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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

Pediatric cancer survivors can be vulnerable to cardiovascular disease in the short- or long-term with increased recognition of cardiotoxic cancer treatments, as 5-year survival rates for children are greater than 85%. 

Pediatric cancer survivors and cardiovascular toxicity, disease risk

With 1 in 7 adolescents worldwide diagnosed with mental health disorders, emerging research suggests that diet is a powerful yet often overlooked therapeutic tool. 

Brain food: Nutrition's critical role in teen mental health

Walker and Harris emphasize the importance of early hearing loss detection, screening, and intervention to support optimal child development.

Camille Walker, Sacheen Harris discuss hearing loss, screenings, and testing in primary care

The PANDAS/PANS questionnaire is based on symptoms and comorbidities described in the literature and is a self-report completed by parents of children younger than 18.

New questionnaire effectively screens for PANDAS/PANS

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Authors

Freely available measures may seem initially like a bargain, but their excess demands on staff time not only are expensive but often deter one of the central goals of well-child visits. 

Economics of developmental/mental health screening at well-child visits

**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

Danielle Van Damme, DNP, CPNP-AC, discussed key updates from the 2024 IDSA guideline on diagnosing complicated intra-abdominal infections, emphasizing ultrasound as the preferred imaging modality.

A review of IDSA's 2024 complicated intra-abdominal infection clinical practice guideline

At the 2025 NAPNAP National Conference in Chicago, Danielle Van Damme, DNP, CPNP-AC, a pediatric nurse practitioner specializing in acute and critical care at the Infectious Diseases Department of C.S. Mott Children's Hospital, discussed the updated 2024 Infectious Diseases Society of America (IDSA) guidelines on complicated intra-abdominal infections (cIAIs). Her session focused on risk assessment, diagnostic imaging, and microbiological evaluation.

“Intra-abdominal infections, are the second leading cause of morbidity and mortality in ICUs, and this affects adults and children,” Van Damme explained. “Understanding what the current literature and recommendations are is very important when taking care of these patients.” 

The 2024 guideline differs from its 2010 predecessor. While the previous version covered both diagnosis and management, the latest iteration is the first in a series of guidelines focusing on diagnosis and risk assessment. 

Shift in Diagnostic Imaging Recommendations

One of the most significant changes in the guideline is the recommendation to move away from computed tomography (CT) as the primary imaging modality.

“There has been a shift away from CT as the first-line imaging modality to help diagnose that and really overwhelmingly has supported the use of abdominal ultrasound to diagnose complicated intra-abdominal infection,” Van Damme stated.

Ultrasound is now the conditional recommendation from IDSA because of its accessibility, and no sedation requirement for the child, where with an MRI, sedation could be required. Additionally, unlike CT, ultrasound does not expose patients to ionizing radiation or contrast agents, making it a safer option for pediatric populations.

From a practical standpoint, ultrasound offers greater feasibility across various healthcare settings.

“Ultrasound is more readily available. And it does not expose the patient to contrast, doesn't expose the patient to the large amounts of radiation that CT does, and doesn't require the patient to travel,” Van Damme noted.

Despite these advancements, Van Damme highlighted a critical limitation in the current literature.

“All of these guidelines really are graded as conditional recommendations and almost all of them with low certainty of evidence,” she said.

Because of limited high-quality studies on pediatric intra-abdominal infections, these recommendations serve as guidance rather than definitive protocols, reinforcing the need for further research (IDSA, 2024).

Van Damme encouraged pediatric healthcare providers to stay informed about forthcoming guideline updates, which will address the management of cIAIs following diagnosis.

“The fact that they have separated out [the guidelines]… providers should look out for the subsequent publications that will continue to guide the management after we've made a diagnosis of intra-abdominal infection.” 

1. Van Damme D, Madden MA, Spruit JL. Pediatric clinical guidelines update. Presented at: NAPNAP. March 10-13, 2025. Chicago, Illinois. 

2. Bonomo RA, Hemphries R, Abrahamian FM, et al. 2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Utility of Intra-abdominal Fluid Cultures in Adults, Children, and Pregnant People. 

Volume 79. Issue Supplement_3. October, 2024. doi:10.1093/cid/ciae353 

News

Pediatric Guidelines

Karen Y. Capusan, DNP, CPNP-PC, explored RSV’s shifting epidemiology, seasonal trends, and new vaccines’ role in reducing hospitalizations at the 2025 NAPNAP National Conference.

Karen Capusan, DNP, CPNP-PC, discusses the current landscape of RSV

At the 2025 NAPNAP National Conference in Chicago, Illinois, Karen Y. Capusan, DNP, CPNP-PC, of Cohen Children's Medical Center, Northwell Health, discussed the evolving epidemiology and burden of 

in her session, "Lions, Tigers and RSV Bronchiolitis: Health Care Burden, Changing Epidemiology, New Vaccines and the Future."

"[RSV] has an expected seasonality. So in the Northern Hemisphere, it’s typically late fall into early spring,” Capusan explained while noting that the COVID-19 pandemic altered this pattern. 

“In 2021, when we all started to emerge out of our bubbles from quarantine and lockdown, we started to see it emerge again in the spring, like March and April, and then peak in the summer, which we had never seen before,” said Capusan. “Then that subsequent year, 2022, it really peaked again in the summer, like July.”

Capusan noted that RSV is now trending back to pre-pandemic seasonality, but ongoing monitoring remains necessary. 

“There’s definitely a lot of literature out there about RSV infection, especially severe RSV infection, so that would mean hospitalization and subsequent wheezing in preschool children,” stated Capusan. “We can’t say there’s a causality, but there’s certainly a relationship, because a lot of studies show that after you get RSV, it seems to induce asthma-like symptoms.”

According to the CDC, RSV can become more severe after a few days of onset, leading to early symptoms such as eating or drinking less, runny nose, and coughing, which "may progress to wheezing or difficulty breathing."

Capusan highlighted the need for further research into whether reducing RSV cases could lead to fewer children developing recurrent 

, have expanded the options for protecting infants and high-risk populations.

“Nirsevimab, very exciting, also known as Beyfortus, is a monoclonal antibody. It is recommended for infants under the age of 8 months entering their first RSV season,” Capusan explained. 

While supply issues limited availability during the 2023 season, access has since improved, with vaccination rates for infants now at 46%, she stated.

“The other exciting news is that there are adult vaccines for RSV, specifically for maternal vaccination,” added Capusan. “It is recommended if you’re pregnant between 32 to 36 weeks gestation, and the efficacy is pretty good; 69% efficacy in preventing severe RSV infection in infants up to 6 months after birth.” 

Despite speculation, there is no evidence that RSV has mutated into a more virulent strain, a question Capusan has received from parents.

“They did serotypes, they typed all the strains during 2022, and all the strains we saw of RSV we have seen before, dating back from 2014 to 2019,” Capusan stated. “So no super strain there.” 

She also addressed theories suggesting co-infections could increase RSV severity. 

“They did experimental studies in human and bronchial epithelial cells and found that specifically, COVID-19 paired with RSV does not increase virulence,” she clarified. 

Understanding RSV seasonality and transmission is crucial for future pandemic preparedness. Capusan highlighted the theory of “immune debt” to explain the post-pandemic surge in RSV cases. 

“We were not immunologically challenged during COVID-19, when we were on lockdown and quarantined,” she explained. “Now we’re immunologically naive, and so when we come back to work and school, we’re more susceptible to viruses.” 

With ongoing surveillance, improved vaccination strategies, and continued research, health care providers can better manage RSV and mitigate its impact on pediatric populations. 

1. Capusan K. Lions, Tigers and RSV Bronchiolitis: Health Care Burden, Changing Epidemiology, New Vaccines and the Future. Presented at: 2025 NAPNAP National Conference. March 10-13, 2025. Chicago, Illinois.

2. RSV in infants and young children. CDC. Updated August 30, 2024. Accessed March 17, 2025. https://www.cdc.gov/rsv/infants-young-children/index.html

 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?

Invasive meningococcal disease (IMD) is a life-threatening infection caused by 

. Although IMD is relatively rare in the United States, it progresses rapidly and can lead to death or long-term complications among survivors, particularly in infants and adolescents. 

Amin Barakat, MD, FAAP, details meningococcal disease vaccines and highlights the recently FDA-approved MenABCWY vaccine from GSK.

Frances Page Glascoe

Articles

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