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Tracey Gaslin, PhD, CPNP, FNP-BC, CRNI, RN-BC, CEO, Alliance for Camp Health.

Articles

In this Q&A, nurse practitioner Tracey Gaslin, PhD, discusses tick bites in pediatric patients, from how to prevent a bite to what to do after a bite, and highlights resources available from the Fight the Bite initiative.

Talking ticks with Tracey Gaslin, PhD, CPNP, FNP-BC, CRNI, RN-BC

 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.

Donna Hallas, PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN, shares her thoughts on a featured article from the October 2025 issue of Contemporary Pediatrics.

Screening for suicide ideation and suicide attempts is a priority

. 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.

Key highlights from the conference included public health, advocacy for vaccines, and artificial intelligence.

Our coverage recap from IDWeek 2025

Horton, Jennifer, MD, University of Utah, Primary Children’s Hospital. 

He had no prior history of recurrent ear infections, abscesses, or boils. Can you guess the diagnosis?

Can you diagnose this 10-year-old with an oozy ear?

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

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LGBTQ+ children and adolescents may be particularly vulnerable during these unprecedented times.

Untangling comorbidities in gender diverse children and adolescents

**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

Alcohol use during adolescence is associated with an increased risk for mental health disorders, cognitive impairments, and later substance use disorders. A new study led by Rutgers researchers and published in 

 examined how genetic, psychological, and environmental factors contribute to the initiation of alcohol use and the transition from a first sip to a first full drink.

The study used data from the Adolescent Brain Cognitive Development Study, the largest long-term investigation of brain development and child health in the United States. This National Institutes of Health–funded cohort has followed nearly 12,000 youth from age 9 and will continue through age 18. The current analysis focused on 3 milestones: age at first sip of alcohol, age at first full drink, and the time it took to progress between the 2.

Researchers incorporated polygenic risk scores, neuroimaging data, psychological assessments, and environmental measures to evaluate predictors of early alcohol use. Stepwise Cox proportional hazard models were applied to determine which factors uniquely contributed to each drinking milestone.

Genetic predispositions, impulsivity-related traits, and environmental conditions each played significant roles. “We found that risk for early alcohol use was not just related to key environmental factors like parental substance use but was also associated with individual characteristics like genetics and impulsive personality,” said Sarah Brislin, PhD, assistant professor of psychiatry at Rutgers Robert Wood Johnson Medical School and senior author of the study. “No one type of information provided the whole picture.”

Among the strongest predictors of early sipping were genetic liability for behavioral disinhibition, impulsive personality traits, and prenatal exposure to substances. Transition to a full drink, however, was more strongly influenced by sensation-seeking and genetic predisposition than by environmental factors.

“Environment, particularly home environment, plays a key role in when kids have their first exposure to alcohol; however, once they have their first sip, individual factors like genetic predisposition and sensation-seeking personality features seem to be driving whether they progress to additional milestones,” Brislin explained.

Environmental variables such as parental history of substance use, prenatal drug or alcohol exposure, and family conflict increased the likelihood of earlier sipping and drinking. Conversely, protective factors included higher religiosity, greater parental monitoring, and stronger school engagement. Adolescents living in neighborhoods with greater educational opportunity and socioeconomic stability also had higher rates of early sipping, a finding the authors attributed to greater alcohol availability in the home.

Polygenic risk scores for behavioral undercontrol and sensation-seeking traits showed consistent associations across all drinking milestones. Each standard deviation increase in the genetic risk score for behavioral disinhibition was associated with a 12% to 44% higher risk for initiating or progressing in alcohol use.

Neuroimaging data, however, did not yield significant associations with early sipping or drinking milestones in this cohort. The authors noted that larger samples and longer follow-up may be required to detect neural contributions.

Brislin emphasized that the findings support multifaceted prevention strategies. “Programs that address impulsivity, strengthen school engagement, and promote positive parenting may be especially beneficial,” she said. Early screening that integrates genetic, behavioral, and environmental risk factors may help identify adolescents most vulnerable to early alcohol initiation.

The study highlights the importance of considering both individual predispositions and environmental exposures when developing interventions. By identifying at-risk youth before alcohol initiation, clinicians and public health professionals may be able to reduce future substance use and related health consequences.

Study sheds light on early risk factors for teen drinking. News release. Rutgers University. July 29, 2025. Accessed August 26, 2025. https://www.eurekalert.org/news-releases/1093085

Choi M, Aliev F, Barr PB, et al. Genetic, psychological, and environmental factors are uniquely associated with onset of alcohol use in the adolescent brain cognitive development (ABCD) study. 

. 2025;15(1):229. doi:10.1038/s41398-025-03454-9

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

News

Genetic and environmental influences predict early adolescent alcohol use

Novel therapies are constantly being developed—with dozens of new treatments predicted for approval over the next decade. What isn’t moving as quickly is the ability to offer these therapies in a timely way to the children who need them most because newborn assessments failed to identify the conditions they are designed to treat.

Newborn screening (NBS) tests are used to screen for about 35 core disorders at birth, but many novel treatments target disorders that are not included in the screening and go untreated as a result.

 industry experts highlight the need for better screening tools that offer quicker review and implementation of standards as novel treatments are developed.1 The study called for significant changes to current screening tools, as well as an overhaul of the way new disorders are added to these assessments.

“NBS will soon need to adapt to 2 major forces—advanced technologies such as genome sequencing, and a new generation of therapies,” said lead author Donald B. Bailey Jr., PhD, a distinguished fellow in the Genomics, Bioinformatics, and Translational Research Center at RTI International in Research Triangle, North Carolina. “Although each poses a different set of challenges, they are inextricably linked and the needed system-level changes are similar. We chose to focus on the treatment side of things, to limit the discussion.”

A new screening tool is critical to address the large and “growing pipeline” of novel treatments already in development across many different companies, Bailey added.

The current NBS tool is really just a recommendation created jointly by the US Department of Health and Human Services Recommended Uniform Screening Panel (RUSP) and the Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC). States use this guidance to create their own screening tools, which generally include about 30 disorders that may appear at birth and benefit from early treatment. However, the new report argued that these recommendations aren’t keeping pace with novel therapies, and as a result there are missed opportunities for meaningful intervention.

Only 6 new disorders have been added to the RUSP/ACHDNC recommendations since 2006. Part of the problem, the report notes, is that even with the shortest timeline, it takes about 2 years for new conditions to be considered, reviewed, and recommended by the panel. After that step, it takes states about 3 to 5 years on average to add those recommendations to their screening tools.

The paper provided a significant example in the case of a treatment for spinal muscular atrophy. Nusinersen was first suggested to the RUSP/ACHDNC organization in 2008, but was not recommended until 2018. This means that more than a decade likely passed when infants when this condition could have potentially benefitted from including a screening for this disorder at birth.

“Disorders previously lacking treatments could soon have interventions that are curative or significantly disease-modifying,” the report authors noted. “Their efficacy almost certainly will be maximized if provided early, underscoring the necessity of early screening and diagnosis.”

Even if a national recommendation is made more quickly, the report authors argued that it sometimes takes states several years more to add these screenings to their own assessments—if they are added at all.

“Families, patient advocacy groups, and clinicians are frustrated by what they consider an unnecessarily long process of decision-making and implementation, resulting in preventable death, disability, or a lifetime of needed care,” the report noted. “Policy makers, on the other hand, are concerned about adding new disorders without adequate evidence. Additionally, most state NBS laboratories cannot add new disorders without legislative approval, funding, and time to ensure adequate implementation.”

The problem, however, is that most newborn assessments don’t look deeply enough to identify the needs that many of these novel therapies could treat. Some of these challenges new therapies could pose in regard to screening is that many of them will require some form of genetic testing and ultimately genome sequencing.

“These would-be new technologies that would require a major shift in screening methods for most states,” Bailey said.

The program needs a substantial overhaul, the report continues, since its current setup is that of a loosely interconnected web of independent state programs. As new therapies evolve, this system is not equipped to be able to readily adapt to changes and updates. The paper stops short of suggesting a better system, but spells out the urgent need to develop a more responsive, next-generation system. The report authors call for things like extensive stakeholder engagement, the cooperation of federal and state agencies, and national legislation in developing a new screening system.

The main goal of establishing a new system for creating and updating guidelines would be to ultimately bring the benefits of new treatments to babies who need them more quickly, Bailey explained.

“Pediatricians could potentially be caring for more children with rare disorders who need specialized treatments,” he said. “Although some of these treatments will need to be provided at a specialty clinic, pediatricians will always remain the most trusted source of information for families.”

1. Bailey DB, Porter KA, Andrews SM, Raspa M, Gwaltney AY, Peay HL. Expert evaluation of strategies to modernize newborn screening in the United States. 

 2021;4(12):e2140998. doi:10.1001/jamanetworkopen.2021.40998

Many new therapies have been developed over the past decade to treat disorders that are often present at birth and early treatment can lead to better outcomes. However, the screenings for newborns have been slow to adapt.

Experts call for better newborn screening to take advantage of novel therapies

The etiology of acne is complex and multifactorial with genetics playing a large role in determining risk, particularly for those individuals with severe acne. The results of a recent study have further elucidated the genetics of acne and advanced the knowledge of the genetic basis of acne risk by identifying versions of the genes that are common among individuals who suffer from this very common inflammatory skin disorder.

It is estimated that more than 85% of teenagers are affected by acne to some degree, and up to 8% have been reported with severe disease, making acne the most prevalent skin disease worldwide. Depending on the severity of the disease, acne can significantly impact self-image and the quality of life (QOL). Major complications of acne include scarring as well as the, at times, significant psychosocial distress that can persist long after active lesions have disappeared.

“Approximately 80% of a person’s risk of suffering from severe acne can be explained by differences in their genetic makeup,” said Miguel E. Rentería, PhD, senior research fellow, Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia, and co-author of the study. “It is not a single gene but rather variations across hundreds of genes in the genome that determine whether someone is likely to get acne or not, and the extent or severity of the condition.”

Rentería and fellow colleagues recently performed a large meta-analysis of genome-wide association studies (GWAS) of acne undertaken in 9 independent cohorts compromising a total of 615,396 study participants. Of the participants, 20,165 were acne cases and 595,231 were controls, making it the largest study of its kind, with the aim of identifying specific genetic variants that are more common among people with moderate or severe acne relative to those who have mild or no acne. Fine-mapping and genome-wide analytical approaches were combined to gain insights into the underlying genes and pathways through which the associated loci contribute to disease susceptibility.

Researchers could identify 29 new genetic variants that are more common in individuals with acne, as well as confirm 14 of the 17 variants already known to be associated with the condition, raising the total number of known acne risk loci to 46. Results also exposed relationships between acne and other complex/common traits, including behavioral, hormonal, inflammatory, and psychiatric traits, as well as shared molecular basis between acne and Mendelian hair and skin disorders, including pustular psoriasis.

Fifteen of these loci have been reported to have an effect in European populations while the remaining 2 have been reported to have an effect in a Han Chinese population. This highlights the potential differences in the genetic architecture of acne between different ethnic populations, warranting further investigation in studies of diverse ancestry. According to Rentería, however, one of the main limitations is the lack of availability of cohorts or biobanks focused on diverse ancestries.

“Our study results highlight possible molecular pathways that are implicated in acne, opening new avenues for fundamental research and development of therapeutic targets,” Rentería said. “Looking forward, we could apply this knowledge to do genetic tests of acne risk and identify those individuals who are likely to present with acne.”

Novel research studies will need to be designed and performed to better understand the role of the newly identified acne genes and the mechanisms of action of these new variants need to be characterized and their potential as therapeutic targets to treat acne need to be assessed, he said.

According to Rentería, the estimation of individual genetic acne risk scores relative to the general population will be perhaps the most immediate application of the current study findings.

“We demonstrated that it is possible to use a person’s genetic information to estimate their genetic risk of developing acne based purely on which genetic variants they inherited from their parents,” Rentería said. “In the future, we will be able to identify those individuals who are at high-risk of acne many years before they even notice the first signs.”

Finding genes implicated in acne is the first step toward patient stratification and personalized medicine. Although continued research has been inching closer towards personalized medicine on the genetic level, this fulfillment is likely a few years away. A clinician’s treatment and management choices in the future could be informed by the genetic profile of each individual patient, Rentería said, however there is still much work to be done regarding characterizing the genetic basis of different acne types and treatment response across different life stages.

Specific genetic variations could be key in identifying acne risk far before the signs arise.

Christy L. Olezeski, PhD

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