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 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.

A pediatrician warns of the resurgence of vaccine-preventable diseases, urging awareness of their devastating impacts on children's health.

Deadly horizon

. 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.

IDWeek 2025 heads to Atlanta October 19–22 with cutting-edge sessions on AMR, AI, vaccines, HIV, pediatrics, and global health challenges.

IDWeek 2025 to spotlight innovation, AI, and global collaboration in infectious diseases

IDSA’s new GAS pharyngitis guidance emphasizes selective testing using clinical scoring to reduce overtreatment and antibiotic misuse.

IDSA recommends use of scoring systems to guide testing for group A streptococcal pharyngitis

Craig Press, MD, PhD, Associate professor, Clinical Neurology, University of Pennsylvania; Medical director, Neuroscience Unit, Children's Hospital of Philadelphia.

At the 2025 CNS Annual Meeting, Craig Press, MD, PhD, discussed challenges in achieving equitable access to diagnostics and expertise in pediatric neurocritical care.

Craig Press, MD, PhD, highlights challenges in pediatric precision care for epilepsy

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

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Henoch-Schönlein purpura developing after COVID-19 vaccination in a pediatric patient

**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.

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.

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.  

Below, take your best guess at diagnosing this patient

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

Case Studies

News

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

As both a pediatric phlebotomist and registered behavior technician, I witness daily how health care and behavioral therapy intersect—yet rarely collaborate. For neurodivergent children, this gap has real consequences.

Every pediatrician has experienced it: the child who freezes at the sight of a needle, the parent apologizing while restraining their distressed child, the appointment running overtime. For children with autism, attention-deficit/hyperactivity disorder, or sensory sensitivities, a routine blood draw or vaccination can become genuinely overwhelming. Yet most health care providers receive minimal training in behavioral strategies that could transform these encounters.

The result? Mounting medical anxiety, cancelled appointments, and children developing fear-based associations with health care that persist into adulthood. Research shows that untreated needle phobia affects up to 25% of adults—often rooted in childhood medical experiences. We can prevent this.

Applied behavior analysis (ABA) offers practical, evidence-based tools that integrate seamlessly into medical care. Task analysis breaks procedures into manageable steps. Positive reinforcement pairs cooperation with meaningful acknowledgment. Visual supports reduce uncertainty. Most importantly, offering choice and assent—even in small ways—gives children agency in their care. A child who learns "not yet" is still progressing and has learned self-advocacy.

These aren't therapy techniques requiring certification—they're trauma-informed approaches any provider can implement. Through my work developing behavioral protocols for medical settings, I've seen how a 5-minute preparation using a visual storyboard can replace a 45-minute struggle. I've watched children who couldn't even walk into a room do so when they knew they were going to feel the tourniquet or read a storyboard—meeting them where they are instead of demanding compliance.

When health care and ABA collaborate, everyone benefits. Providers gain practical strategies that reduce appointment stress. Parents receive tools that extend beyond the clinic. ABA professionals ensure behavior plans align with medical needs. Most importantly, children transform from "difficult patients" into confident partners in their own care.

This collaboration is why I founded Poke Pals—to provide medical teams and families with trauma-informed preparation tools that make procedures calmer and kinder. But the larger opportunity extends far beyond any single program. If we integrate behavioral insight into standard medical training, we don't just improve individual appointments—we reshape how an entire generation experiences health care.

The path forward requires pediatricians, behavioral specialists, and families working together. When we do, anxious appointments become growth opportunities and medical visits become experiences children can navigate with confidence rather than fear.

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

Special Report: STI Diagnostic Innovations and At-Home Testing

In part 3 of this 7-part Special Report, the discussion turns to the importance of diagnostic stewardship, with Denise Heaney, PhD, underscoring how FDA-cleared assays—ranging from at-home sample collection to point-of-care testing—can make it easier to detect infections accurately and treat in a timely fashion. She noted that lessons from the COVID-19 pandemic reinforced the need to bring diagnostics closer to patients and reduce barriers to care.

Kylee Johnson, MS, ARNP, highlighted the relevance for adolescents and their families. She explained that, much like self-collection for human papillomavirus in adults, young people increasingly seek discreet, convenient, and less invasive testing options. For pediatric clinicians, this may mean adapting workflows to ensure that positive results from at-home or pharmacy-accessed tests are properly followed up, integrated into records, and tied to effective treatment.

The panel also discussed how digital platforms can help reduce the risk of patients being lost to follow-up—a key concern when moving testing outside of traditional clinic walls. Johnson emphasized that adolescents, in particular, are digital natives who often find health care information and services online, and they are likely to gravitate toward providers who offer flexible and patient-centered testing solutions. For pediatric providers, the opportunity lies in embracing these tools while maintaining strong education, counseling, and safety nets to ensure continuity of care.

Kylee Johnson, MS, APRN, is a women’s health nurse practitioner at Rocky Mountain Women's Clinic.

Brooke Redmond, MD, is an attending neonatal critical care physician at the Yale New Haven Children’s Hospital. She is the creator and director of the 24/7 BABY program. 

Denise Heaney, PhD, is a senior scientific affairs manager in diagnostics information solutions at Roche Diagnostics Corporation in Indianapolis.

Redmond and Johnson have no relevant disclosures to report. Relevant disclosures for Heaney include Roche. 

Hufstetler K, Llata E, Miele K, Quilter LAS. Clinical updates in sexually transmitted infections, 2024. 

. 2024;33(6):827-837. doi:10.1089/jwh.2024.0367

Guidelines for the Management of Asymptomatic Sexually Transmitted Infections

. World Health Organization; 2025. Accessed September 30, 2025. 

https://www.ncbi.nlm.nih.gov/books/NBK616637/

Explore how diagnostic stewardship enhances infection detection and treatment, especially for adolescents seeking convenient testing options.

Video Series

Special Report: STI diagnostic innovations and at-home testing

Craig Press, MD, PhD, discussed the evolution of pediatric neurocritical care toward individualized, evidence-based approaches that move beyond seizure suppression to holistic patient care.

Craig Press, MD, PhD, on bringing precision medicine to pediatric neurocritical care

As precision medicine reshapes pediatric neurology, clinicians are working to personalize treatments for children facing life-threatening neurologic crises. At the 2025 Child Neurology Society (CNS) Annual Meeting in Charlotte, North Carolina, Craig Press, MD, PhD, associate professor of clinical neurology at the University of Pennsylvania and medical director of the Neuroscience Unit at Children’s Hospital of Philadelphia, discussed how data-driven approaches are redefining how clinicians manage seizures, inflammation, and critical neurologic disease at the bedside.

Press presented during the session “Bringing Precision Therapy to the Neurocritical Care Bedside,” part of Seminar 7: Optimizing NeuroICU Care: Treating Patients Rather Than Seizures

 The program explored novel pharmacologic and immunologic strategies—such as ketamine, ganaxolone, and cytokine-targeting therapies—and how integrating quantitative electroencephalography (EEG) and genetic testing can tailor interventions to each child’s unique etiology.

Rethinking seizure and inflammation management

“The biggest goal here was, when we think about neurocritical care and pediatric patients, there’s a lot of variety in the kids that we take care of,” Press said. “Each individual patient may respond differently to these therapeutics, or they may need a different diagnostic path.”

Press emphasized that although care pathways serve most patients, others—such as those experiencing new-onset refractory status epilepticus—require rapid diagnostics and customized intervention. “They need rapid genetic testing and new quantitative ways of looking at their EEG in response to therapies so that we can better target the underlying causes,” he said.

Press highlighted several promising treatments under study, including 

, noting that although ganaxolone’s recent trial did not meet all primary end points, “there were some exciting signals that suggest there may be ways this drug could be used.”

 to monitor real-time treatment response 

“One of the most important things we deal with in pediatrics is that therapies developed in adults often haven’t been tested in children yet. We’re trying to pull together large samples of kids to better understand responses to therapy so we’re not just relying on correlations or individual cases to drive care,” he said.

Press C. Bringing precision therapy to the neurocritical care bedside. Presented at: 2025 Child Neurology Society Annual Meeting; October 8-11, 2025; Charlotte, NC. 

Craig Press, MD, PhD, discussed the evolution of pediatric neurocritical care toward individualized care at the 2025 Child Neurology Society meeting. 

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.

Andrew J. Kienstra, MD

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