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Meet the Editors

Lori Handy, MD, MSCE, is an attending physician in the Division of Infectious Diseases, Children’s Hospital of Philadelphia; and associate director, CHOP Vaccine Education Center. 

Videos

. 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.

As families prepare for a new school year, pediatricians are essential in helping parents navigate immunization schedules and school requirements and ensuring vaccine confidence.

Experts discuss importance of vaccination prior to school year

 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.

Articles

A US study finds influenza-associated necrotizing encephalopathy in children has high mortality and disability, underscoring need for early care.

Flu-linked necrotizing encephalopathy in children carries high risks

Aligning vaccinations with the start of a new school year 

Cary M. Wright, MD, MS, is a recent graduate of the University of Illinois College of Medicine at Chicago and is an intern at the Stanford Pediatrics Residency Program in California

Despite their frequency, it can be challenging to distinguish between types of bites. Can you identify the source of this bite mark? 

Puzzler poll: Can you identify this bite? 

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

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Both the protests in the summer of 2020 for racial justice and the news that non-White Americans are disproportionately affected by COVID-19 have highlighted the urgent need to address racism everywhere, including in pediatric practice.

Racism in pediatric health: How to talk to children about racism

**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

Richard Auchus, MD, PhD, highlights data showing that crinecerfont use in children with CAH can improve metabolic outcomes. 

Crinecerfont demonstrates improvements in weight-related outcomes in children with CAH

Twelve-month findings from the Phase 3 CAHtalyst Pediatric trial presented at ENDO 2025 demonstrated that treatment with crinecerfont (Crenessity; Neurocrine Biosciences) led to improvements in weight-related outcomes for children with classic congenital adrenal hyperplasia (CAH) when combined with glucocorticoid therapy.

Richard Auchus, MD, PhD, professor of pharmacology and internal medicine at the University of Michigan, highlighted the metabolic risks these patients face. “Children with CAH have a high prevalence of obesity, as do adults with CAH, which places them at increased risk for cardiovascular disease,” he explained. "In adults, secondary to adrenal crisis, the second most common cause of death in CAH is cardiovascular disease. They have a significant metabolic risk, which begins developing in childhood due to prolonged exposure to the high doses of glucocorticoids traditionally necessary to manage the condition adequately."

The intention behind the trial was to determine whether adding crinecerfont—a CRF1 receptor antagonist—could lower adrenal androgens and allow for lower, more physiologic glucocorticoid doses. In the 28-week, double-blind period, androstenedione dropped by about 50% in the crinecerfont group, enabling an 18% glucocorticoid dose reduction, whereas dosing increased in the placebo group.

"In the crinecerfont group, BMI decreased following this period, whereas BMI slightly increased in the placebo group," said Auchus. "At the 28-week point, the placebo arm was crossed over into crinecerfont, and additional data presented showed that this transition resulted in reductions in androstenedione and 17-hydroxyprogesterone levels. This, in turn, allowed for glucocorticoid dose reduction and a subsequent decrease in BMI in the placebo group post-crossover."

According to a press release from Neurocrine Biosciences, pediatric patients on crinecerfont achieved reductions in BMI standard deviation scores (SDS) at Week 28, and these improvements were maintained through Week 52. For pediatric patients who were overweight or obese at baseline (~60%), a higher percentage on crinecerfont achieved at least a 0.2 reduction in BMI SDS compared to placebo. 

Auchus noted that after the placebo group crossed over to crinecerfont, they too experienced reductions in BMI and hormone levels, though, “At 12 months, the improvement in BMI was greater in those who had received crinecerfont from the start," he said. “Even modest excesses in glucocorticoids appear harmful over the long term,” and underscored the value of early intervention. 

Crinecerfont was approved by the FDA in December 2024

 for use in adults and children aged 4 years and older with classic CAH, based on data showing meaningful reductions in glucocorticoid dosing and serum androgen levels. Its mechanism targets adrenal androgen overproduction directly, helping reduce reliance on high-dose steroids.

Kyriakie Sarafoglou, MD, discusses crinecerfont FDA approval for congenital adrenal hyperplasia

“General pediatricians will encounter these patients… There is now an intervention that was not previously available,” Auchus added. “Evidence now shows that even small reductions in glucocorticoid dosing can significantly impact body weight and insulin sensitivity.” 

Neurocrine Biosciences presented one-year data from phase 3 CAHtalyst studies showing improvements in weight-related effects of glucocorticoid treatment at the 2025 Endocrine Society’s Annual Meeting. Neurocrine Biosciences. Press release. July 14, 2025. Accessed July 31, 2025. 

Ebert M. FDA approves Crenessity for treatment of classic congenital adrenal hyperplasia. Contemporary Pediatrics. December 13, 2024. Accessed July 31, 2025. https://www.contemporarypediatrics.com/view/fda-approves-crenessity-for-treatment-of-classic-congenital-adrenal-hyperplasia 

Richard Auchus, MD, PhD, highlights data showing that crinecerfont use in children with CAH can improve metabolic outcomes.

News

Richard Auchus, MD: Crinecerfont's positive weight-related outcomes in children with CAH

Suzanne Hollander, MS, RD, LDN and Timothy Tramontana, MD offer thoughts on the newly FDA-approved sepiapterin for PKU.

WATCH: Experts react to the FDA approval of sepiapterin to treat PKU

FDA approved PTC Therapeutics' sepiapterin (Sephience) 

to treat adult and pediatric patients with phenylketonuria (PKU). Sepiapterin is now the third FDA-approved medication for lowering blood phenylalanine (Phe) levels and can be used alongside a Phe-restricted diet to expand protein tolerance in individuals with sepiapterin-responsive PKU. 

"This is a really exciting time in PKU, with a new treatment coming out," said Suzanne Hollander, MS, RD, LDN, metabolic dietitian at Boston Children’s Hospital. "Sepiapterin is an oral Phe-lowering medication just recently approved for PKU in individuals of all ages. For individuals with PKU, historically, standard-of-care treatment has included a protein-restricted diet with low phenylalanine formula. More recently, there have been 2 Phe-lowering medications available on the market. These previous 2 medications and the diet do not always sustainably work for everyone to keep their Phe level within the target treatment range. That target treatment range is less than 360 µmol/L."

FDA approval follows the phase 3 APHENITY trial, in which sepiapterin demonstrated potential benefits such as increased dietary protein intake and reduced reliance on PKU-specific formula.

"Sepiapterin will become the third FDA-approved Phe-lowering medication. The approval is exciting because it offers an additional Phe-lowering option, and it may be appropriate for some people who have not achieved their treatment goals with the other 2 available medications and/or with the PKU diet," Hollander said. 

For metabolic care teams, the approval introduces new considerations for treatment planning. "Many individuals will still require a phenylalanine-restricted diet alongside this therapy. However, sepiapterin does offer a Phe-lowering effect that could allow individuals to liberalize their diet and eat more dietary phenylalanine and more dietary protein. For some people, it may lower their blood phenylalanine level enough that they could receive all the dietary protein they need from food, allowing them to discontinue use of the phenylalanine-restricted PKU formula. Anytime people on a restricted diet can liberalize their protein intake, it is a huge win."

Timothy Tramontana, MD, medical and biochemical geneticist at Cleveland Clinic Foundation, emphasized the broader impact. "The added benefit is that we currently have a drug called sapropterin, which we have been utilizing for a long time under the brand name Kuvan. Sepiapterin provides an alternative treatment to this, hopefully helping patients with extremely diminished levels of phenylalanine hydroxylase, the enzyme affected in this disorder. It is thought that patients even with null mutations or mutations that may be leaky—meaning there may be minimal to almost no enzyme—may benefit from this treatment. The drug has a chaperone effect; it can help with the conformation of the enzyme, which may be affected. Those with almost no enzyme activity may actually see benefit from it in reducing their phenylalanine levels compared with a drug like sapropterin or Kuvan." 

"It goes hand in hand; the approach has always centered on diet, with pharmacologic management as an adjunct to hopefully help liberalize diet. That approach has helped a number of people through the use of sapropterin and now with sepiapterin. The hope is to expand the number of patients who may be able to liberalize their diet and increase their protein intake. That is our goal for most of our patients: to help them live a more normal life in terms of intake. It may never be 100% protein unrestricted, but the hope is to liberalize it enough to allow increased intake," Tramontana added.

Both experts encouraged primary care providers to support continued specialty care. "For general practitioners working with individuals with PKU, we absolutely want you to encourage individuals with PKU in your practice to come to a PKU clinic, which may also be referred to as a metabolism or metabolic clinic. Even if someone has been away from clinic for many years, we always welcome people back so they can be made aware of these new treatment options," Hollander said.

"We are excited that there is another drug on the horizon that can help our patients live a more normal life and increase their protein intake," Tramontana added. "That is always exciting. General providers need to be aware that there are treatments available and should enlist the help of a biochemical geneticist. We work hand in hand with metabolic dietitians who are integral to the team and the management of these patients. Knowing that a new treatment may help patients further liberalize their protein intake is going to be important," Tramontana said. 

Suzanne Hollander, MS, RD, LDN; and Timothy Tramontana, MD, offer thoughts on newly FDA-approved sepiapterin for PKU.

Lori Handy, MD, MSCE, highlights how pediatricians can better prepare families and systems for missed vaccines during the back-to-school rush.

Lori Handy, MD: Vaccine-only visits can help ease back-to-school gaps

With the start of the school year approaching, pediatricians can expect a familiar trend: families realizing their otherwise healthy children may have missed a crucial well visit—and vaccines—before kindergarten registration. According to Lori Handy, MD, MSCE, associate director of the Vaccine Education Center and attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia (CHOP), this scenario plays out every year. 

“By the time a child is 4 years of age, particularly if they are otherwise healthy, there might be a missed well visit,” said Handy. “Then you go to register them for kindergarten and realize, ‘Oh, we missed a visit,’ possibly one with several vaccines due.” 

To help manage this annual rush, Handy said pediatric practices can consider offering vaccine-only appointments if the full well-child visit is already scheduled for later in the fall. “This allows the child to enter kindergarten on time and provides more time later in the fall for the full visit,” she noted. 

 Handy emphasized that school entry is not only a logistical checkpoint but a critical public health opportunity. “It is a nice pause to say, let’s look back: have you missed anything?” she said.

Handy also pointed to common difficulties parents and providers face when trying to determine what vaccines are due, especially with variations in vaccine products and timing. “The CDC schedule is complicated because it tries to account for every scenario,” she said, noting that some children may receive a 2-dose rotavirus series, while others might need 3 doses. For pediatric providers, integrating immunization schedules into their electronic health records can help simplify the process. 

“If providers know the brand of a certain vaccine they use, they can simplify the process rather than going to the CDC and looking at different colored bars and timelines,” Handy explained. On the family side, she encouraged proactive communication. “Families can always call or send a message to their pediatrician and say, ‘We have an upcoming visit. Can you remind me what shots might be happening so I can read up on them and we can have a good conversation?’” 

The Vaccine Education Center on the CHOP website provides easy-to-navigate information related to vaccination in children across all ages. 

Click here to view the age groups and vaccines

. Handy encouraged providers to share this link with parents who have questions about vaccine timing, or sharing with all parents for familiarity and scheduling purposes.

Fitch J. Lori Handy, MD on importance of vaccine catch-up before the school year. Contemporary Pediatrics. July 17, 2024. Accessed July 25, 2025. https://www.contemporarypediatrics.com/view/lori-handy-md-importance-vaccine-catch-up-before-school-year

Offit P (reviewed). Age group and vaccines. Children's Hospital of Philadelphia. Updated June 1, 2023. Accessed July 25, 2025. https://www.chop.edu/vaccine-education-center/vaccine-schedule/age-groups-and-vaccines

Lori Handy, MD, MSCE, highlights how pediatricians can better prepare families and systems for missed vaccines during the back-to-school rush. 

Tyra Bryant-Stephens encourages families to revisit asthma triggers, refill medications, and manage allergies to prevent avoidable complications.

Tyra Bryant-Stephens, MD talks asthma reminders ahead of school year

The summer months offer an ideal opportunity for families of children with asthma to take proactive steps ahead of the school year, according to Tyra Bryant-Stephens, MD, chief health equity officer at the Center for Health Equity and medical director of the Asthma Prevention Program at Children’s Hospital of Philadelphia. 

“When we talk about the school physical or asthma checkup, there are 5 things to review with parents,” Bryant-Stephens said. “The child’s asthma triggers, what they need from their doctor, talking to the school, making sure they are taking control medication, and making sure they have refills.” 

In addition to asthma-specific medications and planning, Bryant-Stephens highlighted the role that allergy management plays in maintaining good control, especially during the back-to-school season. 

“September is a bad time for allergies, so making sure allergies are controlled as well as asthma is important,” she said. “I often tell parents that if they take a vacation from allergy medications in July, they should restart them at the end of August so the child is less likely to have allergic symptoms that can trigger asthma.”

Although respiratory viruses are difficult to avoid once children return to crowded school settings, Bryant-Stephens said that managing known triggers, such as allergens and environmental factors, can still help minimize flares. 

Tyra Bryant-Stephens, MD, encourages families to revisit asthma triggers, refill medications, and manage allergies to prevent avoidable complications. 

Brandi Kaye Freeman, MD, MS

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