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Colleen Sloan, PA-C, RDN is a board-certified PA and registered dietitian. 

Articles

Colleen Sloan, PA-C, RDN, highlights the connection between poor dietary patterns and mental health challenges in children, and offers nutrient-focused solutions.

Diet, mental health, and pediatric nutrition, with Colleen Sloan, PA-C, RDN

. 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.

 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.

Federal health agencies have adjusted COVID vaccine guidance, potentially changing eligibility and access for pediatric patients. Experts respond in this article. 

Expert reactions to new COVID-19 vaccine policies

Victor Carrion, MD, director of the Stanford Early Life Stress Research Program and professor of child and adolescent psychiatry at Stanford University. 

Victor Carrion, MD, explains how providers can recognize the signs of accumulated stress in children and support recovery through education and connection.

Understanding childhood trauma, with Victor Carrion, MD

New phase 3b durability data revealed nirsevimab reduced RSV hospitalizations in infants by 82.7% through 180 days vs no intervention. 

Nirsevimab demonstrates sustained efficacy in reducing RSV hospitalizations through 6 months

Contemporary Pediatrics connects pediatricians with peer-reviewed articles, guideline updates, and practice strategies for real-world clinical application.

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The incidence of childhood melanoma is increasing. There is evidence that cumulative exposure to ultraviolet radiation from the sun in the first 18 years of life contributes to the development of future skin cancers.

Ultraviolet radiation exposure and melanoma

**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, March 26, 2025 at 12:00 PM ET or later for the full case presentation, differential diagnoses, and the correct patient diagnosis. The full case will be presented as a separate article on our home page.

This case was presented by Ngozi I. Eboh, MD, FAAP, FHM, Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, Texas

A 13-year-old female with a history of iron deficiency anemia presented with altered mental status preceded by 5 days of headache, vomiting, nausea, and worsening somnolence that was not responsive to flumazenil, naloxone, or ammonia salts. She had a Glasgow coma scale of 12 and was drowsy with no cranial nerve deficits, or other abnormal physical examination findings. Laboratory evaluation showed microcytic anemia (hemoglobin 7.7 g/dL and MCV (mean corpuscular volume):64.7, lymphocytosis, and mildly elevated liver enzymes [Aspartate Aminotransferase (AST) 52, Alanine Transaminase (ALT) 110] otherwise her electrolytes and kidney function were normal. 

Urine toxicology, Tylenol level, Salicylate level, alcohol level thyroid studies, iron studies, hepatitis panel were normal. Urine pregnancy and COVID tests were negative. Head computed tomography (Head CT) showed mild hydrocephalus, and brain magnetic resonance imaging (MRI) showed increased signal folia and compression of the lower portion of the fourth ventricle and foramen of Magendie. 

She then had an emergency external ventricular drain placed (EVD) by pediatric neurosurgery, and the team started her on high-dose steroids and intravenous immunoglobulin (IVIG). On the third day of admission, she developed new onset left-sided facial drooping, drooling, downbeat nystagmus, and difficulty following commands. An emergent subcortical craniectomy and decompression, duraplasty, and cerebellar biopsy were performed. A cerebellar biopsy was performed due to findings on brain MRI.

Click here for the full case presentation, differential diagnoses, and the correct patient diagnosis.

Can you diagnose this patient? Take our poll and find out! Then check back for the full case, differential diagnosis, and correct diagnosis. 

News

Case Studies

Poll: Can you diagnose this 13-year-old female with altered mental status?

Then, visit our website on Wednesday, May 7, 2025 at 12:00 PM Eastern Time or later for the full case presentation, differential diagnoses, and correct patient diagnosis.

This case was provided by Akash Deswaney, MD, Neil Copeland, MD, and John Bishara, DO.

An 18-day-old female presented to the ED with concerns of apnea, cyanosis, and decreased feeding. The mother reported intermittent cyanosis of the lips, pale-appearing skin, and suspected apnea episodes. Since birth, Mom states patients had retractions since birth, which the PCP reassured her was normal periodic breathing. She had nasal flaring and grunting a couple of days after discharge from the nursery. Mom has noticed she breathes quickly, in the 60s or 70s at times.

Initial vitals in the ED showed hypoxemia, tachypnea, and fluctuating oxygen saturations were between 65-100% on room air. A chest X-ray is shown (

Click here for the full case presentation, differential diagnoses, and correct patient diagnosis.

Diagnose this 18-day-old female with apnea, cyanosis, decreased feeding concerns

 on Monday, March 24, 2025 at 12:00 PM ET or later for the full case presentation, differential diagnoses, and the correct patient diagnosis. 

This case was provided by Muhammad Aamir Anees and Bernard A. Cohen, MD

Want more puzzler and dermatology cases? 

A healthy 9-year-old girl developed an asymptomatic eruption of discrete and confluent, 2 to 3 mm, hypopigmented papules in a linear pattern along the lines of Blaschko on the back of her left thigh and leg over the past 3 weeks. The lesions cleared without treatment 4 to 5 months later. 

Inflammatory linear verrucous epidermal nevus

on Monday, March 24, 2025 at 12:00 PM ET or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

Take your best guess and try to diagnose this 9-year-old girl's linear eruption on the back of her left thigh and leg. Stay tuned for the full case presentation and correct diagnosis! 

Poll: What's the diagnosis of this linear eruption on the leg of a 9-year-old girl?

Tina Tan, MD, discusses impact of FDA's stricter COVID-19 vaccine policy for children

On May 20, 2025, the FDA announced a new COVID-19 vaccination regulatory framework for future seasonal vaccines and additional clinical trial requirements for approval of vaccines intended for healthy individuals. According to the framework, published in the 

), the FDA will use a immunogenicity basis to make favorable benefit-risk findings for adults older than 65, and for all persons aged 6 months and older with at least one risk factor that increases risk for severe COVID-19 outcomes.

"Unfortunately, that basically does eliminate access of vaccination to the majority of the pediatric population," said Tina Tan, MD, FIDSA, FPIDS, FAAP, editor in chief, 

; president, Infectious Diseases Society of America (IDSA). Tan is also the Infectious Diseases attending at Ann & Robert H. Lurie Children's Hospital of Chicago, and professor of Pediatrics Northwestern University's Feinberg School of Medicine.

"COVID-19 is a disease that occurs in children, even though there is all this misinformation out there that COVID-19 doesn't cause infection in children, but it does cause infection in children. Some kids can actually get quite sick with it, and they can develop long-COVID symptoms," added Tan. "This is really just not addressing the public health issue that this particular organism can cause in the pediatric population."

 publication, authored by Martin Makary, MD, MPH, commissioner of the FDA, and Vinay Prasad, MD, MPH, director of the FDA's Center for Biologics Evaluation and Research, stated that for healthy individuals aged 6 months to 64 years, with no risk factors for severe COVID-19, the FDA "anticipates the need for randomized, controlled trial data evaluating clinical outcomes," before biologic license applications for the vaccines can be approved. 

For those in high-risk group categories, the FDA will "encourage manufacturers to conduct randomized, controlled trials in the population of healthy adults as part of their post-marketing commitment," stated Makary and Prasad in the publication. 

This approach differs from the creation of the previous COVID-19 vaccines, and, according to Tan, could impact availability of approved vaccines. Given available safety and efficacy data for previous COVID-19 vaccines, Tan said clinical trials are not warranted. 

"[The trials could] be a major factor in delaying whether or not individuals are going to be able to receive the vaccine, and that that is not how this should be done, because we know these vaccines work," said Tan. "The vaccines are being reformulated every year to take into account the circulating sub serotypes. We know the vaccines work, we know the vaccines are safe. To do [this is] really going to delay availability."

May 19, 2025, the FDA approved the NVX-CoV2705

 (Nuvaxovid; Novavax) COVID-19 vaccine. The framework announced by the FDA mirrors the restrictions seen in the approval of NVX-CoV2705, as the recombinant protein-based vaccine is indicated only for those aged 12 to 64 years with at least one underlying health condition that puts individuals at increased risk for severe COVID-19 outcomes. Underlying conditions such as cancer, asthma, diabetes, obesity, or smoking were used as examples in a company press release of the approval announcement.

"If [that restriction isn't removed], then healthy individuals are not going to be able to receive the vaccine this fall," said Tan of the newly-approved vaccine. For other vaccines though, it is unclear what the framework changes mean for those who want a COVID-19 vaccine in the fall but do not fit into one of the new eligibility categories, according to 

READ MORE: FDA approves NVX-CoV2705 COVID-19 vaccine

 quoted Paul Offit, MD, of Children's Hospital of Philadelphia, in the article, who said "The only ting that can come of this will make vaccines less insurable and less available."

Sharon Nachman, MD, chief of pediatric infectious diseases at Stony Brook Children's Hospital echoed a similar sentiment as Offit in an 

“I think that pediatricians will not have it in their office, so that means families will have to figure out how to get it,” said Nachman. "The children are in school, the families are working, and most of the pharmacies did not want to vaccinate children under 5 and sometimes even under 8. So, that means for the school-aged children that we would like to vaccinate, there's not going to be a whole lot of access for them, even if they're willing to pay for the vaccine.”

The FDA criticized the United States' vaccination strategy for all individuals, saying the "one-size-fits-all" approach differs from other countries in Europe that recommend seasonal and booster vaccines based on age, risk, along with other factors.

"My thoughts are, this is really going back on the preventative measures that should be taken to protect an individual against COVID-19," said Tan. "By putting those types of restrictions on the vaccine, you are not allowing individuals to protect themselves by getting the vaccine, and that's really not the way that public health works. Public health really is there to protect individuals and prevent them from becoming ill, and this is removing that prevention for all individuals," she concluded.

Editor's note: This is the first article in a series highlighting changes to COVID-19-vaccine-related changes from federal agencies

Click here for more on the CDC pulling the COVID-19 vaccine recommendation for healthy children

1. Prasad V, Makary MA. An evidence-based approach to covid-19 vaccination. 

. Published online May 20, 2025:NEJMsb2506929. doi:10.1056/NEJMsb2506929

2. Fitch J. FDA approves NVX-CoV2705 COVID-19 vaccine. Contemporary Pediatrics. May 19, 2025. Accessed May 22, 2025. https://www.contemporarypediatrics.com/view/fda-approves-nvx-cov2705-covid-19-vaccine

3. Perrone M, Neergaard L. New Trump vaccine policy limits access to COVID shots. 

. May 20, 2025. Accessed May 22, 2025. https://apnews.com/article/vaccines-fda-kennedy-covid-shots-rfk-trump-bb4de15b6ff955d6cd0b406aaec3cdc5

Our editor-in-chief Tina Tan, MD, reacts to a new FDA COVID-19 framework that will limit eligibility for seasonal vaccination in pediatrics. 

Abha Gupta, MD

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