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Laura Santry, MD, is a third-year PEM fellow at Nemours Children's Hospital in Delaware.

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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.

Pediatric e-scooter injuries are surging as popularity rises, highlighting the need for increased awareness and safety measures to protect young riders.

The rise of electric scooter injuries: What the general pediatrician needs to know 

Aditi Rao
Final-Year Medical Student
Dr VMGMC, Solapur, India

A teenage girl with acne lesions on her forehead

. 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.

The FDA has assigned a target action date of February 28, 2026, for a potential expanded indication of pegvaliase-pqpz to include adolescents with PKU. 

FDA accepts pegvaliase-pqpz sBLA to expand treatment to patients with PKU aged 12-17 years

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

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

Full case: Don’t turn a blind eye to 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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This issue focuses on pediatricians like you who stand up for what they believe in - starting a business from scratch, fighting big insurance, or practicing in an economically disadvantaged community.

The Independent Pediatrician: The Challenges and Rewards of Independence

**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 Wednesday, October 29, 2025, at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

This case was presented by Jennifer Horton, MD, and Anna Suessman, DO, MED, FAAP

A previously-healthy and fully-immunized 10-year-old male presented to an outside Emergency Department for evaluation of one week of left ear pain with itching, drainage, and associated postauricular swelling. The parent reported that the symptoms began after frequent swimming while on vacation and were not relieved by over-the-counter swimmer's ear drops. There was no history of recent trauma or insect bites. He had no prior history of recurrent ear infections, abscesses, or boils. On the day of presentation, the patient reported a mild headache and neck pain, but denied any associated fevers, upper respiratory, or gastrointestinal symptoms. The patient had no significant past medical or surgical history and had no known allergies.

Upon arrival to the Emergency Department, the patient was non-toxic appearing and in no acute distress with normal vital signs for age (HR 97, BP 108/55, T 37.7C, RR 20, and SpO2 100% on room air). Physical examination was notable for proptosis of the left ear and a considerable amount of purulent drainage obstructing visualization of the left tympanic membrane. There was also fluctuant swelling and associated tenderness of the left mastoid without overlying erythema, induration, or warmth (Figure 2).

The patient had bloodwork completed, which was significant for leukocytosis to 15.5 (ref range: 4.5–13.5 10

/μL) with a left shift and elevated CRP to 32.8 (ref range: 0.0 - 8.2 mg/L). CBC also demonstrated a normocytic anemia with Hgb 9.3 (ref range: 11.5 – 15.5 g/dL), and CMP was notable for mild hypoalbuminemia of 2.6 (ref range: 3.2 – 4.7 g/dL), but labs were otherwise unremarkable. He was started on empiric IV Ampicillin-Sulbactam (Unasyn). While awaiting transfer to a pediatric facility, the patient underwent a CT temporal bone with/without contrast, which revealed the following (Figure 3).

Below, take your best guess at diagnosing this patient

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

Want more puzzler case studies? Click here.

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

News

Case Studies

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

Tina Tan, MD, FIDSA, FPIDS, FAAP, comments on the FDA's recent selection of the 2025-2026 influenza vaccine compositions, without the CDC's ACIP meeting and FDA's VRBPAC meeting. 

Tina Tan, MD on FDA's 2025-2026 influenza vaccine composition

On March 13, 2025, the FDA announced influenza vaccine virus strain recommendations to vaccine manufacturers for the 2025-2026 influenza season in the United States.

In a press release, the federal agency stated it convened a meeting of members from the FDA, CDC, and Department of Defense (DoD) for an in-depth discussion that informed the selected compositions of the influenza vaccines to be used.

The FDA stated it does not foresee any impact of timing or availability of the vaccines for the American public for next flu season.

 concerns among health care professionals

 that delays in vaccine availability could arise following the postponement of the CDC's Advisory Committee on Immunization Practices (ACIP) meeting, originally scheduled for February 26, 2025.

Shortly after the ACIP meeting was postponed, the FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC), scheduled for March 13, 2025, was canceled.

According to Tina Tan, MD, FIDSA, FPIDS, FAAP, editor in chief, 

; president, Infectious Diseases Society of America (IDSA), these meetings typically contribute to the FDA's selection of influenza vaccine compositions. This year, however, compositions were selected and announced by the FDA without these meetings having occurred. 

 published on March 20, 2025, the ACIP meeting has been rescheduled for April 15-16, 2025. The publication stated the reason for the initial postponement, according to the Department of Health and Human Services, was to accommodate public comment.

"Basically what was in the document that [the FDA] released about the selection was they just basically took the strains that the [World Health Organization] (WHO) had used, and were going to use those strains to make the vaccines," Tan said in the video above. 

The FDA stated that it used global and United States surveillance data to determine the recommendation for the vaccine manufacturers. These topics included, according to a press release

"Data and information on flu virus strains that are circulating in the US and globally and the types that are causing disease;

Data and information on mid-season vaccine effectiveness for the 2024-2025 vaccines; and 

Information on candidate vaccine virus strains for use in manufacturing flu vaccines for the upcoming flu season."

The federal agency recommended that the trivalent formulation of egg-based influenza vaccines for the upcoming flu season contain:

An A/Victoria/4897/2022 (H1N1)pdm09-like virus; 

An A/Croatia/10136RV/2023 (H3N2)-like virus; and

A B/Austria/1359417/2021 (B/Victoria lineage)-like virus

The FDA recommended that the trivalent formulation of cell- or recombinant-based influenza vaccines contain: 

An A/Wisconsin/67/2022 (H1N1)pdm09-like virus;

An A/District of Columbia/27/2023 (H3N2)-like virus; and

With the recommendations, the FDA also listed the names of the interagency meeting participants from the FDA, CDC, and DoD who collectively made the recommendation. 

"For FDA and for CDC, I did not recognize any names on there, and the individuals [who] are considered [to be] absolute flu experts, were not anywhere on that list," Tan told 

.  "What I found very interesting was that there were several people from the Department of Defense that were on that committee to decide what strain should be included in the vaccine." 

Tan, a former member of VRBPAC (2019-2023

), stated the selection process for the 2025-2026 influenza vaccine composition was not traditional.

"Having sat on VRBPAC, which is the FDA committee that basically reviews surveillance data from the WHO and the CDC to determine what strains are included in the vaccine, I can tell you that you don't just look at WHO's choices and say 'that's what's going to be included,'" said Tan. 

"You have to review all the other scientific information. My concern is the fact that this administration has pulled us out of WHO. So, if this vaccine is not as effective as it could be because they didn't review any other surveillance data, I think this administration will say, 'see, that's why we pulled out of WHO, because you can't trust them, and the flu vaccine is not worth taking,' or 'It's ineffective.'"

Even with the unique situation in which the FDA recommended the influenza vaccine compositions, Tan said vaccination is crucial for protection, especially among a pediatric population.

"We just went through one of the most severe influenza seasons that we've had in decades," she said. "Part of it was the fact that there were so many people that were not taking influenza vaccination. It's a wait and see, but we could see another severe season if we don't get people vaccinated." 

"I still think that having someone vaccinated is better than not being vaccinated, and with the increasing amount of vaccine hesitancy that is occurring, I would just ask all the providers to please take the time and talk to their patients about why it's so important to be vaccinated," added Tan. "Especially for infants and kids, because they can't advocate for themselves." 

1. Influenza Vaccine Composition for the 2025-2026 U.S. Influenza Season. FDA. Press release. March 13, 2025. Accessed March 24, 2025. https://www.fda.gov/vaccines-blood-biologics/influenza-vaccine-composition-2025-2026-us-influenza-season#:~:text=The%20FDA%20recommends%20that%20the%20trivalent%20formulation%20of%20cell%2D%20or,H3N2)%2Dlike%20virus%3B%20and

2. Fitch, J. How canceled government agency meetings could impact vaccination schedules, with Mary Koslap-Petraco, DNP. 

Tina Tan, MD, FIDSA, FPIDS, FAAP, comments on the FDA's recent selection of the 2025-2026 influenza vaccine compositions, without the CDC's ACIP meeting and FDA's VRBPAC meeting.

Ginger Irish

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