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Articles

"Less pain and no need for sedation are major benefits," said Jon Matthew Farber, MD, in this edition of Journal Club.

Lidocaine gel eases the pain of removing an entrapped zipper

. 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.

Videos

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

Get caught up with Contemporary Pediatrics! This list helps you navigate our top stories from the week, all in one place.

Weekly review: New delgocitinib data for eczema, FDA action items, more

 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.

FDA accepts BLA for lerodalcibep for lowering LDL-cholesterol in patients with ASCVD

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Authors

Can you diagnose this month's dermatology case? 

1-month-old boy with annular, red plaques on his scalp and face

**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

Tina Tan, MD, FAAP, FIDSA, FPIDS, discusses the severity of the current respiratory virus season and stresses the importance of vaccinations to protect against influenza, COVID-19, RSV, and more. 

Tina Tan, MD, comments on a severe respiratory season, stresses timely vaccination

Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief of 

; professor of pediatrics at Northwestern University’s Feinberg School of Medicine; infectious diseases attending at Lurie Children's Hospital of Chicago; and president of the Infectious Diseases Society of America, emphasized the importance of vaccination to combat the severity of this year’s respiratory virus season. 

“I think this respiratory season is really starting to get much more severe because we're having flu outbreaks, we're still seeing a lot of RSV and older kids hospitalized with respiratory issues. We're seeing human metapneumovirus, some COVID-19, and adenovirus. This respiratory season really is just getting much more severe right now, which is not unexpected, given the fact that we are in the midst of winter,” Tan explained. 

According to the latest data from the CDC, seasonal influenza activity remains elevated across the country and continues to rise in many areas. Additionally, COVID-19 activity remains high in several regions, while RSV activity has peaked but continues to contribute to pediatric hospitalizations.

What's more, according to the CDC, emergency department visits across ages and including adults, are "very high" and increasing across the United States, making immunization a focus point. 

“The number one thing is to make sure that the children are up to date on their vaccines," Tan said. "They need to be getting the influenza vaccine, they need to be getting the COVID vaccine. If they’re in that age group—under 8 months—they should be getting the RSV vaccine if the mother has not been vaccinated."

Current CDC reports indicate that vaccination rates for influenza and COVID-19 remain low among both children and adults. Despite the availability of effective vaccines, many children remain vulnerable to severe illness, hospitalizations, and complications from these infections, according to the federal agency. 

“If someone presents to your practice and they look like they have some type of walking pneumonia, you really need to test them, because you have to treat the mycoplasma and you have to treat the pertussis. People can spread it to other individuals, and then you can really get a lot of cases going on,” Tan stated.

One major challenge in pediatric vaccination is parental hesitation and the desire to delay or modify vaccine schedules. 

“I know people want to defer the vaccines, they want to pick their own schedule, but that's not how vaccines work. If you give vaccines on time, you're able to protect individuals and get the maximum immune response against the disease you're vaccinating against,” Tan emphasized.

Respiratory illnesses data channel. CDC. January 24, 2025. Accessed January 30, 2025. https://www.cdc.gov/respiratory-viruses/data/index.html

Tina Tan, MD, FAAP, FIDSA, FPIDS, discusses the severity of the current respiratory virus season and stresses the importance of vaccinations to protect against influenza, COVID-19, RSV, and more.

News

Nurse practitioner Donna Hallas, PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN underscores how critical simple, but factual, conversations can be with parents when it comes to pediatric care. 

Explaining health care facts with families in a world of headlines and quick news

In today's world, it is no secret parents must navigate countless headlines, misinformation, and disinformation that are scattered across the internet. With health care overall and pediatric health care in the national headlines, parents may see pieces of information related to their child's health in various forms such as reports about certain foods, vaccine information, or disinformation.

Naturally, parents will react with their children in mind to various forms of information, which can often lead to questions for the pediatric health care provider. Whether it is a quick reaction or overreaction, it can be difficult to navigate so much information in the world of social media, for example. 

Our editorial advisor board member Donna Hallas, PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN, joined us to discuss how important explaining facts to parents is, from sources such as the CDC or FDA to parents directly, so they have the most up-to-date information available, backed by their child's primary care provider. 

In the video above, Hallas—clinical professor, program director of Pediatrics NP at New York University Rory Meyers College of Nursing in New York, New York—used the recent news of the 

On January 15, 2025, the FDA banned the artificial food color in foods and ingested drugs (to be implemented January 15, 2025, and January 18, 2028, respectively) after a pair of studies demonstrated cancer in laboratory male rats that were exposed to high levels of FD&C red no. 3.

Upon reading this news, parents may be quick to search for foods in the house with this ingredient, initially thinking it could cause cancer in humans. In the ban announcement, the FDA pointed out that the way the dye causes cancer in male rats does not occur in humans, and claims that the "use of red no. 3 in food and ingested drugs puts people at risk are not supported by the available scientific information," wrote the agency.

In this example, this is where the provider can come in with a better understanding of specific news items, or, go over the data and facts with the parents directly, at the same time. It is this formula, Hallas said, that can give parents an accurate way to dissect information, all while having a health care provider offer guidance. 

"We have to look at the facts," said Hallas. "What is a reputable source, such as the CDC saying? What is the FDA saying? Not what somebody is saying on some obscure website or some social media site, which is frightening. So when the parents ask us, 'What do you think?' our response should be, 'Let's look at the evidence.'" 

This approach can also be applied to various aspects of health care, including vaccines. In a 

, Robert Frenck, MD, professor of pediatrics in the Division of Infectious Diseases and director of vaccine research at Cincinnati Children’s Hospital, noted that a clear message with parents regarding their efficacy and safety for vaccine-preventable diseases helps. He also noted that parents are coming to providers for a reason.

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

Hallas also echoes that message, saying it's important to remind parents of the alternative risks associated with not taking routine vaccines. 

"'What is the harm of not taking the vaccine?' The harm is death in some instances, and we can't know which child is going to suffer such a horrible adverse outcome... but we talk about risk-benefit with parents," said Hallas. "We say, 'Are you willing to risk your child getting very ill, being in the hospital on life support equipment, or do you want to have your child get the vaccine? It's not to say 100% that child won't get the flu [for example], that is not realistic, it'll be a much milder case as it is with other things." 

Overall, these conversations with parents, whether they are vaccine-hesitant or not sure what to make of a headline or piece of information, are crucial when it inevitably impacts the health of the child. 

"We have to remember as health care providers that people are coming to us because they trust us," said Frenck. 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'.”

1. Fitch, J. FDA bans red no. 3 in food and ingested drugs. 

. January 15, 2025. Accessed January 28, 2025. https://www.contemporarypediatrics.com/view/fda-bans-red-no-3-in-food-and-ingested-drugs

2. Fitch, J. Discussing pediatric vaccination with vaccine-hesitant parents. January 20, 2025. Accessed January 28, 2025. https://www.contemporarypediatrics.com/view/discussing-pediatric-vaccination-with-vaccine-hesitant-parents

Talking with facts in a world of headlines and quick 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?

 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. 

Sana Suhail, BS

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