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Lori Handy, MD, MSCE, is an attending physician in the Division of Infectious Diseases, Children’s Hospital of Philadelphia; and associate director, CHOP Vaccine Education Center. 

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.

In this brief clip, Lori Handy, MD, MSCE, of CHOP, explains the evolving dynamic of trust between patients, parents, and health care. 

Lori Handy, MD, MSCE, highlights the shift of trust in health care

PCR boosts detection of bacteria in pediatric bone and joint infections

Lori Handy, MD, MSCE, discussed how clinicians can strengthen vaccine communication by engaging openly and partnering with trusted community messengers.

Building trust through vaccine education, science with Lori Handy, MD, MSCE

Nicholas P. Marshall, MD, FAAP, Fellow - Pediatric Infectious Diseases and Clinical Informatics Stanford University, Palo Alto, CA, United States. 

Nicholas P. Marshall, MD, FAAP, discussed how generative AI can help streamline infectious disease workflows and enhance evidence-based care at IDWeek 2025 in Atlanta.

Practically expanding AI's role in infectious diseases, with Nicholas Marshall, MD, FAAP

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

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Experts at AAP 2025 highlight criteria, medication options, access barriers, and family engagement in pediatric obesity management.

Ihuoma Eneli, MD; and Jamie Moore, MD, discuss pediatric obesity management

**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.

on Monday, January 6 at 12:00 PM ET for the full case presentation, differential diagnoses, and the correct patient diagnosis. 

This case was provided by Amar Davé, MD, FAAP and Pahroul Davé, APRN

A boy aged 10 years presented to the outpatient office with a history of painful nodules on the plantar surface of his bilateral feet 8 to 10 hours after spending time in a hot tub. He was unable to bear weight or put on socks and shoes due to his pain. The photos were taken soon after the painful and red papules appeared. The lesions affected the whole plantar aspect of both feet. Over the following 4 days, the nodules became less painful and red. 

Medical advice was sought on the fifth day of symptoms, and by this time, the child was improving clinically. He was stable with subcutaneous, mildly painful, fleshy nodules mostly populating the medial arch of the foot. His remaining clinical examination results were within a normal range. Further questioning of the child’s mother revealed that other children exposed to the hot tub experienced painful feet but without lesions. 

Due to the patient’s improving symptoms and the self-limiting nature of the illness, no tests or labs were ordered as the child was not acutely ill. No peer consultations or specialists were utilized.

Click here for the full case presentation, differential diagnoses, and the correct patient diagnosis, in a separate article.

The photos in this case were taken soon after the painful and red papules appeared.

News

Case Studies

Can you diagnose this boy with painful nodules on his feet?

 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. 

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

In our second interview with Peace Madueme, MD, he explains the types of conditions that frequently appear on ECGs, which are aiding routine sports physicals in youth athletes in Florida.

Using ECGs to identify heart conditions in youth athletes, with Peace Madueme, MD

 in identifying hidden cardiac conditions among young athletes. According to 

chief of cardiology at Nemours Children’s Hospital in Orlando

, these screenings—set to become mandatory for high school athletes beginning in the 

—offer a vital supplement to the traditional sports physical. 

“There are definitely certain conditions that, when you see them on an ECG, make a diagnosis,” said Madueme. “The simplest example I can give you is 

, which is a condition associated with having a very rapid and fast heartbeat. There’s a specific feature on an ECG that, when you see it, means they have the substrate, and they oftentimes need more therapy, whether it’s medication or a procedure called an ablation.” 

Identifying silent cardiac conditions in young athletes

Although the incidence of such findings is relatively low, Madueme emphasized that even a few detected cases can be lifesaving. 

“When you look at 500, 1000, or 2000 kids, there will be a few that get caught because they’re asymptomatic and just happen to have it. They’ve never had an ECG, and it finds it,” he said.

The Second Chance Act, signed into law in 2025, was designed to supplement the Florida High School Athletic Association’s standard presport physical, requiring an ECG to screen for cardiac abnormalities that could lead to sudden cardiac arrest. The measure honors Chance Gainer, a student-athlete who died after collapsing on the field due to an undiagnosed condition. 

, Madueme discussed the Second Chance Act at greater length. 

Madueme noted that although most ECG results in youth athletes are normal, the test is invaluable when interpreted alongside a detailed family history and physical examination.

“That’s why it’s a supplement to the sports physical—because it’s an additional tool,” he explained.

According to Madueme, ECGs provide pediatricians with 3 distinct advantages:

Detecting silent or asymptomatic conditions that might otherwise go unnoticed

Supporting early referral to cardiology for follow-up and potential intervention

Enhancing confidence in clearance decisions for safe sports participation

Looking ahead: Florida as a model for the nation

Madueme acknowledged challenges in scaling the program statewide, citing resource and staffing limitations. 

“There are issues with resources and being able to see and handle that amount of patients and ECGs—and who reads them, etc,” he said.

Still, he believes Florida’s implementation could set a national example. “I think how this goes in Florida will probably help with the rest of the nation in terms of whether this is something that can be done economically and logistically and without too much impact on the patients in terms of missing sports,” he said. “How that gets implemented is going to be the key.”

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

This case was presented by Rutva Vora, BS; and Monica Guirguis, DO.

A 2-month-old girl 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 neonatal intensive care unit 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 nonbulging, 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.

Diagnose this 2-month-old with scalp swelling

At CNS 2025, Kathryn Xixis, MD, highlighted the growing adoption of EPAs and outcomes-based learning in pediatric neurology.

Kathryn Xixis, MD, on developing EPAs for child neurology training

At the 2025 Child Neurology Society (CNS) Annual Meeting in Charlotte, North Carolina, Kathryn Xixis, MD, associate professor of pediatrics at the University of Virginia, discussed how competency-based medical education is transforming the evaluation of medical trainees in child neurology and beyond.

Defining the Outcome: Developing EPAs for Child Neurology Training

, where she outlined how this model moves away from traditional, time-based training to focus instead on measurable competence and readiness for independent practice.

Jamie Moore, MD, MPH

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