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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.

Articles

Severe RSV disease in 2022–2023 was most likely to occur in infants under 6 months and older children with pulmonary or neurologic conditions.

Age, condition-specific risks for severe RSV disease in children

Colleen Sloan, PA-C, RDN is a board-certified PA and registered dietitian. 

Colleen Sloan, PA-C, RDN, highlights what she is seeing in practice related to screen time, devices, and social media and impacts on nutrition. 

Discussing social media and potential nutrition impacts with Colleen Sloan, PA-C, RDN

Delandistrogene moxeparvovec-rokl (ELEVIDYS) showed significant motor function improvements in 8- to 9-year-old Duchenne muscular dystrophy patients in part 2 of the phase 3 EMBARK study.

Duchenne muscular dystrophy gene therapy demonstrates improved motor functions

Jenna Marcovitz, MA, MT-BC, CCLS, RMT, director, Music Therapy Integrative Medicine, UCLA Health.

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

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Offering an inclusive, safe space along with the best care for transgender and nonbinary adolescent patients is more important than ever.

Providing the best care for transgender 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

 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 Rutva Vora, BS; and Monica Guirguis, DO.

A 2-month-old female was born after an uneventful pregnancy at 40 weeks’ gestation via vacuum-assisted vaginal delivery to a G2P1011 female. The patient’s APGAR scores were 7 and 9 at 1 and 5 minutes, respectively, at birth. No bleeding or other complications were reported during delivery. The newborn and mother were discharged two days after delivery without requiring NICU stay or interventions. The infant briefly developed a small soft palpable scalp swelling that resolved within days after delivery. The patient followed an otherwise uncomplicated growth progression since birth. She did exhibit mild reflux symptoms, which were managed with supportive care measures. Physical examination after delivery and subsequent exams revealed no abnormalities, including no signs of scalp swelling or injury.

At 8 weeks of age, the patient presented to the Emergency Department with a 3-day history of new-onset scalp swelling. The parents decided to seek medical attention after the swelling became noticeably enlarged. Parents denied any changes in her mental status, vomiting, fevers, lethargy, irritability, or any other new concerns. She did have symptoms of gassiness and fussiness that were unchanged from baseline. No history of trauma was reported, and there were no concerning signs suggestive of nonaccidental trauma. The patient appeared well, with a soft, fluctuant palpable subcutaneous fluid collection overlying the parieto-occipital scalp, without crossing suture lines. The anterior fontanelle was soft and non-bulging, and there was no hemotympanum.

Bleeding disorder (e.g. Von Willebrand Disease)

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

Diagnose this 2-month-old with scalp swelling

 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 Wednesday, May 7, 2025 at 12:00 PM Eastern Time or later for the full case presentation, differential diagnoses, and correct patient diagnosis.

This case was provided by Akash Deswaney, MD, Neil Copeland, MD, and John Bishara, DO.

An 18-day-old female presented to the ED with concerns of apnea, cyanosis, and decreased feeding. The mother reported intermittent cyanosis of the lips, pale-appearing skin, and suspected apnea episodes. Since birth, Mom states patients had retractions since birth, which the PCP reassured her was normal periodic breathing. She had nasal flaring and grunting a couple of days after discharge from the nursery. Mom has noticed she breathes quickly, in the 60s or 70s at times.

Initial vitals in the ED showed hypoxemia, tachypnea, and fluctuating oxygen saturations were between 65-100% on room air. A chest X-ray is shown (

Click here for the full case presentation, differential diagnoses, 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. 

News

Diagnose this 18-day-old female with apnea, cyanosis, decreased feeding concerns

 on Monday, March 24, 2025 at 12:00 PM ET or later for the full case presentation, differential diagnoses, and the correct patient diagnosis. 

This case was provided by Muhammad Aamir Anees and Bernard A. Cohen, MD

Want more puzzler and dermatology cases? 

A healthy 9-year-old girl developed an asymptomatic eruption of discrete and confluent, 2 to 3 mm, hypopigmented papules in a linear pattern along the lines of Blaschko on the back of her left thigh and leg over the past 3 weeks. The lesions cleared without treatment 4 to 5 months later. 

Inflammatory linear verrucous epidermal nevus

on Monday, March 24, 2025 at 12:00 PM ET or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

Take your best guess and try to diagnose this 9-year-old girl's linear eruption on the back of her left thigh and leg. Stay tuned for the full case presentation and correct diagnosis! 

Poll: What's the diagnosis of this linear eruption on the leg of a 9-year-old girl?

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 at UCLA Health, 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.

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.

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

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

Peter S. Jensen, MD, discusses the risks and benefits of social media use by children, emphasizing the need for parental oversight and national guidelines.

Social media and pediatric mental health with Peter S. Jensen, MD

Social media use among children and adolescents presents both opportunities and risks, yet guidelines for its safe use remain underdeveloped. In this brief discussion with 

, Peter S. Jensen, MD, highlighted the challenges of unmonitored social media access, its potential mental health impacts, and the importance of structured oversight. 

Jensen is a child and adolescent psychiatrist and the founder and board chair of The REACH Institute, a 501(c)(3) nonprofit organization that aims to deliver effective, scientifically proven mental health care to children and families by providing thousands of primary care physicians with training in evidence-based therapies to better diagnose, treat, and manage child mental health issues.

Jensen stressed the need for a collaborative effort among pediatricians, educators, and policymakers to establish clear recommendations that help protect children while allowing for the responsible use of social media. 

MORE: Peter Jensen, MD, discusses mental health in primary care

Social media has been linked to mental health for some time now. hat are your thoughts or clinical pearls about dealing with social media and mental health in the pediatric population? 

Well, the first thing to consider is that this is a new invention that has taken the world, the country, parents, and kids by storm. Think about when the car was invented—it took people a while to realize that handing a teen the reins to a buggy was not the same as handing them the keys to a vehicle [in which] they could get seriously hurt. 

There are a lot of risks involved. It took time for the country to establish training programs, licensing procedures, and age limits [for driving cars]. We have not yet done that for social media. 

We know that social media can be beneficial, but also very harmful. Are we just handing our kids the keys and saying, “Good luck, I hope everything works out”? Parents may think, “My child asked me for a phone. I need to get one because all the other kids have phones.” But wait—these are potentially dangerous tools. We see the impact of social media on anxiety, cyberbullying, and other problematic issues that have emerged because we did not anticipate these risks. 

Now we have to get ahead of it. Several questions arise: At what age should a child be allowed on social media? That is an important question, and pediatricians, educators, and the [National Parent Teacher Association (PTA)] should weigh in. It is certainly not at age 8. Maybe a general rule could be age 14. What skills does a child need? How much should a parent monitor their use [of social media]? Before learning to drive, a child starts with a learner’s permit, and a parent has full access to their driving habits. 

Perhaps social media use should follow a similar model—starting at age 13 or 14 with full parental oversight. If the child demonstrates responsible use, they could gradually earn more independence, understanding both the risks and benefits. 

We need a national standard. Major organizations, including the American Academy of Pediatrics [and those that specialize in] family medicine, psychiatry, [and] psychology, and the PTA, need to weigh in and analyze the evidence. Right now, the biggest danger is unmonitored use. Parents may say, “I shouldn’t read my child’s journal,” but this is not the same as a journal. When a child presses send [on social media], that content can spread worldwide, including personal photos and information. This poses huge risks. 

We are already seeing the destructive impact of cyberbullying and other social media–related issues. Once all the data are in, we will likely agree as a country and as childcare providers that we need to establish appropriate limits. We must come together to address this sooner rather than later. It is a national priority that we all must be involved in.

1. The resource for advancing children’s mental health. The REACH Institute. Accessed February 6, 2025. https://thereachinstitute.org/

Peter S. Jensen, MD, discusses the risks and benefits of social media use by children, emphasizing the need for parental oversight and national guidelines. 

Frances Grimstad, MD, MS

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