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Meet the Editors

Richard A. Bermudes, MD, psychiatrist, chief medical officer, BrainsWay; associate physician, University of California Davis.

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.

Richard A. Bermudes, MD, underscored the need for pediatricians to integrate ongoing conversations into well visits in this video interview.

Richard Bermudes, MD, on screen-related addictions and youth mental health

 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.

New evidence-based guideline provides 22 recommendations to standardize nutritional care for neonates after enterostomy.

Guideline introduces recommendations for postoperative nutrition in neonates with enterostomy

Watch our FDA pipeline news recap for the month for August 2025, as well as a preview of PDUFA dates listed for September. 

August's FDA Focus: Approvals and pipeline updates in pediatrics

Tina Tan, MD, FAAP, FIDSA, FPIDS—editor in chief of 

, professor of pediatrics at Northwestern University’s Feinberg School of Medicine, Infectious Diseases attending at Lurie Children's Hospital of Chicago, and president of the Infectious Diseases Society of America.

Florida is not aiming to ban vaccinations, but its surgeon general stated "Who am I to tell you what your child should put in [their] body? I don’t have that right."

Tina Tan, MD, reacts to state of Florida seeking elimination of all vaccine requirements

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

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Dr Still is a pediatric resident, University of Nevada School of Medicine, Las Vegas.

**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

“It’s not just about screen time—it’s about context,” says Richard A. Bermudes, MD, on guiding conversations in pediatric well care visits.

Richard Bermudes, MD, on discussing screen use and time at well care visits

Concerns about the impact of screen use on youth mental health continue to grow across the pediatric community. In this video interview, Richard A. Bermudes, MD, psychiatrist, chief medical officer at BrainsWay, and associate physician at the University of California Davis, stressed the importance of keeping the conversation grounded in the broader context of adolescent well-being. 

“Speaking as a parent, and to give a little more context, I trained in family medicine and have done well care visits as a general psychiatrist as well. It’s a complicated world, and we are all worried about the effects of social media and screens on ourselves, and we are especially worried about kids. I think it has to be part of the conversation at well care visits,” Bermudes said. 

He noted that discussions about screens should not replace the fundamental questions providers already ask during well care visits. “Much of what we discuss at well care visits is around questions such as: 'Do you have any concerns about mood or anxiety? Do you have any concerns about how your child or adolescent is functioning socially? How are they achieving in school or outside of school? Are they engaged in hobbies?' That same conversation hopefully was happening before screens, and it should continue now with screens included.” 

Bermudes also cautioned against an overemphasis on total time spent online. “The other interesting point from the study is that we got really hooked on total time. I can remember my parents having conversations about whether to have a television in the house. This is almost like the new generation’s version of that debate; can we function without screens? I don’t think we can eliminate them, it’s about how we are using them.” 

—rather than screen time alone—were most strongly tied to risks of suicidal ideation, suicidal behaviors, and internalizing or externalizing symptoms in youth. The study noted that while nearly one-third of children showed increasing addictive use of social media or mobile phones by age 11, while baseline screen time totals were not predictive of outcomes.

“We know that if we are using them, kids and adolescents may be socializing with friends and family across the United States. This happened during COVID, and it continues now. My kids are in college, and they still connect with their high school friends online at a certain cadence. Do I think that’s unhealthy? No. They get something out of it. But we need to really understand why our kids and adolescents are spending time online, whether dysfunction results from it, and whether they are experiencing impairment.” 

Ebert M. Addictive screen use tied to youth mental health risks. 

. June 19, 2025. Accessed September 2, 2025. https://www.contemporarypediatrics.com/view/addictive-screen-use-tied-to-youth-mental-health-risks 

News

Michael Haller, MD, tell providers they shouldn't be surprised if more children with T1D use inhaled insulin. 

Providers could see more T1D patients on inhaled insulin

Michael Haller, MD, professor and chief, Pediatric Endocrinology, University of Florida, explained that general providers should familiarize themselves with inhaled insulin for use among patients with type 1 diabetes in the pediatric population, despite it currently being used off-label. 

It is currently only FDA approved in adults, but lots of people are prescribing it off label, and hopefully we'll have that FDA stamp of approval by sometime mid next year," Haller said. MannKind Corporation, manufacturer of the inhaled insulin Afrezza, earlier this month 

submitted a supplemental Biologics License Application

 to the FDA for a pediatric indication. As reported by 

, the filing was based on data from the INHALE-1 study, led by Haller.

findings indicated that inhaled insulin is safe and effective in children with T1D. Full study results, including a safety extension, have been submitted for presentation at a medical meeting sometime in the second half of 2025, according to MannKind.

Even if off-label, Haller anticipates more children to be using it because of the benefits associated with it. 

"I expect general pediatricians will see more and more of their patients coming in on it, [so] just being aware of its existence and offering it as an opportunity for their patients to achieve better control in a way that fits their lifestyle is, I think, what all of us as pediatricians, seek to do to serve our patients and families. So just being aware of it is a big first step. 

, haller explained the safety and uses for inhaled insulin among patients with T1D. 

"“The safety features of inhaled insulin are really now, quite clear,” said Haller. “There is a per-label instruction to check FEV1 before and then after starting inhaled insulin. What we saw in the pediatric study was that there was actually less of a decline in FEV1 in the inhaled insulin patients than there was in the injected insulin patients, which just adds to the dataset indicating that it really is safe.”

Click here for this 5-minute interview with Haller.

Fitch J. Michael Haller, MD, discusses inhaled insulin and Afrezza data for type 1 diabetes. Contemporary Pediatrics. August 7, 2025. Accessed August 20, 2025. https://www.contemporarypediatrics.com/view/michael-haller-md-discusses-inhaled-insulin-and-afrezza-data-for-type-1-diabetes 

MannKind Corporation reports second quarter 2025 financial results and provides business update. MannKind Corporation. Press release. August 6, 2025. Accessed August 7, 2025. https://investors.mannkindcorp.com/news-releases/news-release-details/mannkind-corporation-reports-second-quarter-2025-financial

Fitch J. Michael Haller, MD, discusses safety and use for inhaled insulin in T1D. August 18, 2025. Accessed August 18, 2025. https://www.contemporarypediatrics.com/view/michael-haller-md-discusses-safety-and-use-for-inhaled-insulin-in-t1d

Michael Haller, MD: Providers could see more T1D patients on inhaled insulin

A proinflammatory diet during pregnancy may increase the risk of type 1 diabetes in offspring, according to findings from a large prospective cohort study in Denmark published in the 

Journal of Epidemiology & Community Health

Researchers evaluated data from 67,701 mother-child pairs enrolled in the Danish National Birth Cohort (DNBC) between 1996 and 2002. The study excluded mothers with preexisting diabetes or implausible dietary reports. Maternal diet was assessed at approximately 25 weeks of gestation using a comprehensive 360-item food frequency questionnaire. An empirical dietary inflammatory index (EDII) score was calculated to quantify the inflammatory potential of each participant’s diet, with higher scores indicating a more proinflammatory dietary pattern.

Over an average follow-up period of 17.6 years, 281 children (0.42%) were diagnosed with type 1 diabetes. The investigators observed a statistically significant association between maternal EDII score and the risk of type 1 diabetes in offspring. Each SD increase of 1 in the EDII score was associated with a 16% increased risk (adjusted HR, 1.16; 95% CI, 1.02–1.32) of type 1 diabetes diagnosis during childhood or adolescence.

“A low-grade inflammatory state secondary to an altered immune cell profile, which triggers proinflammatory pathways, is increasingly acknowledged as a critical early-life factor influencing offspring health,” the authors wrote.

The EDII score was derived using reduced rank regression. It was weighted based on associations between specific food group intake and circulating C-reactive protein concentrations, using data from a similar Nordic cohort. Diets high in red or processed meats, low-fat dairy, pizza, french fries, margarine, and savory snacks were associated with higher EDII scores. Conversely, higher intake of alliums, tomatoes, whole grains, fruits, vegetables, tea, and dark meat fish contributed to lower (anti-inflammatory) EDII scores.

Higher EDII scores were also associated with other maternal characteristics such as younger age, higher body mass index (BMI), smoking beyond 12 weeks of pregnancy, lower alcohol consumption, shorter breastfeeding duration, and lower socioeconomic status. However, total energy intake did not significantly differ across EDII quintiles.

Notably, the observed association between a proinflammatory diet and type 1 diabetes remained robust after adjusting for multiple potential confounders, including maternal age, BMI, smoking status, socioeconomic status, breastfeeding duration, and energy intake. Additional analyses indicated that gluten intake during pregnancy was also independently associated with elevated type 1 diabetes risk in offspring (HR per 10 g/day increase, 1.36; 95% CI, 1.09-1.71). In contrast, continued smoking during pregnancy was associated with a reduced risk (HR, 0.47; 95% CI, 0.31-0.72).

“Of particular note is the fact that 3 factors during midpregnancy, a proinflammatory dietary pattern, gluten, and smoking, seemed to independently predict the child’s risk of type 1 diabetes,” the authors stated. “This suggests that midpregnancy may be a critical period during which the fetus is particularly susceptible to maternal lifestyle influences in relation to the individual’s later risk for developing type 1 diabetes during childhood or adolescence.”

While the findings support the role of fetal programming in the development of autoimmune disease, the authors acknowledge limitations. As an observational study, causality cannot be established. Additionally, the child’s own diet postnatally was not assessed, and residual confounding from unmeasured factors remains possible.

Nevertheless, the study adds to a growing body of evidence linking maternal dietary exposures during pregnancy to long-term metabolic and immune outcomes in children. The authors concluded that further studies are warranted to replicate these findings and elucidate underlying biological mechanisms.

This article was originally published by our sister publication 

1. BMJ Group. ‘Inflammatory’ diet during pregnancy may raise child’s diabetes type 1 risk. News release. Eurekalert. July 1, 2025. Accessed July 9, 2025. https://www.eurekalert.org/news-releases/1089224?

2. Noorzae R, Bjerregaard AA, Halldorsson TI, et al. Association between a pro-inflammatory dietary pattern during pregnancy and type 1 diabetes risk in offspring: prospective cohort study. 

. Published online July 7, 2025. doi:10.1136/jech-2024-223320

A proinflammatory maternal diet during pregnancy was linked to a 16% higher risk of type 1 diabetes in offspring, a Danish cohort study finds.

Pro-inflammatory diet during pregnancy tied to diabetes in children

Despite their elevated risk of complications during pregnancy and delivery, young women with congenital heart disease (CHD) are less likely to receive contraception than those without CHD. This was the chief finding of an analysis of data involving female patients aged 14 to 21 years with CHD compared with young women of a similar age without the disease seen at a tertiary care center. Investigators analyzed data during the 6.5-year study period for a total of 12,368 visits from 7819 patients. Of those visits, 698 (6%) were patients with simple CHD, 1357 (11%) were patients with moderate CHD, 243 (2%) were patients with complex CHD, and 146 (1%) were patients with single ventricle (SV) CHD.

Specific patient characteristics were associated with the likelihood of receiving contraceptives. For example, those on contraception were significantly older (median age, 17 years vs 16 years) and more likely to be White than those who were not. Diagnosis also made a difference, with the highest rate of contraception seen in those with complex CHD (30%); those with simple CHD had the lowest (19%). However, the percentage of patients on contraception steadily increased over the study period, regardless of diagnosis. Nonetheless, patients with CHD were significantly less likely to be prescribed contraception than patients without CHD, though both increased age and later year of visit increased those odds. As to the type of contraception chosen, those with no or less complex CHD were most likely to use oral contraceptive pills, whereas most patients with SV CHD who were on contraception used a form of long-acting reversible contraception (55%). This was a far greater percentage than other groups that used long-acting reversible contraception: those without CHD (18%), with simple CHD (17%), with moderate CHD (16%), or with complex CHD (46%).

Patients with CHD may be more likely to have complications from pregnancy, and CHD is generally not a contraindication to contraception. Do not assume the cardiologist is handling this; make sure that your patients who would benefit from contraception receive it.

Giafaglione J, Mah ML, Wright LK. Contraception use in adolescents and young adults with congenital heart disease. 

Published online March 3, 2025. doi:10.1007/soo246-025-03791-y

Young females with congenital heart disease face barriers to contraception, increasing their risk during pregnancy despite rising usage over time.

Gordon Gray Still, MD

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