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. 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.

Articles

Read these quick comments from Donna Hallas, PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN, and Bernard Cohen, MD, regarding the banning of red No. 3 from foods and ingested drugs. 

Quick reactions to the FDA ban of FD&C red No. 3

The digestive enzyme cartridge is designed to mimic pancreatic lipase function.

FDA expands immobilized lipase cartridge clearance down to 1 year

A CDC report shows only 23% of U.S. teens get enough sleep, with disparities highlighting the need for targeted health interventions.

 CDC: Most US teens fail to get recommended 8 hours of sleep, report finds

Across all years in the report, the CDC rated each physical activity trend with a color of red, indicating that trends are going in the "wrong direction." 

CDC: 2013-2023 youth risk physical activity behavior report

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A 10-year-old boy injured his left elbow during football practice. He subsequently had pain with normal range of motion of the elbow.

Supracondylar Process

**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 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.

News

Case Studies

Can you diagnose this boy with painful nodules on his feet?

Principal investigator Lewis Romer, MD, of Johns Hopkins Medicine joined us to discuss the actively-recruiting MOD PAH trial assessing mono vs dual therapy for pediatric PAH. 

Investigating mono vs dual therapy for pediatric pulmonary arterial hypertension

Lewis Romer, MD, professor of Anesthesiology and Critical Care Medicine at Johns Hopkins University, is the principal investigator of the Mono vs. Dual Therapy for Pediatric Pulmonary Arterial Hypertension (MoD PAH) trial. This Phase 3 study aims to determine the optimal first-line treatment for children newly diagnosed with pulmonary arterial hypertension (PAH).

The trial is currently in the recruiting stage and seeks to enroll pediatric patients to examine the comparative safety and efficacy of sildenafil monotherapy versus  sildenafil and bosentan combination therapy. 

"Our study is focused on what is the best initial therapy for children with a new diagnosis of pulmonary hypertension," said Romer. "We are trying to address what would seem to be a very fundamental question but one that really is very pressing."

Romer acknowledged the challenges of conducting pediatric clinical trials, particularly in rare diseases like PAH. 

"One of the biggest challenges to doing clinical trials for drug therapy in children is the pace of enrollment," he explained. "This is a rare disease. People are very protective of their kids, [questioning] 'What's this business of doing research on my child?' So the pace of enrollment is challenging."

Participants must meet specific inclusion criteria, including a confirmed PAH diagnosis via cardiac catheterization (for children over 1 year old) or 2 echocardiograms (for those under 1 year). Additionally, eligible children must have World Health Organization functional class II or III PAH symptoms.

"We are very interested in quality of life," Romer stated. "We focused on the primary outcome being something called the World Health Organization functional class, which means, do we have symptoms?"

While combination therapy is supported in adult populations, evidence for its use in children remains limited. "There are data to support the use of multiple drugs for initial therapy in adults, but this is a question that has never been asked in children," Romer noted.

Furthermore, the trial includes children with group 1 and group 3 PAH, the latter of which has not been studied in terms of optimal treatment at any age. "We feel that our study represents a great setting to decide that question," said Romer.

The MoD PAH trial represents a critical step toward improving outcomes for children with PAH. Recruitment efforts aim to provide essential evidence for guiding future treatment protocols. 

Mono vs. Dual Therapy for Pediatric Pulmonary Arterial Hypertension (MoD). ClinicalTrials.gov. Updated October 15, 2024. Accessed Jan. 13, 2025. https://clinicaltrials.gov/study/NCT04039464#contacts-and-locations 

Principal investigator Lewis Romer, MD, of Johns Hopkins Medicine joined us to discuss the actively-recruiting MoD PAH trial assessing mono vs dual therapy for pediatric PAH. 

Results from a recent study revealed that compulsive and addictive elements can contribute to the risk of disordered eating. Study investigator Susan Carnell, PhD, explains these findings.

Addictive behaviors surrounding social media could lead to binge eating

, Susan Carnell, PhD, explained details of a study she co-authored titled, "Concurrent and prospective associations of social media usage with binge eating symptoms in early adolescence," published in 

Carnell is an associate professor in the Division of Child and Adolescent Psychiatry at Johns Hopkins University School of Medicine.

"The reason we did this study is because we were interested to understand more about the effects on social media," Carnell previously said. "We were particularly interested in eating disorders because we know that there is potential for social media to impact mental health, but perhaps particularly eating disorders, because of the certain content to do with social comparison, which could lead to body dissatisfaction and disordered eating." 

The study utilized data from the Adolescent Brain Cognitive Development (ABCD) study, a large-scale, longitudinal project conducted across 21 sites in the United States. "They recruited a large number of children when they were 9 to 10 years old, and they've been following them every year," Carnell said. "We were able to use this data to look at the relationship between social media use, and we looked at both time spent using social media and also addictive behaviors around social media."

Results demonstrated that time spent on social media by itself was not directly associated with binge eating, though individuals with high levels of addictive behaviors surrounding social media at baseline were 3.5 times more likely than those who had no addictive behaviors to develop binge eating by 14 to 15 years of age.

In the above video, Carnell explains, "I think our results suggest that there are some children who may be particularly vulnerable to the addictive nature of social media, which is kind of designed to make us want to keep clicking, or perhaps to binge eating, or perhaps to a third factor which could influence both, like anxiety or depression, which could lead to both of these behaviors."

"So I think our results suggest that those might be the things to key in on, perhaps even more than overall time spent on social media, which might be okay for some kids, but maybe more problematic for others," said Carnell.

Click here to watch Carnell explain initial study details, reason for the study, and the first video in this series with Susan Carnell, PhD.

1.Shi X, Duck SA, Jansen E, et al. Concurrent and prospective associations of social media usage with binge eating symptoms in early adolescence. 

2. Fitch, J. Social media use and binge eating in early adolescence. 

. January 6, 2025. Accessed January 9, 2025. https://www.contemporarypediatrics.com/view/social-media-use-and-binge-eating-in-early-adolescence 

Robert Frenck, MD, explained why 2024 was a big step in the right direction for RSV prevention, and emphasized the importance of vaccination against preventable diseases. 

Robert Frenk, MD: 2024 was big year for RSV prevention

Robert Frenck, MD, professor of pediatrics in the Division of Infectious Diseases and director of Vaccine Research at Cincinnati Children’s Hospital, highlighted the significance of advances in respiratory syncytial virus (RSV) prevention during a discussion on maternal immunization and the monoclonal antibody nirsevimab (Beyfortus; Sanofi and AstraZeneca). Frenck emphasized the transformative potential of these interventions, comparing them to past successes in pediatric infectious disease prevention, especially as they became more readily available in 2024.

"I think that the RSV with the maternal immunization and then the nirsevimab is really a big deal," Frenck stated. Reflecting on historical parallels, he recalled the substantial reduction in rotavirus-associated hospitalizations following vaccine introduction. "Before that, we used to have kids that were just the whole wards in the hospital. The units in the hospital were full of kids who were having dehydration due to rotavirus-associated diarrhea, and now that's basically gone, or significantly decreased with the rotavirus vaccine." Frenck expressed optimism that maternal RSV vaccination and nirsevimab administration could yield similar outcomes in preventing severe RSV infections in infants.

Nirsevimab, approved by the FDA to prevent RSV in neonates and infants, has been recognized for its potential to reduce hospitalizations and severe respiratory illness in vulnerable populations. Frenck noted the promising reception of maternal RSV vaccines in his community, explaining, "About 40% of moms have said yes, they'd be interested in getting the vaccine. With 40% acceptance within the first year, that's actually a very high acceptance rate, and to me, very encouraging." 

Frenck underscored the broader implications of declining immunization rates and the resurgence of preventable diseases. The re-emergence of vaccine-preventable illnesses follows predictable patterns when immunization coverage declines. "Every time they slip, we have the same answer... outbreaks," said Frenck.

Addressing vaccine hesitancy, Frenck acknowledged, "People talk about vaccines, [saying] 'these are vaccine-preventable illnesses, but these are just normal childhood illnesses, and kids get over it.'"

However, he stressed the unpredictability of severe outcomes.

"Most of the time, that's right, but I can't predict which kid is going to be the one to get real sick, and that's why we need to immunize everyone. The vaccines are really a dual kind of thing," said Frenck. "They protect you by giving you the vaccine, but then they also help protect people that can't get vaccinated because they have conditions where they're medically unable to get vaccinated, or they're too young that the vaccines don't work yet."

In his view, the development of RSV vaccines and monoclonal antibodies represents "a huge move forward" in safeguarding child health. 

Nirsevimab-alip FDA approved to prevent RSV in neonates, infants. 

. Published July 2023. Accessed January 6, 2025. https://www.contemporarypediatrics.com/view/nirsevimab-alip-fda-approved-to-prevent-rsv-in-neonates-infants

Robert Frenck, MD, explained why 2024 was a big step in the right direction for RSV prevention, and emphasized the importance of vaccination against preventable diseases.

Susan Carnell, PhD explains social media addiction symptoms, but not time on social media, were cross-sectionally and prospectively associated with binge eating. 

Social media use and binge eating in early adolescence

Susan Carnell, PhD, associate professor in the Division of Child and Adolescent Psychiatry at Johns Hopkins University School of Medicine, and co-author of the "Concurrent and prospective associations of social media usage with binge eating symptoms in early adolescence," publication in 

, recently discussed the link between social media use and the development of binge eating behaviors in adolescents. 

Carnell and her team aimed to explore the impact of social media on eating disorders, focusing on how social comparison and content could drive body dissatisfaction.

Susan Carnell, PhD explains social media addiction symptoms, but not time on social media, were cross-sectionally and prospectively associated with binge eating.

Ayman Abdul-rauf, MD

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