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Meet the Editors

 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 Rutgers-led study found genetics, personality traits, and environment uniquely shape early adolescent alcohol use, guiding prevention efforts.

Genetic and environmental influences predict early adolescent alcohol use

Less than half of US adolescents with major depressive episode received treatment in 2022, with disparities by race, gender, and geography.

Many adolescents with major depressive episode do not receive mental health care

Robert M. Cavanaugh, Jr, MD, is professor of Pediatrics and Director of Adolescent Medicine at SUNY Upstate Medical University in Syracuse, New York.

Discover effective strategies for conducting psychosocial screenings in adolescents using the HEADS FIRST Checklist to enhance health outcomes.

Psychosocial screening of adolescents: Using the HEADS FIRST Checklist, part 1

Large Korean study finds no link between prenatal or infant antibiotic exposure and autoimmune disease risk in children.

Early antibiotic exposure not linked to autoimmune disease in children

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

A new modeling study projects that South Korea could eliminate cervical cancer within the next 2 decades, with timelines varying based on screening methods and vaccination coverage. Findings published in 

 demonstrate that adopting high-risk human papillomavirus (hrHPV) testing and increasing vaccination rates could accelerate elimination compared with current practices.

Globally, cervical cancer remains a significant health concern, with approximately 604,127 new cases reported in 2020 and more than 85% of cases occurring in lower-resource regions. The World Health Organization (WHO) has set an elimination target of fewer than 4 cases per 100,000 women, calling for 90% vaccination coverage of girls by the age of 15 years, 70% screening coverage by 35 and 45 years, and 90% treatment coverage for diagnosed patients.

In South Korea, incidence has declined over the past 2 decades, dropping to 8 cases per 100,000 women in 2019. This reduction is attributed to the implementation of the National Cancer Screening Program in 1999, which provides biennial Papanicolaou tests for women 20 years or older, and to the introduction of the HPV vaccination program in 2016. Vaccination coverage among 12-year-old girls reached approximately 74% by 2023.

Researchers constructed a deterministic, age-structured dynamic model to simulate HPV transmission, cervical cancer progression, and the effects of vaccination and screening in the Korean population from 2024 to 2100. The model incorporated sexual behavior data, demographic trends, and natural disease progression through stages of cervical intraepithelial neoplasia, leading to invasive cervical cancer.

The study evaluated 36 screening strategies, varying by test type (Papanicolaou or hrHPV), screening interval (2, 3, or 5 years), and age range. Two scenarios were modeled: a realistic scenario, based on current screening participation (51.5%) and vaccination rates (75%), and an ideal scenario, assuming 70% screening and 90% vaccination coverage beginning in 2030.

Under the current biennial Papanicolaou test program, South Korea is projected to achieve cervical cancer elimination by 2044. Extending the Papanicolaou interval to 5 years delayed elimination by a decade or more, whereas 3-year Papanicolaou testing produced similar outcomes to the current strategy.

Switching to hrHPV testing substantially improved outcomes. Biennial hrHPV testing could reduce cervical cancer cases by 20% to 27% and deaths by 11% to 14% compared with current Papanicolaou-based strategies. Under realistic assumptions, elimination could occur as early as 2038 with hrHPV testing, whereas in the ideal scenario, elimination could be achieved by 2034.

The model further estimated that achieving 70% screening and 90% vaccination coverage from 2030 could prevent an additional 12% of cervical cancer cases and 7% of deaths by 2100. Sensitivity analyses showed that without the national HPV vaccination program, elimination could be delayed by up to 7 years, emphasizing the role of government-led immunization efforts.

The investigators noted that “shifting to HPV-based screening has a greater impact on reducing cervical cancer incidence and mortality than merely increasing screening and HPV vaccination rates.” They added that HPV vaccination takes decades to influence incidence because cervical cancer typically arises later in life whereas screening provides a more immediate reduction by detecting and removing precancerous lesions.

Global comparisons show that South Korea’s elimination timeline is earlier than projections for many other countries. For example, estimates for Malaysia predict elimination between 2056 and 2062 whereas US models suggest elimination between 2038 and 2046, depending on screening and vaccination coverage. Australia, which implemented early nationwide vaccination for both sexes, is projected to eliminate cervical cancer by 2028.

The authors acknowledged limitations, including the deterministic nature of the model, which does not capture individual-level variability, and the exclusion of coinfections with multiple HPV types. The study also did not incorporate economic evaluations, which would be relevant for assessing the cost-effectiveness of transitioning to hrHPV-based screening.

Findings from this modeling study suggest that South Korea could achieve cervical cancer elimination as early as 2034 with biennial hrHPV testing and high vaccination coverage. Under current policies, elimination is projected by 2044. The findings highlight the importance of integrating effective screening strategies with expanded vaccination programs to meet WHO elimination goals.

Luu XQ, Jun JK, Suh M, Oh J, Yu S, Choi KS. Cervical cancer screening, HPV vaccination, and cervical cancer elimination. 

 2025;8(8):e2526683. doi:10.1001/jamanetworkopen.2025.26683

Global strategy to accelerate the elimination of cervical cancer as a public health problem. World Health Organization. November 17, 2020. Accessed August 19, 2025. 

https://www.who.int/publications/i/item/9789240014107

Biennial HPV testing and higher vaccination rates could help South Korea eliminate cervical cancer up to a decade earlier than current policy.

News

HPV screening, vaccination accelerate cervical cancer decline

Researchers from the Children’s Hospital of Philadelphia (CHOP) and the Children’s Hospital Colorado have found that controlling chronic eosinophilic esophagitis (EoE)–associated inflammation during childhood reduces esophageal stiffening and the likelihood of long-term disease complications. The findings, published in 

, demonstrate that histologic remission is associated with improved esophageal distensibility over time and that baseline distensibility may predict which patients are at higher risk for fibrostenotic progression.

EoE is a chronic allergic inflammatory disease of the esophagus, the muscular tube responsible for transporting food from the throat to the stomach. Symptoms in children include nausea, regurgitation, vomiting, abdominal pain, reflux-like burning, gagging, and difficulty swallowing. Dysphagia, the sensation of food sticking in the throat, is a frequent concern. Untreated EoE may result in esophageal narrowing due to scarring, also referred to as stricture.

Chronic EoE-associated inflammation can also lead to tissue remodeling and fibrostenosis, characterized by reduced esophageal flexibility. Although the severity of EoE is recognized, the long-term influence of inflammation control during childhood on esophageal remodeling has remained unclear.

The research team conducted a prospective longitudinal study at CHOP and Children’s Hospital Colorado to evaluate the relationship between esophageal distensibility, histology, and fibrostenotic complications in pediatric EoE. A total of 112 individuals aged 3 to 18 years were included, undergoing 300 endoscopies during the study period. Participants were predominantly male (72.3%), with a mean age of 12.8 years. The median follow-up was 11 months, though some patients were followed for up to 4.5 years.

Investigators used impedance planimetry with endoluminal functional imaging during clinically necessary endoscopies to measure esophageal distensibility. Symptomatic, endoscopic, and histologic data were collected at each visit.

Patients who demonstrated histologic response to treatment had the most significant improvement in esophageal distensibility over time (1.41 vs 0.16-0.53 mm/y; 

 = .003). After adjustment for esophageal reference score and age at symptom onset, lower esophageal distensibility was independently associated with higher odds of patient-reported dysphagia (OR, 0.85; 95% CI, 0.75-0.96; 

Children who developed fibrostenosis were typically older at diagnosis (9.9 vs 6.7 years; 

 = .032), had a longer disease duration (4.4 vs 2.4 years; 

 = .046), and had lower baseline distensibility (13.0 vs 14.9 mm; 

 = .012). Baseline distensibility also predicted the future need for stricture dilation (area under the curve, 0.757; 

“Following children living with EoE over time has given us a clearer picture of how inflammation affects the esophagus and how treating it can improve the esophagus and outcomes for patients,” said senior study coauthor Calies Menard-Katcher, MD, associate director of clinical research for the Gastrointestinal Eosinophilic Diseases Program at Children’s Hospital Colorado. “It’s exciting to see these results confirm what we’ve suspected in caring for patients, and they may even help us spot those at risk for more severe disease.”

“This is the first study to follow kids over time [with these endoscopic assessments] and evaluate the patients who are at the highest risk of complications,” said senior study coauthor Amanda Muir, MD, a pediatric gastroenterologist in the Division of Gastroenterology, Hepatology and Nutrition at CHOP. “With the recent FDA approval of 2 medications for EoE, having this data could help identify the patients who could benefit from these therapies the most and observe improvement at a histologic level over time.”

The study findings suggest that measuring esophageal distensibility offers a quantifiable marker of tissue remodeling and may serve as a predictor of disease severity and progression. This tool may assist clinicians in identifying patients most likely to require more aggressive therapy or stricture dilation.

The authors note that further research examining molecular mechanisms of EoE progression could refine risk stratification and help guide individualized therapy. “Having these data could help identify the patients who could benefit from these therapies the most,” Muir added.

The findings support the importance of early and consistent disease control in pediatric EoE to prevent long-term complications associated with esophageal remodeling and fibrostenosis.

Children’s Hospital of Philadelphia and Children’s Hospital Colorado researchers conduct first prospective study of pediatric EoE patients and disease progression. News release. Children’s Hospital of Philadelphia. August 15, 2025. Accessed August 18, 2025. https://www.eurekalert.org/news-releases/1094933

Kennedy K, Burger C, Pan Z, et al. Histologic response is associated with improved esophageal distensibility and symptom burden in pediatric eosinophilic esophagitis. 

. Published online August 11, 2025. doi:10.1053/j.gastro.2025.07.042

Controlling childhood EoE inflammation improves esophageal flexibility, reduces dysphagia risk, and may predict need for stricture dilation.

Study findings link pediatric EoE treatment to reduced stiffening

Tacrolimus (TAC) improves symptoms in most cases of juvenile myasthenia gravis (JMG), with few serious adverse drug reactions (ADRs), according to a meta-analysis of 9 trials involving retrospective/prospective comparison studies in 313 individuals younger than 18 years with JMG. Two studies compared TAC and corticosteroids (CSs), and the remaining 7 had a single-group pretest-posttest design.

In the 6 trials that reported myasthenia gravis activities of daily living scores, TAC had a significant effect in reducing these scores. These improvements were observed as early as 1 month after initiating TAC treatment. Further, the degree of improvement increased along with an increase in follow-up duration. TAC also had a positive significant effect in reducing quantitative myasthenia gravis scores in the 3 trials that considered these scores. In addition, TAC was associated with reducing serum acetylcholine reception titers, according to data from the 3 studies. Finally, TAC therapy was associated with a reduction in CS dose.

A total of 23 ADRs related to TAC were reported in 4 studies; none were serious. However, 2 studies reported that TAC-related adverse effects led 13 patients to discontinue participation in the study.

Investigators concluded that TAC may be a beneficial treatment option for patients with JMG.

TAC looks to be a useful second-line addition for myasthenia gravis. My suspicion, however, is that it will soon become a third-line medicine, as I expect monoclonal antibodies to become first-line treatment in pediatrics in the next few years.

Jiang A, Hu Q, Wang Z, Wu F. Efficacy and safety of tacrolimus therapy in patients with juvenile myasthenia gravis: a single-arm meta-analysis. 

. 2025;166:32-38. doi:10.1016/j.pediatrneurol.2025.02.007

Tacrolimus shows promise in treating juvenile myasthenia gravis, improving symptoms with minimal adverse effects, suggesting a valuable second-line therapy option.

How effective is tacrolimus therapy in juvenile myasthenia gravis? 

A 21-year-old primigravida woman 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 6 days earlier. In the delivery room, she still had fresh excoriation marks on her arms. She had not received any measles-mumps-rubella (MMR) vaccines.

Six hours after admission, the patient delivered a female newborn via spontaneous vaginal delivery at 35 weeks of gestation. The baby weighed 2410 g, which was approximately the 50th percentile for her gestational age. The baby had mild respiratory distress after delivery and briefly required supplemental blow-by oxygen during transitioning. Apgar scores of 8 at 1 minute and 9 at 5 minutes were given at delivery. The baby subsequently improved and was allowed to room in with her mother, without the need for neonatal intensive care unit (NICU) admission. The nursing staff noticed a rash on the baby’s back.

The baby had mild respiratory distress after delivery and briefly required supplemental blow-by oxygen during transitioning. 

Brandi Kaye Freeman, MD, MS

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