Animal Allergies

Food Allergies

Allergy, Immunology, and ENT

Cardiovascular Diseases

Cardiology

Acne

Atopic Dermatitis

Dermatology

Emergency Medicine

Diabetes

Endocrinology

Formula

Nutrition

Obesity

Gastroenterology

Antibiotic Resistance

Bacterial Conjunctivitis

COVID-19

Influenza

Pneumonia

Sexually Transmitted Diseases

Vaccination and Immunization

Vaccines

Infectious Diseases

ADHD

Addiction

Antisocial Personality Disorder

Anxiety

Autism

Depression

Developmental/Behavioral Disorders

Psychiatry

Mental, Behavioral and Development Health

Concussion

Epilepsy

Headache

Neurology

Neonatal/Perinatology

OB/GYN

Pain

Drug Pipeline News

Pharmacology

Telemedicine

Practice Improvement

Asthma

Cystic Fibrosis

Respiratory

Rheumatology

News 

All News

PNP Corner

AAP News

Media

Around the Practice

Cure Connections

Expert Interviews

Insights

Medcast

Peer Exchange

Peers & Perspectives

Podcasts

Webinars

Puzzler

Publications

Contemporary Pediatrics Journal

Supplements And Featured Publications

CME/CE

Resources

Handouts

Job Board

Conferences

Conference Coverage

Conference Listing

Partnerships

Subscribe

Editorial

Editorial Advisory Board

Writer’s Guidelines

Reference Guidelines

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

. 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.

Many families face common potty training challenges, including anxiety and setbacks, highlighting the need for patience and personalized strategies.

Study: Potty training challenges common, with anxiety and setbacks affecting many families

Achieving the primary endpoint, 44.6% and 54.3% of patients treated with upadacitinib (15 mg and 30 mg) reached 80% or more scalp hair coverage.

Alopecia areata data: Upadacitinib demonstrates improvements in scalp hair coverage

Nektar Therapeutics remains on track to announce top-line phase 2 data in December. 

FDA grants fast track to rezpegaldesleukin for severe alopecia areata in ages 12 and up

Pegcetacoplan (Empaveli; Apellis Pharmaceuticals) is indicated for patients 12 years or older to reduce proteinuria.

FDA approves pegcetacoplan as first treatment for C3 glomerulopathy or IC-MPGN

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

About Us

Advertise

Contact Us

Terms and Conditions

Privacy

Do Not Sell My Personal Information

Contemporary Pediatrics – Clinical News & Pediatrician Practice Tips

Facebook

LinkedIn

Instagram

Clinical

Gynecology

Infectious disease

Mental Health

Oncology

Rheumatoid Arthritis

Sexual Health

View More

1rem

Authors

A variety of nonprescription treatments, supplements, and patches can alleviate pain for children and adolescents.

Healing the young athlete with OTC medications

**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

According to results from a randomized clinical trial that evaluated emollient intervention in infants not selected for risk of atopic dermatitis (AD), daily emollient application before the age of 9 weeks reduced incidence of AD at the age of 24 months.

According to the study authors led by Eric Simpson, MD, MCR, from the Department of Dermatology at Oregon Health & Science University in Portland, AD imposes a global health burden for children and can be a risk factor for developing food allergy and asthma.

Atopic dermatitis phenotypes and allergic disease development in children

Those who develop AD early in life can carry a risk of developing allergic comorbidities, sleep disturbances, behavioral changes, and mental health disorders and can experience bullying or stigma associated with AD.

"The objective of this current study, the Community-based Assessment of Skin Care, Eczema, and Allergies (CASCADE trial), was to determine whether once-daily, full-body emollient initiated within the first 9 weeks of life can reduce the cumulative incidence of AD in a community-based population not selected for risk," wrote Simpson and investigators.

The trial was a randomized, decentralized pragmatic clinical trial that featured 1247 infant-parent dyads from 25 community-based pediatric and family medicine clinics that are members of 4 statewide practice-based research networks. 

Dyads were broken up into one of 2 groups: a daily, full-body emollient application daily moisturizer group that started by 9 weeks of age or a control group that did not use emollient. Physician-diagnosed AD recorded in medical records by 24 months of age was the primary outcome of the study.

"In the primary analysis, the risk of diagnosed AD by age [of] 2 years in the intervention was compared with the control groups under an intention-to-treat assumption and missing outcomes were imputed using multiple imputation," wrote the study authors. "The relative risk (RR) was estimated using a generalized linear model with a binomial distribution and log link and reported 

 values from a 2-sided Wald test at the .05 level of significance. Risk differences [RDs] are presented using the 

 commands in Stata version 18 (StataCorp)."

Of the 1247 infants included in the trial, 44.3% were girls. The mean (SD) age at random assignment was 23.9 (16.3) days. At the 24-month mark, the cumulative incidence of AD was 36.1% (SE, 2.1) in the daily moisturizer group and 43.0% (SE, 2.1) in the control group, with an RR of 0.84 (95% CI, 0.73-0.97; 

 = .02). The effect magnitude was larger in the population not at high risk of AD (RR, 0.75; 95% CI, 0.60-0.90; 

A weaker intervention effect was observed for those who had a first-degree blood relative with atopic disease compared with children with a lower risk, though the interaction was not statistically significant. Additionally, protective effect of emollient was modified by a dog in the house, as a stronger effect of protection was observed of the intervention in a subset of families (RD, −14.2; 95% CI, −23.2 to –4.6) than in those without any pets (RD, 0.3; 95% CI, −9.6 to 10.3). 

Skin infections, a secondary outcome, occurred at lower rates in the daily moisturizer group compared with the control group (19.8% vs 21.1%; RR, 0.94; 95% CI, 0.74-1.20) with no statistical difference between groups.

Findings suggested that routine use of emollients for AD prevention could be an approach for families, as 64% of participants reported using emollients before study enrollment.

"This suggests that routine emollient use is part of infant skin care routines for many households in the US. The composition of the emollient likely makes a difference in efficacy, as differences have been observed in skin barrier assessments between ceramide and non–ceramide-containing moisturizers," wrote the authors.

Overall, results demonstrated that full-body emollient application that began in the first 2 months of life reduced the risk of AD development, particularly in those with a family history of AD and those who had a dog in the house.

The investigative team concluded by writing that "further work will be needed on the cost-effectiveness of this approach and implementation strategies" and that "the effect of this approach on allergic comorbidities is also a high priority for future work."

Simpson EL, Michaels LC, Ramsey K, et al. Emollients to prevent pediatric eczema: a randomized clinical trial. 

. Published online July 23, 2025. doi:10.1001/jamadermatol.2025.2357

Fitch J. Atopic dermatitis phenotypes and allergic disease development in children. July 25, 2025. Accessed July 28, 2025. https://www.contemporarypediatrics.com/view/atopic-dermatitis-phenotypes-and-allergic-disease-development-in-children

The study enrolled infants not selected for risk, a population that has been studied few times with regard to emollient intervention.

News

Study: Daily emollient for infants could reduce atopic dermatitis incidence

 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 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. 

Below, take your best guess at diagnosing this patient

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.

Case Studies

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

This case was presented by Giridhar Guntreddi, MD, FAAP, FAPHM; Achuth Jayasankar Kondoor; Taylor Boske; Neelima P. Theella, MD; and Jayasree Vasudevan Nair, MD, MPH, FAAP. 

A healthy 12-month-old girl presented with one small skin lesion over the right heel (

) for one month. On examination, her right lateral heel showed a round, white, pearl-like, hard, tiny lesion with a smooth appearance without any redness or itching. The patient's mother denied any pain, swelling, itching, or fever. No significant travel, bites, or heel-stick injuries were reported in the history. No systemic symptoms suggested any underlying systemic diseases. The infant is closely monitored at subsequent well visits and rechecked. After 3 months, the child showed full resolution of the skin lesion over the heel area (

Below, take your best guess at diagnosing this patient.

click here for the full case presentation, differential diagnosis, and correct patient diagnosis. 

Diagnose this infant with an asymptomatic pearl-like nodule on the heel

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. 

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

Cole Papakyrikos, MD

Articles

Latest Updated Articles