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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.

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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.

Training tools and EHR prompts boosted pediatricians’ adherence to early peanut introduction guidelines in a new trial.

Simple interventions improve pediatrician adherence to peanut allergy prevention guidelines

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

Peace Madueme, MD, explains how Florida’s pre-sports cardiac evaluations—and upcoming ECG mandate—strengthen youth safety in athletics.

Peace Madueme, MD, discusses cardiology screenings and Florida's Second Chance Act

Lawrence Eichenfield, MD, Chief, Pediatric and Adolescent Dermatology,

A pair of roflumilast clinical trial investigators react to the FDA approval of the 0.05% formulation to treat atopic dermatitis in children 2 to 5 years. 

Lawrence Eichenfield, MD; and Rocco Serrao, MD, react to roflumilast approval for pediatric atopic dermatitis

Heather Boone, OMS-III, Rocky Vista University College of Osteopathic Medicine, Englewood, CO.

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?

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

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An 11-year-old boy with a history of asthma and allergic rhinitis presented to the emergency department (ED) with worsening fatigue, minimal responsivity to external stimuli, and diffuse muscle weakness for 2 months.

Boy presents with fatigue, minimal responsivity, and diffuse muscle weakness

**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

Case Studies

News

Infant feeding recommendations have undergone significant changes over the past 2 decades. “The 2000 guidelines actually recommended against feeding allergenic food. So we advised no milk until 1 year of age, no eggs until 2, no peanuts, or seafood until 3,” said David Stukus, MD, professor of clinical pediatrics and director of the Food Allergy Treatment Center at Nationwide Children’s Hospital and the Ohio State University College of Medicine in Columbus, Ohio.

By 2008, recommendations shifted, though they still did not actively promote early allergen introduction. A major turning point occurred with the Learning Early About Peanut (LEAP) trial published in 2015. “This was the first prospective, randomized clinical trial that took a group of infants and exposed them to peanut on a regular basis early in life, and compared them to a group of infants that avoided peanut, and what they showed after that trial was 81% reduction in peanut allergies in those infants who ate it on a regular basis,” Stukus said.

Since then, multiple prospective clinical trials and meta-analyses have demonstrated that introducing allergenic foods early and maintaining them consistently in the diet is both safe and effective for preventing food allergy.

Despite the evidence, many parents remain fearful or uncertain. Stukus advised clinicians to address concerns proactively. “Reassurance is the key, I think, some humility as well,” he said. He noted the importance of acknowledging how prior evidence differed from current recommendations. Pediatricians can integrate food allergy prevention discussions into routine visits, including newborn, 2-, 4-, 6-, and 9-month checkups. Handouts and consistent messaging can further support families.

True severe allergic reactions as a first exposure are rare, Stukus emphasized, and families should be reassured while also receiving practical advice on how to safely introduce allergenic foods.

Parents may request screening tests before introducing foods, but these should be discouraged without a clinical indication. “IgE tests are really designed to detect specific IgE, but they’re not designed to diagnose anything. We get a lot of false positives. Panel tests cause a lot of overdiagnosis, misdiagnosis, and really talking about the harm that comes from a wrong diagnosis,” Stukus explained.

In cases where parents insist, a focused discussion on specific concerns may help guide next steps. If testing is pursued, clinicians should clarify how results will be used and consider in-office food introduction when feasible.

Introducing allergenic foods only once is not enough. “It’s really intentionally keeping it in the diet consistently,” said Stukus. While strict dosing guidelines are not necessary, families can be encouraged to make regular inclusion part of the routine. Revisiting the topic at future visits is also important.

Many families never receive counseling on food allergy prevention. Stukus suggested systematic approaches, such as checklists or standardized handouts, to ensure discussions occur. “It takes effort, just like anything else that we do in medicine; it’s really making sure that you put this into your blueprint that you have for a visit,” he said.

By embedding food allergy prevention into routine pediatric care—particularly for underserved or high-risk populations—clinicians can help reduce future allergy burden.

David Stukus, MD, on how early allergen introduction lowers food allergy risk

Stukus D. Feeding the Future: How to Prevent Food Allergies. Abstract. Presented at: American Academy of Pediatrics 2025 National Conference & Exhibition. September 26-30, 2025. Denver, Colorado.

Early allergen introduction, beginning in infancy and sustained over time, can safely reduce food allergy risk, said David Stukus, MD, at AAP 2025.

Then visit our website on July 23 at 3:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis. 

This case was presented by Umer Muhammad, MD; Neil Copeland, MD; and John Bishara, DO

A 23-month-old girl presented with a 3-day history of cough, rhinorrhea, and increased work of breathing. Initially, she was treated for bronchiolitis at an urgent care center, where a nasopharyngeal swab identified adenovirus. Despite initial treatment, the patient's condition worsened, and she required oxygen supplementation via nasal cannula for oxyhemoglobin desaturation. Her hypoxemia further deteriorated, necessitating an increase in oxygen supplementation (

On physical examination, the patient showed signs of respiratory distress. A chest x-ray (CXR) revealed opacities in the right middle and lower lobes. The patient's condition improved with supportive care, and she was discharged after several days in the hospital. 

However, 9 months later, due to recurrent wheezing, she was referred to the pulmonary service for further evaluation. A follow-up CXR, taken 3 months after the initial infection, demonstrated complete opacification of the right hemithorax, with a mediastinal shift to the right, as well as collapse of the right upper and middle lobes. 

Congenital pulmonary adenomatoid malformation (CPAM) 

website on Wednesday, July 23, at 3:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

Can you diagnose this patient? Take our poll and find out! Then check back for the full case, differential diagnosis, and correct diagnosis.

Puzzler poll: Diagnose this 23-month-old with cough and rhinorrhea

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.

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 six days earlier. In the delivery room, she still had fresh excoriation marks on her arms. She had not received any MMR vaccines.

Six hours after admission, the patient delivered a female infant via spontaneous vaginal delivery at 35 weeks’ gestation. The baby weighed 2410 grams, which was approximately the 50

 percentile for her gestational age. The baby had mild respiratory distress after delivery and briefly required supplemental oxygen via blow by during transitioning. Apgar’s of 8 at 1 minute and 9 at 5 minutes was given at delivery. The baby subsequently improved and was allowed to room in with mother without the need for NICU admission. Nursing staff noticed a rash on the baby’s back. 

 website on Wednesday, August 20 at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

Can you diagnose this rash in a newborn?

 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.

Brian Chang, MD, MS

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