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

Mike Hennessy Jr, President and CEO of MJH Life Sciences kicks off our March Mental Health issue with a look into the ongoing pediatric mental health crisis. 

The pediatric mental health crisis: A call to action for pediatricians

. 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.

First approved for PNH in 2007, the monoclonal antibody is now the first and only treatment for pediatric patients living with gMG. 

FDA expands use of eculizumab to patients 6 years and up with generalized myasthenia gravis

On World Obesity Day, take this short quiz and test your knowledge of the AAP's clinical practice guideline to evaluate and treat children and adolescents with obesity.

Clinician quiz: AAP clinical practice guideline for treatment of children with obesity

Results will be included an a final analysis of safety and efficacy data for CTx-1301, which will be included in a NDA submission with the FDA, stated Cingulate Inc. 

Cingulate reports phase 3 safety data for CTx-1301 to treat ADHD in children, adolescents

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

A 19-year-old male presents to the emergency department (ED) with headache and fever of 4 days’ duration. Six days earlier, his left palm had been punctured by a rusty nail. What's the diagnosis?

Muscle spasms in a 19-year-old male

**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

The Youth Risk Behavior Survey (YRBS) Data Summary & Trends Report for Dietary, Physical Activity, and Sleep Behaviors: 2013–2023, developed by the CDC, provides a comprehensive overview of sleep behaviors among US high school students. The report is part of a broader examination of adolescent health, which 

The findings regarding sleep behaviors highlight a trend of inadequate sleep among adolescents, which can have significant implications for their overall health and academic performance. 

The report revealed that a substantial percentage of high school students are not getting the recommended amount of sleep. Specifically, the CDC recommended that adolescents aim for at least 8 hours of sleep on an average school night.

However, data from the YRBS indicated that only 23% of students reported achieving this guideline in 2023. That figure reflects a stagnation in sleep duration, as it has remained relatively unchanged over the past decade, with only slight fluctuations observed in the two-year comparisons.

Disparities in sleep behaviors are also evident in the data. In 2013, 35% of males got at least 8 hours of sleep on an average school night compared to 25% in 2023. The trend also decreased across the decade for females, as 29% reported 8 hours of sleep in 2013 compared to 22% in 2023. 

The lack of sufficient sleep among adolescents is a growing concern, as it is linked to various negative health outcomes, including increased risk of obesity, mental health issues, and impaired cognitive function. The report emphasizes that inadequate sleep can hinder students' ability to concentrate, perform academically, and engage in physical activities, further compounding the challenges they face in maintaining a healthy lifestyle.

Racial and ethnic disparities are also present in sleep behaviors. The report showed that students from various racial and ethnic backgrounds experience different levels of sleep adequacy. For instance, Black (19%) and Hispanic (24%) students reported lower percentages of achieving the recommended sleep duration compared to their White peers (25%) in 2023.

The report also examined the impact of external factors on sleep behaviors. The COVID-19 pandemic significantly altered students' daily routines, including sleep patterns. Many students experienced disruptions in their sleep schedules because of remote learning, increased screen time, and changes in social interactions. As schools returned to in-person learning, some students may have found it challenging to readjust their sleep habits, which contributed to ongoing issues with sleep adequacy.

Despite the concerning trends in sleep behaviors, the report underscores the importance of promoting healthy sleep habits among adolescents. Schools and communities can play a vital role in fostering environments that prioritize sleep health. Initiatives such as education on the importance of sleep, encouraging consistent sleep schedules, and reducing the stigma around mental health can help students recognize the value of adequate sleep. 

In conclusion, the YRBS Data Summary & Trends Report reveals a troubling picture of sleep behaviors among US high school students, with a significant portion of adolescents failing to meet the recommended sleep guidelines.

Click here to view highlights from the CDC's youth risk report of dietary behavior from 2013-2023.

Click here to view highlights from the CDC's youth risk report for physical activity behavior.

Youth risk behavior survey data summary & trends report for dietary, physical activity, and sleep behaviors: 2013-2023. CDC. January 14, 2025. Accessed January 16, 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

A CDC report shows only 23% of U.S. teens get enough sleep, with disparities highlighting the need for targeted health interventions.

News

 CDC: Most US teens fail to get recommended 8 hours of sleep, report finds

According to a research letter published in 

, nearly 80% of infants who were born amid the 2023 to 2024 respiratory syncytial virus (RSV) in a specific health care system received RSV protection with nirsevimab (Beyfortus; Sanofi and AstraZeneca) or the maternal RSV vaccine RSVpreF (ABRYSVO; Pfizer).

Those measures to protect against the respiratory virus were approved in 2023 by the FDA. Nirsevimab, a monoclonal antibody, is approved to prevent RSV lower respiratory tract disease (LRTD) in neonates and infants entering, or born during their first RSV season aged younger than 8 months, or up to 24 months of age that remain vulnerable to severe RSV through their second season.

RSVpreF is approved for pregnant persons at 32 to 36 weeks' gestation.

Investigators sought to determine RSVpreF and nirsevimab uptake at Kaiser Permanente Northern California (KPNC), an integrated health care delivery organization during the early period of availability.

"Uptake of maternal vaccines against respiratory pathogens is lower among younger individuals and Black or Hispanic individuals," wrote the research letter authors. "We investigated uptake of RSVpreF and nirsevimab and sociodemographic factors associated with uptake within KPNC during the early period of availability."

The data-only study used electronic medial record data from infants born to mothers aged 15 to 49 years at KPNC from October 17, 2023 to March 31, 2024. Nirsevimab was available as of October 17, 2023, while RSVprF became available on October 25, 2023.

The investigative team calculated the percentage of infants who received nirsevimab, those born to mothers exposed to RSVpreF, infants exposed to both, and infants exposed to neither protection method.

"We compared maternal characteristics, including race and ethnicity (Asian, Black, Hispanic, White, and other [eg, American Indian or Alaska Native, Native Hawaiian or Pacific Islander]), age, parity, neighborhood deprivation index, insurance type, and prenatal visit frequency, among infants in different categories using χ

 and Kruskal-Wallis tests," the letter stated.

values were 2-sided with statistical significance set at 

In all, 17,251 infants (51.4% male) were included in the analysis. Of these, 77.5% received protection from either RSVpreF or nirsevimab. There were 5855 (33.9%) infants who were only exposed to the maternal vaccine, with a median gestational age of 34 weeks (32.6-36.0). Median time from RSVpreF to delivery was 34 days.1 

Of the 13,366 infants who received protection, 40.9% received only nirsevimab, while 460 (2.7%) were exposed to both protection methods. Of these infants, 143 (31.1%) were born preterm and 111 or 24.1% were admitted to the NICU.

A majority of infants (74.5%) who were born October to November received nirsevimab. More than half (52.3%) of infants born January to March were exposed to the maternal vaccine.

"Uptake of RSVpreF and nirsevimab differed by maternal age and race. Infants of mothers aged younger than 25 years were less likely than infants of mothers aged 35 years or older to be exposed to only RSVpreF (26.4% [95% CI, 24.3%-28.4%] vs 37.9% [95% CI, 36.5%-39.4%]), but more likely to receive only nirsevimab (44.2% [95% CI, 41.9%-46.5%] vs 40.1% [95% CI, 38.6%-41.5%])," according to study results.

Nirsevimab and/or RSVpreF exposure was highest among infants born to Asian mothers (86.7% [95% CI, 85.7%-87.7%]) and lowest among infants of Black mothers (70.2% [95% CI, 67.3%-72.9%]).

"However," the authors noted, "the proportion receiving only nirsevimab was similar among infants of Black (42.3% [95% CI, 39.2%-45.4%]) and Asian (42.7% [95% CI, 41.2%-44.1%]) mothers and lower in infants of White mothers (36.6% [95% CI, 35.3%-37.9%])."

A limitation of the study was a population that was insured and may not be generalizable. Overall, the availability of 2 different RSV protection methods could have contributed to an increased proportion of infants protected from the respiratory disease, which "may help mitigate disparities."

1. Jacobson KB, Watson AJ, Merchant M, Fireman B, Zerbo O, Klein NP. Uptake of Maternal RSV Vaccination and Infant Nirsevimab Among Infants Born October 2023 to March 2024. 

 2025;8(1):e2453696. doi:10.1001/jamanetworkopen.2024.53696

2. Fitch, J. Nirsevimab-alip FDA approved to prevent RSV in neonates, infants. 

. July 17, 2023. Accessed January 8, 2025. https://www.contemporarypediatrics.com/view/nirsevimab-alip-fda-approved-to-prevent-rsv-in-neonates-infants

The study within a single health care system revealed that most infants born prior to December received the nirsevimab monoclonal antibody. 

Study: Nearly 80% of infants born in 2023-24 RSV season received RSV protection

Vaccine doses provided to children outside of the CDC's Advisory Committee on Immunization Practices' (ACIP) recommendations for minimum and maximum ages of vaccination and minimum intervals are considered invalid. According to new research published in 

, invalid vaccine doses have decreased over time, however many children with an invalid dose lack full vaccination series completion.

With the objective to quantify the prevalence of and factors associated with invalid doses among children aged 0 to 35 months in the United States, the study authors analyzed provider-verified vaccination records from the nationally representative 2011–2020 National Immunization Survey–Child.

"We quantified the number of children with at least 1 invalid vaccine dose overall, by survey year, and by vaccine type," stated the investigators, led by Alexandria N. Albers, MPH, MS, of the Center for Population Health Research, University of Montana and the School of Public and Community Health Sciences, Missoula, Montana.


"Among children who received vaccine doses before the minimum age or minimum dose interval, we quantified the prevalence of receiving extra doses such that series were completed with the recommended number of valid doses," stated Albers and authors.

The investigators included all 10 recommended vaccination series during the study period, which included:

Diphtheria, tetanus, acellular pertussis 

RELATED: Kindergarten vaccine coverage decreased, exemptions increased in 2023-2024 school year

"ACIP guidelines allow for a 4-day grace period, which we incorporated in our analyses," said Albers in a featured video on the 

"We reviewed current and historical ACIP schedules, and for each vaccine dose, we determined the minimum recommended age in days for vaccination and the minimum interval between doses for multi-dose series." 

The investigative team used logistic regression models to identify factors associated with the receipt of an invalid vaccination.

Of the 161,187 children in the survey, 22,209 (weighted percent for US children: 15.4%, 95% CI, 15.0%–15.8%) received an invalid vaccine dose. Of those with a minimum age or minimum interval invalid dose, 44.9% (95% CI, 43.2%–46.6%) received extra doses and completed the series.

The 3-dose rotavirus had the highest prevalence of invalid doses (n = 5733; 4.4%), with the first dose being administered after the maximum age (n = 3996; 3.1%), according to study results.

"Receiving the third dose of the 3-dose Hib series too soon was another top reason for invalid doses," said Albers in the 

 video. "However, 84% of children with an invalid Hib dose also had a repeat valid vaccination to essentially correct the invalid Hib dose."

Results demonstrated that factors associated with at least 1 invalid vaccination dose were if the child had 3 or more vaccination providers compared to 1 provider (aOR: 1.5, 95% CI, 1.2-1.8), or if they moved across state lines compared to children who did not move (aOR: 1.5, 95% CI, 1.4-1.6).

Of those with a minimum age or minimum interval vaccine dose, 44.9% ended up receiving extra doses to complete a vaccination series.

Hanna S. Sahhar, MD, FAAP, FACOP

Articles

Latest Updated Articles