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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

 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.

According to the FDA, infant monitors sold without agency authorization pose safety risks and are not approved to prevent SIDS or SUID.

FDA alerts clinicians to potential harms from OTC infant monitoring devices

The agency "tentatively concluded that its use has been abandoned by industry and that the color additive regulation is outdated and unnecessary."

FDA could revoke authorization for Orange B color additive in food

Thao-Ly Phan, MD, MPH, Medical director of the Healthy Weight and Wellness Clinic, Nemours Children’s Health.

Thao-Ly Phan, MD, MPH, highlights how lessons from pandemic-related weight gain can guide pediatricians in addressing stress, prevention, and whole-child health.

Thao-Ly Phan, MD, MPH, stresses healthy routines to prevent weight gain during respiratory season

Ibrahim Gwarzo, DrPH, MPH, MBBS, of the Department of Pediatrics at Nemours Children's Health and the Sidney Kimmel Medical College at Thomas Jefferson University.

Ibrahim Gwarzo, DrPH, MPH, MBBS, explains his study that found timely opioid administration was associated with lower hospitalization rates for children with uncomplicated sickle cell pain. 

Ibrahim Gwarzo, DrPH, discusses opioid timing, hospitalizations for sickle cell pain

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

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Dr Jon E. Grant talks about the genetics, neurobiology, and cognitive processes of body-focused repetitive behaviors, which include trichotillomania, skin picking, and other behaviors.

Treating Patients with Trichotillomania and Other Related Behaviors

**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 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.

Case Studies

Diagnose this 2-month-old with scalp swelling

The FDA has revoked the authorization of red no. 3 in food and ingested drugs according to a January 15, 2025 announcement, with basis from the Delaney Clause of the Federal Food, Drug, and Cosmetic Act (FD&C Act).

According to the federal agency, manufacturers who use FD&C red no. 3 in food and ingested drugs have until January 15, 2027 and January 18, 2029, respectively, to reformulate products.

The revoke of authorization follows a 2022 color additive petition that requested whether the Delaney Clause applied. The Delaney Clause, enacted in 1960 as part of the Color Additives Amendment to the FD&C Act, prohibits FDA authorization of a food additive or color additive if it has been found to induce cancer in humans or animals.

The 2022 petition cited various data including 2 studies that demonstrated cancer in laboratory male rats that were exposed to high levels of FD&C red no. 3. The FDA noted the way the dye causes cancer in male rats does not occur in humans, and that claims that the "use of red no. 3 in food and ingested drugs puts people at risk are not supported by the available scientific information," wrote the agency.

"FD&C Red No. 3 has been primarily used in certain food products, such as candy, cakes and cupcakes, cookies, frozen desserts, and frostings and icings, as well as certain ingested drugs," stated the FDA in the announcement.

, Jamie Alan, RPh, PharmD, PhD, associate professor, Department of Pharmacology and Toxicology, Michigan State University, noted that no. 3 was in over 2800 foods at the time.

A discussion of red dye no. 3 in the pediatric population

Potential impacts red dye No. 3 has on children

"Red dye No. 3 is also known as a risk erythrosine," Alan said in the interview. "Think Halloween candy. Lots of processed foods also have red dye no. 3."

The FDA points out FD&C red no. 3 can also be referred to as red dye no. 3, red dye 3, and erythrosine, all of which could be on food labels, said Alan in the above video.

Artificial food colors (AFC) have been associated with child behavior, a topic that has been studied for over 35 years, including attention-deficit/hyperactivity disorder (ADHD).3 

In a summarized history article of AFC and child behavior published in 2012 and featured in 

, authors noted that studies of this association have been flawed by aspects such as study sample selection, non-standardized diagnosis, and non-standardized outcome measures.3 

In review of available data at the time of publication "suggest a small but significant deleterious effect of AFCs on children’s behavior that is not confined to those with diagnosable ADHD."3 

"AFCs are not a major cause of ADHD per se, but seem to affect children regardless of whether or not they have ADHD, and they may have an aggregated effect on classroom climate if most children in the class suffer a small behavioral decrement with additive or synergistic effects," wrote the study authors, led by L Eugene Arnold, MD, MEd, of the Department of Psychiatry, at The Ohio State University. 

In the video above, Alan also summarized available data of the association, which made additional headlines in 2022.

"[Investigators] looked at the effects of red dye No. 3 along with some of the other dyes like red dye No. 40 and yellow dye No. 5, and what they found was in a majority of studies, there is an increased association between red dye No. 3 consumption and an increase or an exacerbation of ADHD symptoms in children," Alan told 

Click here for more expert reaction from members of the 

1. FDA to revoke authorization for the use of red no. 3 in food and ingested drugs. FDA. January 15, 2025. Accessed January 2025. https://www.fda.gov/food/hfp-constituent-updates/fda-revoke-authorization-use-red-no-3-food-and-ingested-drugs?utm_medium=email&utm_source=govdelivery 

2. Fitch, J. Potential impacts red dye No. 3 has on children. 

. May 2, 2023. Accessed January 15, 2024. https://www.contemporarypediatrics.com/view/potential-impacts-red-dye-no-3-has-on-children 

3. Arnold LE, Lofthouse N, Hurt E. Artificial food colors and attention-deficit/hyperactivity symptoms: conclusions to dye for. 

. 2012 Jul;9(3):599-609. doi: 10.1007/s13311-012-0133-x. PMID: 22864801; PMCID: PMC3441937.

Manufacturers who use red no. 3 in food and and ingested drugs will have until January 15, 2027 or January 18, 2028, respectively, to reformulate their products. 

News

FDA bans red no. 3 in food and ingested drugs

A 32 weeks and 6/7 days, 1970 g infant was born via meconium-stained vaginal delivery to a 37-year-old G2P1 mother who recently immigrated from India. The mother presented with preterm premature rupture of membranes (PPROM) for 11 hours prior to eventual vaginal delivery. 

Maternal history was otherwise notable for rubella nonimmune, advanced maternal age, and a prior history of intrauterine fetal demise 4 years prior. Prior to delivery, the mother received 1 dose of ampicillin given unknown Group B streptococcus (GBS) status, and a single dose of betamethasone to accelerate fetal lung maturity.

After delivery, the infant was vigorous with delayed cord clamping of 1 minute. The Apgar scores were 8 and 8 at 1 and 5 minutes of life, respectively. There was mildly increased respiratory effort in the delivery room for which CPAP respiratory support was begun. The child was brought to the NICU on CPAP 5, 30% FiO2. 

Below, take your best guess at diagnosing this patient

E. coli with extended spectrum beta-lactamase

 website on Wednesday, September 10 at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis. 

A recently immigrated mother from India presents in preterm labor at 32 6/7 weeks and delivers a vigorous baby whose initial blood culture result is positive at 18 hours of life with gram-negative rods. 

Can you diagnose this infant with neonatal respiratory distress?

 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.

Jon E. Grant, JD, MD, MPH

Articles

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