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Articles

 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.

Remote monitoring in pediatrics shows promise for improving outcomes, but device design, workflow integration, and reimbursement remain key.

Remote monitoring expands possibilities for pediatric care, with Alisa Niksch, MD

Chief, Emergency Medicine, Nemours Children’s Hospital of Delaware

Clinical Professor, Pediatrics, Thomas Jefferson University

John Loiselle, MD, shares guidance at AAP 2025 on recognizing pediatric musculoskeletal injuries and when urgent orthopedic referral is needed.

John Loiselle, MD, talks recognizing pediatric musculoskeletal injuries

Jeanne Marconi, MD, is a senior vice president for business development and strategic partnerships at Brightline, the leading pediatric mental health solution supporting kids, teens, and their parents. Dr. Marconi is a nationally recognized physician and transformational leader in pediatric and young adult physical and mental health and wellness. Committed to driving systemic change to improve mental health access and improved outcomes for young people, Dr. Marconi serves as a board and committee member for organizations that support youth aging out of foster care and youth who are residents of long-term care facilities. Dr. Marconi is a graduate of New York Medical College and completed her pediatric training at Northshore-Cornell University, Long Island, NY.

. 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.

In this video, Jeanne Marconi, MD, highlights some of the challenges providers face when implementing mental health screenings.

Jeanne Marconi, MD, talks difficulties of implementing mental health screenings

Take a quick look at everything you may have missed this month, including the top FDA approvals and latest clinical updates.

Top 5 pediatric health headlines you missed in September 2025

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

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**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

ADHD affects nearly 1 in 10 children in the United States, but evaluation and management often compete with time and scheduling pressures in pediatric practices. Cesar Ochoa-Lubinoff, MD, MPH, director of Developmental-Behavioral Pediatrics at Cedars-Sinai Guerin Children's, noted that creating structured systems can help.

“One of the important approaches is to develop a system in the office where you can plan a diagnostic visit, where you can explain to the family the diagnosis and the treatment options, and then regular follow-ups, because this is a chronic condition that is changing all the time,” Ochoa-Lubinoff said.

He emphasized the importance of follow-up every 3 months and the use of ADHD rating scales, such as Vanderbilt forms, to gather teacher input efficiently. “If we get families used to taking the Vanderbilts or other rating scales filled by the teachers before every other visit, that can give us the perspective from the teacher on how the child is doing at that time,” he said.

Ochoa-Lubinoff highlighted the utility of the American Academy of Pediatrics (AAP) ADHD clinical practice guideline and toolkit for streamlining care. The guidelines recommend using DSM-5 criteria embedded in parent and teacher rating scales, which can support efficient diagnosis without extensive additional time.

“They explain how the use of the rating scales for parents and for teachers can help make an effective diagnosis of ADHD without dedicating too much time,” Ochoa-Lubinoff said. The guidelines also emphasize the chronic nature of ADHD, with treatment strategies tailored by age group.

Managing ADHD care in primary practice can be complex and time-consuming, particularly with payment and reimbursement challenges. Ochoa-Lubinoff pointed to strategies such as office organization, collaboration with behavioral health specialists, and proactive communication with schools. Some larger practices have incorporated on-site mental health specialists to streamline care.

“It’s really necessary to develop partnerships and communication with school systems, with community resources, and being aware of those providers in the community and having a relationship with them ahead of time,” Ochoa-Lubinoff said.

Ochoa-Lubinoff noted significant variability in pediatricians’ comfort and training with ADHD. Some feel confident managing complex cases, while others seek more support. “Everyone should be interested, because ADHD is a very prevalent condition and it takes a big toll on the developmental trajectories of our patients,” he said.

He encouraged pediatricians to strengthen diagnostic confidence, manage straightforward cases, and know when to refer more complex presentations. Treatment, he said, requires ongoing monitoring and adjustment. “Many times I see a patient and we diagnose, we start treatment, and everyone is super happy because the child is doing so much better. But something I tell parents is, this is just the beginning, because things can change over time,” Ochoa-Lubinoff said.

 Cesar Ochoa-Lubinoff, MD, discusses practical strategies for ADHD care in the primary care setting

Ochoa-Lubinoff reports no relevant disclosures.

Ochoa-Lubinoff C. How to Diagnose and Treat ADHD in a Busy Practice. Presentation. Presented at: American Academy of Pediatrics 2025 National Conference & Exhibition. September 26-30, 2025. Denver, Colorado.

Pediatricians can use structured visits, rating scales, and AAP guidelines to improve ADHD diagnosis, follow-up, and care coordination.

News

Cesar Ochoa-Lubinoff, MD, discusses practical strategies for ADHD care in the primary care setting

 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, February 24, 2025 at 10:00 PM ET or later for the full case presentation, differential diagnoses, and the correct patient diagnosis. 

This case was provided by Irene Chern, MD, Aimee Johnson, MD, and Dana Toib, MD.

A 6-day-old male with history of waxing and waning urticarial rash presents to the general pediatrician’s office for evaluation. The parents describe the rash as red, raised skin lesions that become flat and congregate, lasting several hours to days, resolving without leaving marks and then appearing in new areas. The rash began shortly after birth, and it does not seem to bother the patient. The parents deny any other concerns, including vomiting, fever, joint swelling, oral ulcers, or irritability. The patient is breastfeeding well and has normal urination and bowel movements.

On review of the nursery notes, it appears that at 9-hours of life the patient developed a rash that started as small, blanching, erythematous, circular macules on the legs; gradually increasing in size and number; becoming raised and coalescing to large, diffuse patches on the legs, back, chest, face, and soles that resolved within several hours. The patient was born to a 30-year-old gravida 1 mother at 40-weeks gestation via spontaneous vaginal delivery. The parents are without consanguinity or family history of autoimmune or inflammatory diseases. The pregnancy was complicated by maternal hypothyroidism and group B Streptococcus positive status, with the mother adequately treated with levothyroxine and intrapartum antibiotics.

Neonatal Onset Multisystem Inflammatory Disease

Click here for the full article featuring the complete case presentation, differential diagnosis, and correct patient diagnosis.

For more puzzler case studies, click here.

Can you diagnose this patient in our most recent puzzler poll? 

Case Studies

Puzzler poll: Urticarial rash in a 9-hours-old male 

 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.

Then visit our website on August 20 at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

This case was provided by Andrew Faniku, MD, pediatric hospitalist at Scott & White Healthcare.

A 21-year-old primigravida female presented to the hospital in preterm labor, with an otherwise uneventful pregnancy except for a febrile illness after exposure to family members with measles a week prior.

She reported having fever, cough, conjunctivitis, and a rash that started on her face and spread to her trunk, consistent with measles. Her fever and symptoms had mostly resolved, except for her lingering rash that began six days earlier. In the delivery room, she still had fresh excoriation marks on her arms. She had not received any MMR vaccines.

Six hours after admission, the patient delivered a female infant via spontaneous vaginal delivery at 35 weeks’ gestation. The baby weighed 2410 grams, which was approximately the 50

 percentile for her gestational age. The baby had mild respiratory distress after delivery and briefly required supplemental oxygen via blow by during transitioning. Apgar’s of 8 at 1 minute and 9 at 5 minutes was given at delivery. The baby subsequently improved and was allowed to room in with mother without the need for NICU admission. Nursing staff noticed a rash on the baby’s back. 

Below, take your best guess at diagnosing this patient

 website on Wednesday, August 20 at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

Can you diagnose this rash in a newborn?

At 32 6/7 weeks, a 1970-g child was born via meconium-stained vaginal delivery to a 37-year-old mother (gravida 2, para 1) who recently immigrated from India. The mother presented with preterm premature rupture of membranes for 11 hours prior to eventual vaginal delivery. 

Maternal history was otherwise notable for rubella nonimmunity, advanced maternal age, and a prior history of intrauterine fetal death 4 years prior. Prior to delivery, the mother received one dose of ampicillin given her unknown group B 

 status and a single dose of betamethasone to accelerate fetal lung maturity.

After delivery, the newborn was vigorous, with delayed cord clamping of 1 minute. The Apgar scores were 8 and 8 at 1 and 5 minutes of life, respectively. There was mildly increased respiratory effort in the delivery room, for which continuous positive airway pressure (CPAP) respiratory support was begun. The child was brought to the neonatal intensive care unit with CPAP of 5 and 30% fraction of inspired oxygen. 

E. coli with extended spectrum beta-lactamase

 website on Wednesday, September 10, at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis. 

A recently immigrated mother from India presents in preterm labor at 32 6/7 weeks and delivers a vigorous baby whose initial blood culture result is positive at 18 hours of life with gram-negative rods. 

Can you diagnose this infant with neonatal respiratory distress?

Melissa Menezes, MD, assistant professor of pediatrics at the Albert Einstein College of Medicine and attending physician in the Division of Adolescent Medicine at the Children’s Hospital at Montefiore, emphasized the importance of provider readiness in contraceptive counseling.

“I think it's about having the tools and the knowledge as a general provider in all areas of the United States, and the counseling really has more to do with the patient in your room that you're seeing in front of you,” she said.

Menezes noted that while disparities in access exist, “the best way that we as providers can really address these disparities is just having those tools, no matter where we are.”

She highlighted recently available contraceptive methods that can meet specific patient needs. The Twirla patch may be helpful for patients who experience adhesive issues with the standard contraceptive patch. For adolescents leaving home for college, the Annovera ring could provide continuity if they face challenges in accessing routine prescriptions.

Nextstellis, a combined hormonal contraceptive containing a different estrogen formulation, may offer benefits for patients who previously experienced breast tenderness or mood changes with other combined oral contraceptives. “If that's a concern of your patient, now you have this in your toolbox. This is something else you could try,” Menezes explained.

Menezes also discussed Opill, the progestin-only pill now available over the counter. While she noted limited direct counseling on this option, she explained its role in increasing access. “If that's the case, you know, those patients could really benefit from the O pill,” she said, particularly for adolescents unable to reach a provider. “It might not be the perfect option for them, but it is better than nothing, if what they want is to be on contraception.”

Long-acting reversible contraception (LARC) considerations

In counseling patients on long-acting methods, Menezes said she advises them about both FDA-approved durations and evidence supporting extended use. She emphasized respecting patient choice. “There’s some patients who definitely want it removed at the time that FDA says that it's supposed to be removed. And then there’s definitely some patients [who] are like, I don't want to have to do another procedure. Let's just keep it in, as long as you know, I'm protected against pregnancy. That's fine,” she said.

New contraceptive options and counseling strategies aim to improve adolescent access and address patient-specific needs presentedat AAP 2025.

Alisa Niksch, MD

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