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Meet the Editors

Franchesca Kelly, PBT, ASCP, a certified pediatric phlebotomist at Haymarket Medical Center and creator of Poke Pals.

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.

Integrating health care and behavioral science transforms experiences for neurodivergent children, reducing anxiety and fostering confidence during medical procedures.

Bridging health care and behavioral science for neurodivergent children

Peace Madueme, chief, Cardiology, Nemours Children’s Hospital, Orlando, Florida

. 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 our second interview with Peace Madueme, MD, he explains the types of conditions that frequently appear on ECGs, which are aiding routine sports physicals in youth athletes in Florida.

Using ECGs to identify heart conditions in youth athletes, with Peace Madueme, MD

In a recent trial, 11 of 12 children treated with DB-OTO demonstrated meaningful hearing gains.

Regeneron’s DB-OTO shows sustained hearing recovery in phase 1/2 CHORD trial

FDA accepts MannKind’s sBLA for Afrezza in children and adolescents with diabetes.

FDA accepts Afrezza sBLA for pediatric diabetes 

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

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Despite its caveats and good intentions, the AAP guideline will surely invite an inappropriate glut of medication for preschoolers . . .

Pediatricians Issue Dangerous New Treatment Guidelines For Attention Deficit Disorder

Should Temper Tantrums Be Made Into A DSM-5 Diagnosis?

**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

On Monday, October 6, the FDA approved roflumilast cream 0.05% (Zoryve; Arcutis Biotherapeutics) to treat 

 (AD) in children aged 2 to 5 years. According to a press release from Arcutis, the topical, nonsteroidal phosphodiesterase 4 inhibitor can be used anywhere on the body for any duration.

The decision comes ahead of the scheduled October 13, 2025, target action date set by the FDA, following the federal agency's 

acceptance of the supplemental new drug application on February 26, 2025

"It is essential to have safe and effective treatments for children, who are often diagnosed with atopic dermatitis at a young age and can live with the condition across their lifetime," said Lawrence F. Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children’s Hospital-San Diego and INTEGUMENT study investigator, in a statement. "Young children often experience widespread disease, affecting large portions of their skin. Although topical steroids have been the standard treatment for years, they are not appropriate for long-term use."

Top-line data that led to the approval of roflumilast cream 0.05%

The approval of roflumilast cream 0.05% was based on results from the phase 3 INTEGUMENT-PED trial, the

 INTEGUMENT-OLE long-term extension study 

(NCT04804605), and a phase 1 pharmacokinetic study.

In INTEGUMENT-PED, roflumilast achieved rapid disease clearance, with significant improvement seen as early as week 1. By week 4, 25.4% of children treated with roflumilast reached Validated Investigator Global Assessment for Atopic Dermatitis success—defined as “clear” or “almost clear” skin with at least a 2-grade improvement from baseline—compared with 10.7% using vehicle (

Roflumilast also improved itch and overall disease severity, with 39.4% having achieved Eczema Area and Severity Index 75% improvement (EASI-75) at week 4 compared with 20% with vehicle, with over one-third of caregivers having reported a 4-point or greater reduction in itch scores (vs 18% with vehicle). Adverse events were mostly mild and included upper respiratory tract infection, diarrhea, vomiting, rhinitis, conjunctivitis, and headache.

Key atopic dermatitis approvals are changing the treatment landscape

In the INTEGUMENT-OLE extension, efficacy was maintained and enhanced over 56 weeks. Nearly 72% of participants from the pediatric trial achieved EASI-75 after long-term treatment, and those who transitioned to proactive twice-weekly dosing maintained disease control for a median of 238 days. Safety remained consistent with the pivotal trials.

AD affects an estimated 9.6 million US children and typically appears before the age of 5 years. For this population, roflumilast offers a topical, nonsteroidal option that demonstrated both durability and early onset of action in young children.

"With this approval, health care providers and families have an effective new treatment option for young children with atopic dermatitis," added Eichenfield.

Roflumilast foam 0.3% is approved to treat plaque psoriasis of the scalp and body in adults and pediatric patients 12 years or older. 

Click here for more on this indication, which was approved by the FDA on May 22, 2025.

Roflumilast foam 0.3% is approved to treat seborrheic dermatitis in adults and pediatric patients 9 years or older. 

Click here for more on this indication, which was approved by the FDA on December 15, 2025.

Roflumilast cream 0.3% is approved for topical treatment of plaque psoriasis, including intertriginous areas, in adult and pediatric patients 6 years or older. 

Click here for more on this indication, which was approved by the FDA on October 9, 2023.

Roflumilast cream 0.15% is approved to treat mild to moderate AD in adult and pediatric patients 6 years or older. 

Click here for more on this indication, which was approved by the FDA on July 9, 2024.

FDA approves Arcutis’ ZORYVE (roflumilast) cream 0.05% for the treatment of atopic dermatitis in children ages 2 to 5. Press release. Arcutis Biotherapeutics. October 6, 2025. Accessed October 6, 2025. https://www.globenewswire.com/news-release/2025/10/06/3161656/0/en/FDA-Approves-Arcutis-ZORYVE-roflumilast-Cream-0-05-for-the-Treatment-of-Atopic-Dermatitis-in-Children-Ages-2-to-5.html

Fitch J. FDA accepts roflumilast cream 0.05% sNDA for children with atopic dermatitis. 

. February 26, 2025. Accessed October 6, 2025. https://www.contemporarypediatrics.com/view/fda-accepts-roflumilast-cream-0-05-snda-in-children-with-atopic-dermatitis

The once-daily, steroid-free cream can be used anywhere on the body for treatment and for any duration, according to Arcutis.

News

FDA approves roflumilast cream 0.05% for atopic dermatitis for children aged 2 to 5 years

 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 September 24, 2025, at 3:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

This case was presented by Tyler Hanna, MD; Joshua Khuvis, MD; Sara Sanders, MD; Jennifer Haile, MD

A 7-year-old female with a history of receptive-expressive speech disorder presents with her father to establish care. She complains of dull headaches that occur 3 to 4 times per month to her central forehead over the past few months that improve with acetaminophen, ibuprofen, and closing her eyes. They occur in any setting and do not have any clear trigger.

The father also described an episode of chest pain 2 days prior to presentation. She was getting ready to leave for school when she felt her heart racing and father witnessed her fall to the floor. This episode lasted 2 minutes before self-resolving. Father denied dyspnea, loss-of-consciousness, or cyanosis with this event. No previous episodes like this were reported, though father reports that she has had more anxious episodes recently that could be panic attacks. Family history was notable for hypertension in father, neuroendocrine tumor in paternal grandmother, as well as hyperlipidemia and heart disease in paternal grandfather. The initial exam was notable for an elevated automatic blood pressure of 125/88 mmHg, heart rate of 113 beats per minute (BPM), height of 125.6cm (64th percentile), and weight of 26.7kg (75th percentile).

Below, take your best guess at diagnosing this patient

 website again on Wednesday, September 24, 2025, at 3:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

Try to diagnose this patient with a history of receptive-expressive speech disorder and anxiety. 

Case Studies

Poll: Can you diagnose this 7-year-old with anxious episodes?

Heather Boone, OMS-III; and Neil Cella, MD. 

A 12-year-old female with no significant past medical history presents to our Emergency Department with 3 days of right-sided neck swelling, which has progressively worsened. The patient notes some pain with chewing on the right side, which has led to decreased intake. The parents report no known fevers but note that other members of the family have recently been sick with a suspected viral illness. The family also reports that this is a recurrent issue that occurs 2 to 3 times a year and endorses that it began after her tonsillectomy procedure. They state that symptoms typically resolve after a course of antibiotics. She has been seen at an ENT clinic for these concerns in the past, with reportedly no solution. She has no other known medical diagnoses or surgeries and is not taking any medications. She lives with her parents and 3 siblings and is in 7th grade.

Her vital signs, including temperature, are within normal limits upon arrival. Physical exam is significant for an indurated, moderately-tender, swelling approximately 2 cm in diameter located anteroinferior to the mastoid process. An oral exam is unremarkable aside from reported dental discomfort elicited by right-sided bite testing. Some residual tonsillar tissue is noted. Upon consulting with the team, labs and imaging are ordered, including CBC, CMP, CRP/ESR, LDH, uric acid serum tests, and diagnostic ultrasound. The lab values demonstrate mild hemoconcentration (possibly due to living at high altitude) and a mildly elevated lymphocyte count. Ultrasound findings include limited images showing bilateral hypoechoic foci in the parotid gland and upper neck regions, and a broad differential is provided. Due to these nonspecific findings, a blood culture is ordered, which produces no growth.  

Try to diagnose this patient with 3 days of right-sided neck swelling. 

Poll: Can you diagnose this 12-year-old female with right-sided neck swelling?

Joseph Vithayathil, MD, discusses being awarded the Elterman Research Grant at the 2025 CNS Annual Meeting in Charlotte, North Carolina. 

Joseph Vithayathil, MD, discusses CNS Elterman Research Grant

Joseph Vithayathil, MD, attending neurologist in the Division of Neurology at the Children’s Hospital of Philadelphia, has been awarded the 2025 Pediatric Epilepsy Research Foundation (PERF) CNS Elterman Research Grant. The $150,000 award, distributed over two years, supports early-career child neurologists or developmental pediatricians conducting innovative research in neuroscience across the United States and Canada.

Vithayathil’s project explores the mechanisms of iron accumulation in the brain, particularly in the context of neonatal hypoxic-ischemic brain injury—a condition commonly treated by pediatric neurologists. His work aims to uncover how iron dysregulation contributes to brain injury and how targeting these mechanisms could lead to new neuroprotective treatments.

“I became curious about how that whole mechanism of iron accumulation occurred, and what role it might be playing in different neurologic disorders,” said Vithayathil. “That inspired me to start looking at that in the context of neonatal hypoxic-ischemic brain injury, which is one of the more common conditions that we see and treat as neurologists.”

With support from the PERF grant, Vithayathil will conduct experiments to identify cell-specific mechanisms that mediate iron dysregulation following ischemic injury. 

Joseph Vithayathil, MD, discusses being awarded the Elterman
Research Grant at the 2025 CNS Annual Meeting in Charlotte, North Carolina. 

Allen Frances, MD

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