but perhaps particularly eating disorders, because of the certain content to do with social comparison, which could lead to body dissatisfaction and disordered eating.”

The study used data from the Adolescent Brain Cognitive Development (ABCD) study, analyzing both social media use and addictive behaviors associated with it. While time spent on social media increased with age—averaging 1 hour per day at ages 11 to 12 and exceeding 2 hours during adolescence—it was not directly linked to binge eating behaviors. However, “those who had high levels of these addictive behaviors around social media at baseline were about 3.5 times more likely than those who had no addictive behaviors to develop binge eating by 14 to 15,” Carnell noted.

She said in another interview that "I think our results suggest that there are some children who may be particularly vulnerable to the addictive nature of social media, which is kind of designed to make us want to keep clicking, or perhaps to binge eating, or perhaps to a third factor which could influence both, like anxiety or depression, which could lead to both of these behaviors."

In the video above, Carnell emphasized the challenges of addressing these behaviors, particularly for families. “As a parent myself, I understand that these behaviors are challenging. And the world has changed. Social media is out there. So I do think that probably is also a role for kind of regulation on a broader scale. I wouldn’t want to make families feel that it’s all on them.” 

She also highlighted important distinctions in her research. “We were looking at social media time. We were looking at addictive behaviors, but we weren’t really looking at social media content, or whether it was active participation or passive participation. So I think there can be a lot of nuance.”

For parents concerned about binge eating, Carnell recommended seeking professional help if children experience distressing binge episodes once a week for 3 months. “There’s good evidence for cognitive behavioral therapy with an interpersonal component that can help adolescents with binge eating.” 

Carnell’s findings underscore the importance of addressing addictive social media behaviors and the need for further research to explore its nuanced effects on adolescent mental health. 

1. Fitch, J. Social media use and binge eating in early adolescence. 

. January 6, 2025. Accessed January 17, 2025. https://www.contemporarypediatrics.com/view/social-media-use-and-binge-eating-in-early-adolescence 

2. Fitch, J. Addictive behaviors surrounding social media could lead to binge eating. 

. January 10, 2025. Accessed January 17, 2025. https://www.contemporarypediatrics.com/view/addictive-behaviors-surrounding-social-media-could-lead-to-binge-eating 

Susan Carnell, PhD, highlights the nuanced relationship between social media use and binge eating in adolescents, noting the importance of addressing addictive behaviors and seeking support when needed. 

Calling out signs of addictive behavior around social media or binge eating

 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.

Case Studies

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

Caring for someone with blood cancer means pulling a double shift—providing them with help, comfort, and compassion, while managing your own stress and fatigue. We know this is a role you didn’t expect but have risen to meet as best you can. It’s a role that is critical and can be both heartbreaking and rewarding.

The Leukemia & Lymphoma Society (LLS) knows that caregivers have roles they didn’t expect but have risen to meet as best they can. We also know how critical their role is to you, their loved one. This National Family Caregivers Month, we want to acknowledge caregivers and the sacrifices they make.

To ensure that caregivers get answers to their questions and feel supported throughout their patient’s diagnosis, treatment, and survivorship, LLS provides free resources and services developed just for them. Our Information Specialists are highly trained oncology social workers and nurses who personally assist in treatment, financial, and emotional challenges. They can help with communicating effectively with healthcare team members and get answers to questions they have as caregivers.

The LLS Caregiver Workbook and Worksheets provide a guide for managing all aspects of their patient’s blood cancer and space to track all activities related to diagnosis and treatment to help bridge care between healthcare professional teams that may support their patient.

Christopher Bergsman, MD

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