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

AAP News

PNP Corner

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

. 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

 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.

In a recent trial, 11 of 12 children treated with DB-OTO demonstrated meaningful hearing gains.

Regeneron’s DB-OTO shows sustained hearing recovery in phase 1/2 CHORD trial

FDA accepts MannKind’s sBLA for Afrezza in children and adolescents with diabetes.

FDA accepts Afrezza sBLA for pediatric diabetes 

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.

This issue has a number of outstanding must-read articles related to pediatric vaccines. 

Letter from the editor, October 2025 

Explore effective techniques for gathering psychosocial histories from adolescents using the HEADS FIRST Checklist to enhance mental health interventions.

Psychosocial screening of adolescents: Using the HEADS FIRST Checklist, part 2 

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

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

 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 September 24, 2025, at 3:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

Heather Boone, OMS-III; and Neil Cella, MD. 

A 12-year-old female with no significant past medical history presents to our Emergency Department with 3 days of right-sided neck swelling, which has progressively worsened. The patient notes some pain with chewing on the right side, which has led to decreased intake. The parents report no known fevers but note that other members of the family have recently been sick with a suspected viral illness. The family also reports that this is a recurrent issue that occurs 2 to 3 times a year and endorses that it began after her tonsillectomy procedure. They state that symptoms typically resolve after a course of antibiotics. She has been seen at an ENT clinic for these concerns in the past, with reportedly no solution. She has no other known medical diagnoses or surgeries and is not taking any medications. She lives with her parents and 3 siblings and is in 7th grade.

Her vital signs, including temperature, are within normal limits upon arrival. Physical exam is significant for an indurated, moderately-tender, swelling approximately 2 cm in diameter located anteroinferior to the mastoid process. An oral exam is unremarkable aside from reported dental discomfort elicited by right-sided bite testing. Some residual tonsillar tissue is noted. Upon consulting with the team, labs and imaging are ordered, including CBC, CMP, CRP/ESR, LDH, uric acid serum tests, and diagnostic ultrasound. The lab values demonstrate mild hemoconcentration (possibly due to living at high altitude) and a mildly elevated lymphocyte count. Ultrasound findings include limited images showing bilateral hypoechoic foci in the parotid gland and upper neck regions, and a broad differential is provided. Due to these nonspecific findings, a blood culture is ordered, which produces no growth.  

Below, take your best guess at diagnosing this patient

Try to diagnose this patient with 3 days of right-sided neck swelling. 

Case Studies

News

Poll: Can you diagnose this 12-year-old female with right-sided neck swelling?

Joseph Vithayathil, MD, discusses being awarded the Elterman Research Grant at the 2025 CNS Annual Meeting in Charlotte, North Carolina. 

Joseph Vithayathil, MD, discusses CNS Elterman Research Grant

Joseph Vithayathil, MD, attending neurologist in the Division of Neurology at the Children’s Hospital of Philadelphia, has been awarded the 2025 Pediatric Epilepsy Research Foundation (PERF) CNS Elterman Research Grant. The $150,000 award, distributed over two years, supports early-career child neurologists or developmental pediatricians conducting innovative research in neuroscience across the United States and Canada.

Vithayathil’s project explores the mechanisms of iron accumulation in the brain, particularly in the context of neonatal hypoxic-ischemic brain injury—a condition commonly treated by pediatric neurologists. His work aims to uncover how iron dysregulation contributes to brain injury and how targeting these mechanisms could lead to new neuroprotective treatments.

“I became curious about how that whole mechanism of iron accumulation occurred, and what role it might be playing in different neurologic disorders,” said Vithayathil. “That inspired me to start looking at that in the context of neonatal hypoxic-ischemic brain injury, which is one of the more common conditions that we see and treat as neurologists.”

With support from the PERF grant, Vithayathil will conduct experiments to identify cell-specific mechanisms that mediate iron dysregulation following ischemic injury. 

“The funds will be used to help do some of these initial experiments that will be looking for changes in cell-specific gene expression of iron-related proteins, and then also knocking those out or manipulating those genes in animal models,” he explained.

Beyond understanding neonatal injury, Vithayathil’s research may have wider implications for neurological and neuroinflammatory diseases. “These pathways that regulate iron metabolism aren’t just affected in hypoxic-ischemic brain injury,” he noted. “We can see it in lots of other disorders, including neuroinflammatory and genetic disorders.”

Through this work, Vithayathil hopes to identify potential therapeutic targets that could protect brain tissue after injury. “Ultimately, what I’m hoping to identify is a class of therapeutics that might be neuroprotective,” he said.

The PERF CNS Elterman Research Grant recognizes early-career investigators whose work demonstrates promise for advancing understanding and treatment of pediatric neurological conditions.

Our research grants. Pediatric Epilepsy Research Foundation. Accessed October 8, 2025. https://www.pediatricepilepsyresearchfoundation.org/grants/our-current-grants/

Joseph Vithayathil, MD, discusses being awarded the Elterman
Research Grant at the 2025 CNS Annual Meeting in Charlotte, North Carolina. 

Peace Madueme, MD, explains how Florida’s pre-sports cardiac evaluations—and upcoming ECG mandate—strengthen youth safety in athletics.

Peace Madueme, MD, discusses cardiology screenings and Florida's Second Chance Act

In this video interview, Peace Madueme, MD, chief of Cardiology at Nemours Children’s Hospital in Orlando, discusses pediatric cardiology screenings and how they are increasingly playing a role in the state of Florida, accompanying routine physicals for youth sports athletes.

“In the state of Florida, all youth athletes every year have to get a pre-sport, or sports pre-participation physical, and that’s usually done with their pediatrician,” Madueme explained. “That’s the visit where, if there are any symptoms, abnormal family history, or medical history identified, then they get sent to myself or a cardiologist in order to clear them for sports or establish care if that’s necessary.”

Madueme emphasized the role of pediatricians in coordinating this care, ensuring that children who need specialized evaluation—whether for cardiology, asthma, or other medical concerns—receive it quickly. 

“It always starts, and should always start, with the primary care physician, because they’re the ones who coordinate all that care and make sure that the child is getting the appropriate services,” he said. 

While most children ultimately receive clearance to play, Madueme noted that even rare findings can be life-saving. “Obviously, if something serious is found, some kids may not be able to play sports, and then that starts a series of steps that may be necessary,” he said. “But the good news is that most kids are able to play sports, and that’s a good thing for child health.” 

The state’s new Second Chance Act, which goes into effect in the 2026–2027 school year, builds on this long-standing system. The law requires all high school athletes to receive an electrocardiogram (EKG) in addition to the standard physical exam, a step aimed at detecting heart conditions that might otherwise go unnoticed. “What that Act does is require all athletes to get an ECG or EKG prior to participating in sports in order to screen for anything serious that could be seen on an EKG,” Madueme said. “Together with the physical exam and medical history, it’s a very powerful screening tool.”

Nemours has already been conducting these screenings for over a year, clearing students based on both EKG results and traditional evaluations. “We try to do that as quickly and expeditiously as we can,” Madueme added. “The goal is to keep kids healthy and make sure they don’t miss their season or their games.” 

The Second Chance Act – Chance Gainer. Gulf Coast Schools. Published July 10, 2025. Accessed October 6, 2025. https://gulfcoschools.com/the-second-chance-act-chance-gainer/

Peace Madueme, MD, explains how Florida’s pre-sports cardiac evaluations—and upcoming ECG mandate—strengthen youth safety in athletics. 

A pair of roflumilast clinial trial investigators react to the FDA approval of the 0.05% formulation to treat atopic dermatitis in children 2 to 5 years. 

Lawrence Eichenfield, MD, Rocco Serrao, MD, react to roflumilast approval for pediatric atopic dermatitis

A newly approved nonsteroidal topical agent offers pediatricians and caregivers an additional treatment option for young children with atopic dermatitis (AD). Lawrence Eichenfield, MD; and Rocco Serrao, MD, discussed the expanded 

indication of roflumilast 0.05% cream (Zoryve; Arcutis Biotherapeutics)

, a phosphodiesterase-4 (PDE4) inhibitor, for children aged 2 to 5 years with mild to moderate AD. 

Expanding options for pediatric atopic dermatitis

Eichenfield noted that the approval of roflumilast cream 0.05% cream provides a valuable new tool for clinicians managing AD in very young patients. “I’m excited to have an expanded nonsteroidal agent for very young children with atopic dermatitis,” he said. “It’s a water-based cream that’s approved for topical treatment of mild to moderate atopic dermatitis from ages 2 years and older.”

The formulation was specifically designed for this age group, taking into account the larger body surface areas affected by AD in young children. 

“Some children intrinsically have barrier dysfunction—skin that’s drier—and when you have inflammation, it makes it even drier,” Eichenfield explained. “This formulation brings moisturizing properties with anti-inflammatory medicine that can be used safely and effectively without limitation of body surface area.”

Addressing caregiver concerns and unmet needs

Both physicians emphasized that nonsteroidal options can help address parental concerns about long-term topical corticosteroid use. “There’s a huge unmet need for patients with AD in that we need nonsteroid options for long-term control,” Eichenfield said. He added that atopic dermatitis can have “a significant impact on the patient and the family,” citing the common issue of sleep disturbance related to itch. 

Serrao echoed this sentiment, noting the practical advantages for families. “

You can use roflumilast 0.05% cream in these 2-to-5-year-olds once a day, anywhere on the skin where there’s atopic dermatitis,” he said. “It avoids a lot of confusion or potential for misuse because it’s so straightforward in how we can use this drug.”

Clinical trial results show rapid, safe improvement

The approval of roflumilast cream 0.05% was based on results from the phase 3 INTEGUMENT-PED trial, the 

 (NCT04804605), and a phase 1 pharmacokinetic study.

In INTEGUMENT-PED, roflumilast achieved rapid disease clearance, with significant improvement seen as early as week 1. By week 4, 25.4% of children treated with roflumilast reached vIGA-AD success—defined as “clear” or “almost clear” skin with at least a 2-grade improvement from baseline—compared with 10.7% using vehicle (

Roflumilast also improved itch and overall disease severity, with 39.4% having achieved EASI-75 at week 4 compared to 20% with vehicle, with over one-third of caregivers having reported a 4-point or greater reduction in itch scores (vs 18% with vehicle). 

The treatment was well tolerated, with low adverse event rates—most commonly upper respiratory infection, diarrhea, vomiting, rhinitis, conjunctivitis, and headache. “The data set is very reassuring from a safety standpoint,” said Eichenfield.

A pair of roflumilast clinical trial investigators react to the FDA approval of the 0.05% formulation to treat atopic dermatitis in children 2 to 5 years.

Gordon Gray Still, MD

Articles

Latest Updated Articles