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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

In this discussion, leading experts weigh in on the importance of scientific integrity, proactive advocacy, and the crucial role of vaccinations in pediatric health. 

Experts: Now is the time to be the biggest child health care advocate

 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.

Shriners Children’s Boston warns patients and their parents about frostbite risks, offering tips on prevention, signs, and treatment to keep kids safe in extreme cold.

Educating your patients about the dangers of frostbite

Cyclo Therapeutics has enrolled 10 patients in a single-arm sub-study treating newborns to 3 years of age, evaluating the Trappsol Cyclo in the youngest subsets. 

Positive data reported for Trappsol Cyclo in patients 3 years and under with NPC1

A look into nutrition's role in acne care, highlighted by Colleen Sloan, PA-C, RDN.

Debunking myths about diet and acne

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Supplemental oxygen can be delivered safely to patients in their home. Here experts discuss the indications for oxygen therapy, the amount needed, and the interface for delivery.

Oxygen delivery in the home setting

**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

Acne is a common yet frustrating condition that affects nearly 85% of teenagers, often affecting their self-esteem and mental health.

 Acne is influenced by a combination of internal and external factors, including genetics, hormones, lifestyle, and potentially diet. As pediatric providers, we frequently prescribe topical treatments, but how often do we discuss nutrition as a potential pillar of treatment? With the rise of social media platforms such as TikTok offering quick access to a wide array of opinions, misinformation and confusion abound. This article unpacks common acne/diet claims and examines the research behind them.

The relationship between dairy and acne is controversial due to limited and poor-quality studies. Findings from observational studies suggest a correlation, particularly with skim milk, potentially due to hormones such as insulinlike growth factor 1 (IGF-1) and bioactive molecules in milk that may exacerbate sebum production and inflammation.

 However, causation remains unproven, and randomized controlled trials are lacking. 


Encourage teenagers to monitor their skin’s response to different types of dairy rather than eliminate it entirely. Suggest they keep a food and skin log to identify any patterns. For those who choose to adopt a dairy-free diet, emphasize maintaining adequate calcium and vitamin D intake through foods such as beans, soy milk, eggs, salmon, sardines, figs, and leafy green vegetables.

 Reducing high glycemic foods will improve acne.

The glycemic index (GI) ranks carbohydrate-containing foods on a scale of 1 to 100 based on how quickly they are digested and increase blood glucose levels. Evidence increasingly suggests that high-GI foods can worsen acne. Foods such as white bread, sugary cereals, and sweetened beverages cause rapid spikes in blood sugar and insulin, potentially triggering elevated IGF-1 production and androgen activity. Findings from clinical trials have linked high-GI diets to poor glycemic control, elevated postprandial insulin levels, and increased IGF-1 concentrations.

 Conversely, low-GI diets rich in whole grains, vegetables, and lean proteins have been shown to improve acne severity in findings from several studies.

However, it’s essential not to recommend a low-GI diet indiscriminately to all patients. An important distinction must be made between GI and glycemic load (GL). Although GI measures how much a specific food increases blood sugar level, GL considers both the quantity of carbohydrates in a serving and its overall impact on blood sugar levels. GI alone does not reflect how prolonged or significant a blood sugar rise will be after consuming a particular amount of food. GL provides a more accurate representation of a food’s real-life effect on postprandial glycemia. For instance, watermelon has a high GI of 74 but a low GL of just 4 per 100-g serving due to its low carbohydrate content.

Despite conflicting research in this area, having your patient focus on more complex carbohydrates that contain fiber rather than simple carbohydrates and sugary snacks will prove beneficial for their overall health and possibly their skin. Take caution in the words you use to avoid fear or excessive carbohydrate restriction in this population.

The link between chocolate and acne is complex. Pure cocoa may not trigger acne, but the sugar and dairy in milk chocolate might play a role.

 Findings from small studies suggest chocolate consumption may increase inflammatory markers in the skin, but larger studies are needed for definitive conclusions.

Encourage moderation rather than elimination. Teenagers can enjoy chocolate occasionally without exacerbating acne, especially if they choose dark chocolate with minimal added sugar. Discuss the importance of overall dietary patterns rather than singling out specific foods.


Although greasy foods are unlikely to directly cause acne, diets high in unhealthy fats, such as trans and saturated fats, may promote inflammation.

 Acne is an inflammatory condition, so a pro-inflammatory diet could exacerbate it. Conversely, healthy fats from sources such as avocados, nuts, and fatty fish may support skin health.


Focus on promoting anti-inflammatory foods rather than avoiding fried foods entirely. Suggest simple swaps such as roasted vegetables instead of fries or grilled chicken instead of fried options.

Addressing diet and acne with teenagers requires sensitivity and a focus on empowerment. The best dietary approach is to address each patient with acne individually, carefully considering the possibility of dietary counseling. Here are some strategies to make dietary guidance effective and relatable:

 Teenagers are already navigating a complex relationship with food and body image and are faced with a constant stream of information and sales tactics. Avoid framing acne as a punishment for poor eating habits. Instead, highlight the benefits of nutrient-rich foods for overall health and well-being.

 Suggest 1 or 2 manageable changes rather than a complete dietary overhaul. For example, recommend swapping sugary drinks for water or eating a handful of nuts as a snack.

 Encourage teenagers to add more fruits, vegetables, and whole grains rather than focusing on foods to avoid. This positive framing can make dietary changes feel less daunting.

Educating teenagers about the nuanced relationship between diet and acne empowers them to make informed choices without falling prey to exaggerated claims or restrictive regimens. With your guidance, teenagers can adopt a compassionate, realistic approach to managing their skin health, one that integrates lifestyle modifications, evidence-based dietary adjustments, and medical treatments. By doing so, you not only address acne but also help shape their relationship with their body and food—an outcome far more important than the state of their skin alone.

1. Gallitano SM, Berson DS. How acne bumps cause the blues: the influence of acne vulgaris on self-esteem. 

. 2017;4(1):12-17. doi:10.1016/j.ijwd.2017.10.004

2. Meixiong J, Ricco C, Vasavda C, Ho BK. Diet and acne: a systematic review. 

. 2022;7:95-112. doi:10.1016/j.jdin.2022.02.012

3. Calcium. National Institutes of Health Office of Dietary Supplements. Updated July 24, 2024. Accessed December 20, 2024. https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

4. Vlachos D, Malisova S, Lindberg FA, Karaniki G. Glycemic index (GI) or glycemic load (GL) and dietary interventions for optimizing postprandial hyperglycemia in patients with T2 diabetes: a review. 

. 2020;12(6):1561. doi:10.3390/nu12061561

5. Baldwin H, Tan J. Effects of diet on acne and its response to treatment. 

. 2021;22(1):55-65. doi:10.1007/s40257-020-00542-y

6. Caperton C, Block S, Viera M, Keri J, Berman B. Double-blind, placebo-controlled study assessing the effect of chocolate consumption in subjects with a history of acne vulgaris. 

News

 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?

Navigating the ever-evolving landscape of pediatric care means staying ahead of clinical developments, regulatory shifts, and therapeutic breakthroughs—each with the potential to reshape how we support children’s health. In the January 2025 FDA update from Contemporary Pediatrics, we highlight decisions that reflect both the complexity and promise of modern pediatrics, including new drug submissions, a pivotal ban on red No. 3 in food and ingested drugs, and an expanded clearance for a familiar face.

Dive into the details in our monthly FDA recap, and stay connected with Contemporary Pediatrics through 

 for insights that help you meet the challenges of today—and tomorrow.

FDA Updates in Pediatric Care: January 2025

PDUFA date set for neffy 1 mg for children who weigh 33 lbs or more

On January 13, 2025, ARS Pharmaceuticals announced the submission of a supplemental New Drug Application to the FDA for a 1 mg dose of neffy (epinephrine nasal spray) for pediatric patients weighing 33 to 66 lbs. Based on pharmacokinetic studies demonstrating comparable epinephrine exposure to intramuscular injections, this expansion follows neffy’s initial FDA approval in August 2024 for patients over 66 lbs. The FDA has set a PDUFA target action date of March 6, 2025, with potential product availability in the second quarter of 2025.

FDA bans red no. 3 in food and ingested drugs

On January 15, 2025, the FDA announced the revocation of authorization for FD&C Red No. 3 in food and ingested drugs under the Delaney Clause of the FD&C Act. Based on a 2022 petition citing studies linking the dye to cancer in male rats, manufacturers must reformulate food products by January 15, 2027, and ingested drugs by January 18, 2029. While the FDA maintains that available scientific data do not support human risk, concerns remain regarding potential behavioral effects in children.

FDA expands immobilized lipase cartridge clearance down to 1 year

On January 15, 2025, Alcresta Therapeutics announced the FDA’s expanded clearance of the immobilized lipase cartridge (Relizorb) for use in children as young as 1 year old. Based on a retrospective evaluation of real-world data, the decision confirms no additional safety concerns in this younger population. This clearance marks another milestone for enterally fed patients with fat malabsorption, further broadening access to essential nutritional support.

FDA accepts sNDA for higher regimen nusinersen for spinal muscular atrophy

On January 23, 2025, Biogen announced the FDA's acceptance of a supplemental New Drug Application for a higher dose regimen of nusinersen (Spinraza) for spinal muscular atrophy (SMA). Based on data from the phase 2/3 DEVOTE study, the higher dose demonstrated significant improvements in motor function compared to historical controls, with a safety profile consistent with the currently approved 12 mg regimen. If approved, the new regimen could enhance treatment efficacy for SMA patients across all disease types.

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

Parisa Kaviany, MD

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