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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.

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Get caught up with Contemporary Pediatrics! This list helps you navigate our top stories from the week, all in one place. 

Weekly review: Clesrovimab for RSV approved, new dupilumab data, and more

 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.

Currently, Vimkunya is FDA-approved for use among individuals aged 12 years and older.

Bavarian Nordic initiates trial of chikungunya vaccine in children aged 2-11 years

A recent study found screen time and socioemotional problems in children are linked in both directions, with gaming tied to greater risk than other activities.

Study links screen time to socioemotional problems in children, with bidirectional effects 

Michael O. Daines, MD, division chief, Pediatric Allergy and Immunology, University of Arizona College of Medicine; Principal investigator, phase 3 study of Panzyga for PANS. 

Michael O. Daines, MD, outlines key diagnostic criteria and treatment challenges for pediatric acute-onset neuropsychiatric syndrome (PANS), emphasizing the need for multidisciplinary care and improved treatment access.

Michael Daines, MD, discusses pediatric acute-onset neuropsychiatric syndrome

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

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Limping takes many forms, and the cause is not always obvious. The keys to diagnosis are careful observation of the gait disturbance and systematic evaluation, especially high-quality radiographs.

CME: A practical approach to the child who limps

**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.

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

A healthy 12-month-old girl presented with one small skin lesion over the right heel (Image 1) 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, 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 re-checked. After 3 months, the child showed full resolution of the skin lesion over the heel area (Image 2).

Below, take your best guess at diagnosing this patient.

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

Thank you for taking this Contemporary Pediatrics poll! Want more puzzler case studies? 

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

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Case Studies

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

Music therapist Jenna Marcovitz discusses the role of pediatricians in making timely referrals to music therapy to support whole-child health.

  Connecting families to music therapy, with Jenna Marcovitz, MA

Music therapy can support pediatric patients across physical, emotional, and developmental domains—but first, families need to know the service exists. In a follow-up conversation to her 

on music therapy’s wide-ranging benefits for children, Jenna Marcovitz, MA, MT-BC, CCLS, RMT, director of Music Therapy UCLA Health and Children’s Music Fund/UCLA Music Therapy Internship Supervisor, emphasized the role of pediatricians in connecting families with these valuable services. Sharing even basic outcomes, such as support for speech and language development, can serve as an entry point into care.

“The first step, I think a great resource could be suggesting music therapy to patients and families—maybe they haven't even heard of it,” Marcovitz said. For families in the United States, she recommends the American Music Therapy Association’s online directory to locate board-certified professionals. 

“It’s a great starting point,” she said. “You can find organizations that provide music therapy or private practice professionals who can provide, even in-home music therapy services or telehealth music therapy services.” Globally, the World Federation of Music Therapy offers similar access to regional directories.

In an earlier conversation, Marcovitz outlined how music therapy is tailored to clinical goals and delivered through evidence-based interventions in a therapeutic relationship. “Although music entertainment can have therapeutic benefit, it isn’t always necessarily targeting a physical goal,” she explained previously. “In music therapy, that is what we do. In situations where you are working with patients and families that are under immense amounts of stress and existential and emotional distress, music therapy can provide a space for them to really process their emotions,” Marcovitz said. “We know emotions are connected to our whole body health.”

By collaborating with multidisciplinary healthcare teams and centering individualized goals, Marcovitz and her colleagues aim to integrate music therapy not just as a creative complement to care, but as a foundational component of holistic pediatric treatment.

Click here to watch Marcovitz explain how music therapy helps in pediatric care.

Disclosure: Jenna Marcovitz discloses grants/research funding for music therapy interns

Connecting families to music therapy, with Jenna Marcovitz, MA

In this video interview, Jenna Marcovitz, MA, MT-BC, CCLS, RMT, provides insight to music therapy and how it can benefit a wide range of pediatric patients.

Jenna Marcovitz, MA explains how music therapy helps in pediatric care

In this video interview, Jenna Marcovitz, MA, MT-BC, CCLS, RMT, director of Music Therapy UCLA Health and Children’s Music Fund/UCLA Music Therapy Internship Supervisor, explained why music therapy is and some common misconceptions associated with it. 

Marcovitz stated that music therapy is an evidence-based, clinically driven intervention that supports children across a range of medical and developmental needs. 

“Anyone and everyone can benefit from music therapy,” Marcovitz said. “Because it is so individualized and tailored to support clinical goals for the individual and their families and their communities. Premature infants demonstrate very significant physiological changes when supported with live music interventions by board-certified music therapists,” she explained. 

These benefits include improved oral feed coordination, increased weight gain, enhanced oxygen saturation, and faster hospital discharge. The mechanisms behind these outcomes are often rooted in rhythmic entrainment—how the brain and body align with the timing of music, facilitating developmental and autonomic regulation.

“It helps within the neurodivergent population and with individuals with developmental or sensory needs,” Marcovitz said, citing its contributions to behavioral modification and communication support. The broad mental health applications are especially notable, ranging from anxiety and depression support to improving emotional expression and resilience. “Pediatric oncology patients tend to really benefit from music therapy, from an emotional, social, psychological standpoint, as well as physically,” she said, referencing its use in managing pain, nausea, and other treatment side effects.

Marcovitz noted that the appearance of musical therapy could be misleading, and it goes beyond entertainment.

“Although music entertainment can have therapeutic benefit, it isn’t always necessarily specifically targeting a physical goal or some targeted emotional, psychological goal. In music therapy, that is what we do.”

Sessions are built around ongoing clinical assessments and evidence-based techniques—“within the therapeutic relationship, which is just as important, if not even more important than the music itself,” she said.

Jenna Marcovitz, MA, explains how music therapy helps in pediatric care

Beginning in mid-May, the FDA, Health and Human Services (HHS), and the CDC outlined a new COVID-19 vaccine framework and announced on May 27 the removal of the vaccine from the CDC immunization schedule for healthy children and pregnant individuals. However, according to the CDC's Child Immunization schedule that was updated on May 29, healthy individuals aged 6 months to 17 years who are not moderately or severely immunocompromised can receive the vaccine through a "shared clinical decision-making process."

Below is a timeline recap of these changes and announcements. 

May 20, 2025: FDA announces new COVID-19 policy for children 

On May 20, 2025, the FDA announced a new COVID-19 vaccination regulatory framework for future seasonal vaccines and additional clinical trial requirements for approval of vaccines intended for healthy individuals. According to the framework, published in the 

), the FDA will use an immunogenicity basis to make favorable benefit-risk findings for adults older than 65 years, and for all persons aged 6 months and older with at least 1 risk factor that increases risk for severe COVID-19 outcomes.

 publication was authored by Martin Makary, MD, MPH, commissioner of the FDA; and Vinay Prasad, MD, MPH, director of the FDA's Center for Biologics Evaluation and Research, stated for healthy individuals aged 6 months to 64 years, with no risk factors for severe COVID-19, the FDA "anticipates the need for randomized, controlled trial data evaluating clinical outcomes," before biologics license applications for the vaccines can be approved.

Click here for more on the policy outline, as it was reported at the time of publication.

May 27, 2025: CDC pulls COVID-19 vaccine recommendation for healthy children, pregnant individuals 

Just a week after the new framework was announced, on May 27, 2025, HHS Secretary Robert F. Kennedy Jr. announced that the CDC had pulled the recommendation for routine COVID-19 vaccination among healthy children and pregnant women.

In a video posted to X, Kennedy Jr. stated the following: 

"I couldn't be more pleased to announce that, as of today, the COVID vaccine for healthy children and healthy pregnant women has been removed from the CDC recommended immunization schedule."

At the time of the announcement, multiple health care professionals 

about the recommendation removal and frequent changes to policies by federal agencies.

"The craziness never ends, and the recent change to the CDC immunization schedule regarding the COVID-19 vaccine and use in pregnant women and healthy children is complete madness," stated Tina Tan, MD, FIDSA, FPIDS, FAAP, in an interview with 

, president of the Infectious Diseases Society of America, an attending for Infectious Diseases at Ann & Robert H. Lurie Children's Hospital of Chicago, and a professor of Pediatrics at Northwestern University's Feinberg School of Medicine.

"COVID-19 infection can have extremely serious consequences in pregnant women, resulting in hospitalization, pre-term labor, pre-eclampsia, heart injury, blood clots, hypertension, and kidney damage," added Tan. "Not vaccinating them is sheer madness and will contribute to a significant increase in possible morbidity and mortality. Also, not vaccinating healthy children is completely inappropriate, given that some healthy children can have severe COVID infections with long-lasting consequences. This will make it much more difficult for practitioners as they will have to determine which of their patients are eligible for the COVID vaccine to determine how much vaccine to order and to determine if insurance will cover vaccine cost."

Click here for more reactions to the removal of the vaccine recommendation, as it was reported on May 27, 2025.

May 29, 2025: Updated CDC child immunization schedule 

As of May 29, it appears the CDC has again changed course on routine COVID-19 vaccination, stating that children aged 6 months to 17 years who are not moderately or severely immunocompromised may receive the vaccine in situations where the parent wishes their child to get the vaccine, along with clinical judgement provided by a health care professional on a case-by-case basis.

For clarity, the "Shared clinical decision-making" section 

In this article, we recap a timeline of recent federal agency changes to routine COVID-19 vaccination intended for the pediatric population. 

David R Godley

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