Animal Allergies

Food Allergies

Allergy, Immunology, and ENT

Cardiovascular Diseases

Cardiology

Acne

Atopic Dermatitis

Dermatology

Emergency Medicine

Diabetes

Endocrinology

Formula

Nutrition

Obesity

Gastroenterology

Antibiotic Resistance

Bacterial Conjunctivitis

COVID-19

Influenza

Pneumonia

Sexually Transmitted Diseases

Vaccination and Immunization

Vaccines

Infectious Diseases

ADHD

Addiction

Antisocial Personality Disorder

Anxiety

Autism

Depression

Developmental/Behavioral Disorders

Psychiatry

Mental, Behavioral and Development Health

Concussion

Epilepsy

Headache

Neurology

Neonatal/Perinatology

OB/GYN

Pain

Drug Pipeline News

Pharmacology

Telemedicine

Practice Improvement

Asthma

Cystic Fibrosis

Respiratory

Rheumatology

News 

All News

PNP Corner

AAP News

Media

Around the Practice

Cure Connections

Expert Interviews

Insights

Medical World News

Peer Exchange

Peers & Perspectives

Podcasts

Webinars

Puzzler

Publications

Contemporary Pediatrics Journal

Supplements And Featured Publications

CME/CE

Resources

Handouts

Job Board

Conferences

Conference Coverage

Conference Listing

Partnerships

Subscribe

Editorial

Editorial Advisory Board

Writer’s Guidelines

Reference Guidelines

Meet the Editors

Articles

A recap of the FDA submissions and regulatory decisions in pediatrics from January 2025.

FDA news in pediatrics: January 2025

"I’m all for reducing opioids, especially in neonates, for whom we are unsure of long-term adverse effects," stated Jon Matthew Farber, MD.

IV acetaminophen with opioids in EA/TEF repair has advantages and disadvantages

. 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.

The primary and all key secondary endpoints were met compared to cream vehicle in the phase 3 DELTA TEEN trial. 

Phase 3: Delgocitinib improves chronic hand eczema in adolescents

Application submission is based on positive phase 3 data that demonstrated improvement in patients with type 2 and 3 SMA receiving current standard of care.

Apitegromab BLA submitted to FDA for spinal muscular atrophy

About Us

Advertise

Contact Us

Terms and Conditions

Privacy

Do Not Sell My Personal Information

Contemporary Pediatrics

Facebook

LinkedIn

Instagram

Clinical

Gynecology

Infectious disease

Mental Health

Oncology

Rheumatoid Arthritis

Sexual Health

View More

1rem

Authors

Dr Still is a pediatric resident, University of Nevada School of Medicine, Las Vegas.

**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

The Centers for Disease Control and Prevention (CDC) has released its latest findings in the "Youth Risk Behavior Survey Data Summary & Trends Report for Dietary, Physical Activity, and Sleep Behaviors: 2013–2023." This comprehensive report sheds light on the dietary habits of high school students across the United States, revealing concerning trends that could have long-term implications for adolescent health.

Over the past decade, the data indicates a significant decline in healthy dietary behaviors among high school students. The report highlights a decrease in the percentage of students consuming fruits, vegetables, and breakfast daily.

Specifically, the percentage of students eating fruits daily has shown a slight increase from 2021 to 2023, but overall, the long-term trend from 2013 to 2023 indicates a decline in healthy eating habits. In 2023, only about 1 in 5 female students reported eating breakfast daily, and just over half of the students consumed fruits and vegetables daily.

The report emphasizes that a balanced diet not only contributes to physical health but also plays a vital role in cognitive function and academic performance. 

The survey data, collected biennially from a nationally representative sample of U.S. high school students, reveals that only about 20% of female students were physically active for at least 60 minutes daily, and only about 25% attended physical education classes daily. These figures are concerning, especially when considering the link between physical activity and healthy eating.

In addition to fruit and vegetable intake, the report also addresses breakfast consumption, which is critical for kickstarting metabolism and enhancing concentration throughout the school day. The percentage of students who eat breakfast daily has also declined, raising concerns about the potential impact on academic performance and overall health. 

Overall, the CDC noted that daily fruit and vegetable consumption, as well as daily breakfast, were trending in the wrong direction, detailed with a red mark, from 2013-2023. 

In 2023, less than a third of high school students did not drink soda and less than half of students did not drink sports drinks. In the same year, 54$ of high schoolers drank plain water at least 3 times per day, with male students being more likely to do so. 

In 2023, 31% of high school students did not drink soda during the past 7 days. 

The findings from the CDC report underscore the importance of implementing effective strategies to improve dietary behaviors among adolescents. Schools play a pivotal role in this effort, as they can provide access to healthy meals and nutrition education. The report advocates for policies that promote healthy school meals and encourage students to make better food choices. 

Looking ahead, the CDC emphasizes the need for collaborative efforts among educators, parents, and community organizations to foster an environment that supports healthy eating.

Youth risk behavior survey data summary & trends report for dietary, physical activity, and sleep behaviors: 2013-2023. CDC. January 14, 2025. Accessed January 14, 2025. https://www.cdc.gov/yrbs/dstr/pdf/DSTR-Dietary-PhysicalActivity-SleepBehavior2013-2023-508.pdf?ACSTrackingID=DM143930&ACSTrackingLabel=New%20CDC%20Report%20on%20Student%20Dietary%2C%20Physical%20Activity%2C%20and%20Sleep%20Behaviors%20Released!%20-%20Healthy%20Schools&deliveryName=DM143930

According to the report, several key dietary behaviors such as daily fruit or vegetable intake among high school students were trending in the wrong direction. 

CDC releases youth risk dietary behavior report from 2013-2023

Finding drivers of and barriers to counseling for pediatric patients with obesity and high blood pressure (BP) to reduce inequities of care are needed, after new research revealed racial and ethnic disparities exist.

These observations were observed in a secondary analysis study published in 

when it came to the receipt of nutrition, lifestyle, and weight counseling among pediatric patients with high BP. 

It is known that pediatric obesity and hypertension are highly correlated, state the study investigators, who were led by Moonseong Heo, PhD, of the Department of Public Health Sciences, College of Social, Behavioral and Public Health Sciences, Clemson University, Clemson, South Carolina.

"Childhood obesity is prevalent, often originates early in life, and disproportionately affects children from racial and ethnic minority groups and disadvantaged backgrounds," wrote Heo and colleagues. 

"Obesity-related health consequences encompass a broad range of comorbidities, including high BP, elevated cholesterol levels, type 2 diabetes, asthma, sleep apnea, joint problems, and mental health concerns. Despite such undesirable consequences, the CDC reported that the prevalence of pediatric obesity has remained persistently high at 19.7% (ie, 1 in 5; n = 14.7 million) among children and adolescents aged 2 to 19 years in the US from 2017 to 2020."

The American Academy of Pediatrics' (AAP) evidence-based Clinical Practice Guidelines recommend interventions for behavior modification, including counsel on weight, lifestyle, and nutrition amid pediatric primary care visits. These 3 areas are "of critical importance to mitigating weight and high BP problems in children and adolescents."

However, despite direct guidance and recommendation from the AAP, racial and ethnic disparities persist in the prevalence of hypertension and obesity among pediatric patients, noted the authors.

"The present study aimed to examine and compare rates of receiving nutrition, lifestyle, and weight counseling during primary care visits in a pediatric population with at least 1 high BP measurement," said the authors. "Stratified analyses by race and ethnicity and weight groups were conducted using baseline data collected from the Boosting Primary Care Awareness and Treatment of Hypertension (BP-CATCH) quality improvement collaborative (QIC) study, which enrolled pediatric practices across the US."

In a post hoc secondary analysis design, urban, suburban, and rural pediatric primary care practices across the United States—compete with a team of at least 1 physician, 1 nurse and another practice associate, as well as a hypertension specialist—submitted baseline data from clinical encounters. These practices identified the first 17 eligible patients with high BP measurements each month.

With exposures including race and ethnicity and weight status (with or without) obesity, the primary outcome of the secondary analysis was receipt of counseling on nutrition, lifestyle, and weight during primary care visits.

In all, there were 2677 patients from 59 practices included in the analysis with a mean age of 10.8 (5.2) years, and of which 56.6% were male. A total of 593 patients were Black, 414 were Hispanic, 1111 were White, and 559 were "other race and ethnicity." 

The overall crude unadjusted rates of receiving counseling were:

63.5% (n = 1564 of 2463) for nutrition

57.6% (n = 1419 of 2462) for lifestyle

46.4% (n = 1142 of 2461) for all counseling topics 

Hispanic participants, compared with the other 3 groups, received significantly higher adjusted rates of nutrition (78.6%; 95% CI, 73.5%-83.8%), lifestyle (69.3%; 95% CI, 63.6%-74.9%), and all 3 (52.1%; 95% CI, 46.1%-58.2%) counseling topics, according to study results.

When it came to rates of receiving weight counseling, there were no significant differences in between any pairs of groups. Findings were similar in general among those without obesity. The study investigators noted no significant pairwise differences were found among patients with obesity, except that "nutrition counseling rates were significantly different between White participants and those reporting other race and ethnicity (68.3% [95% CI, 61.1%-75.4%] vs 81.6% [95% CI, 74.2%-89.1%]; Bonferroni-corrected 

In children with high BP measurements, there were significant racial and ethnic disparities in receiving nutrition, lifestyle, and all 3 counseling topics, this post hoc analysis found.

"More effort may need to be invested into developing QI or other interventions to promote all topics of recommended counseling, perhaps more intensively among children with obesity, and to attenuate racial and ethnic disparities in pediatric primary care settings," the study authors concluded.

"Our study also suggests that quality metrics should be stratified by demographic categories to highlight disparities and prevent worsening of inequities as efforts continue to improve and standardize care for all children."

Heo M, Rea CJ, Brady TM, et al. Racial and Ethnic Disparities in Pediatric Counseling on Nutrition, Lifestyle, and Weight: A Secondary Analysis of the BP-CATCH Randomized Clinical Trial. 

 2025;8(1):e2456238. doi:10.1001/jamanetworkopen.2024.56238 

According to a new study, racial and ethnic disparities were evident when counseling on nutrition, lifestyle, and weight among children with high blood pressure measurements. 

Racial, ethnic disparities exist when counseling on nutrition, lifestyle, and weight

 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.

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

Gordon Gray Still, MD

Articles

Latest Updated Articles