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Director, Vanderbilt Vaccine Research Program

Division of Pediatric Infectious Diseases

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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.

C. Buddy Creech, MD, MPH, highlights advances in mRNA, monoclonals, adjuvants, and mucosal vaccines, stressing safety and parent communication.

C. Buddy Creech, MD, discusses the future directions in vaccinology

Thomas Crawford, MD, professor of neurology at the Johns Hopkins University School of Medicine.

. 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.

Thomas Crawford, MD, discusses recent data for apitegromab for SMA, as well as overall developments in the field. 

Thomas Crawford, MD, talks advancements for spinal muscular atrophy treatment

From another potential treatment for pediatric atopic dermatitis, to STI therapy for uncomplicated urogenital gonorrhea, take a look ahead at key PDUFA dates in Q4.

Key pediatric FDA decisions to watch for in Q4 2025

Director of Developmental-Behavioral Pediatrics

Pediatricians can use structured visits, rating scales, and AAP guidelines to improve ADHD diagnosis, follow-up, and care coordination.

Cesar Ochoa-Lubinoff, MD, discusses practical strategies for ADHD care in the primary care setting

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

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Jonathan Miller, MD, is a general pediatrician at Nemours Children's Health and president of the Delaware chapter of AAP.

Pediatric flu deaths underscore risks for healthy children and highlight importance of annual vaccination and early recognition.

Jonathan Miller, MD, on how pediatric influenza deaths highlight importance of vaccination, early recognition

**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 August 20 at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

This case was provided by Andrew Faniku, MD, pediatric hospitalist at Scott & White Healthcare.

A 21-year-old primigravida female presented to the hospital in preterm labor, with an otherwise uneventful pregnancy except for a febrile illness after exposure to family members with measles a week prior.

She reported having fever, cough, conjunctivitis, and a rash that started on her face and spread to her trunk, consistent with measles. Her fever and symptoms had mostly resolved, except for her lingering rash that began six days earlier. In the delivery room, she still had fresh excoriation marks on her arms. She had not received any MMR vaccines.

Six hours after admission, the patient delivered a female infant via spontaneous vaginal delivery at 35 weeks’ gestation. The baby weighed 2410 grams, which was approximately the 50

 percentile for her gestational age. The baby had mild respiratory distress after delivery and briefly required supplemental oxygen via blow by during transitioning. Apgar’s of 8 at 1 minute and 9 at 5 minutes was given at delivery. The baby subsequently improved and was allowed to room in with mother without the need for NICU admission. Nursing staff noticed a rash on the baby’s back. 

Below, take your best guess at diagnosing this patient

 website on Wednesday, August 20 at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

News

Case Studies

Can you diagnose this rash in a newborn?

Melissa Menezes, MD, assistant professor of pediatrics at the Albert Einstein College of Medicine and attending physician in the Division of Adolescent Medicine at the Children’s Hospital at Montefiore, emphasized the importance of provider readiness in contraceptive counseling.

“I think it's about having the tools and the knowledge as a general provider in all areas of the United States, and the counseling really has more to do with the patient in your room that you're seeing in front of you,” she said.

Menezes noted that while disparities in access exist, “the best way that we as providers can really address these disparities is just having those tools, no matter where we are.”

She highlighted recently available contraceptive methods that can meet specific patient needs. The Twirla patch may be helpful for patients who experience adhesive issues with the standard contraceptive patch. For adolescents leaving home for college, the Annovera ring could provide continuity if they face challenges in accessing routine prescriptions.

Nextstellis, a combined hormonal contraceptive containing a different estrogen formulation, may offer benefits for patients who previously experienced breast tenderness or mood changes with other combined oral contraceptives. “If that's a concern of your patient, now you have this in your toolbox. This is something else you could try,” Menezes explained.

Menezes also discussed Opill, the progestin-only pill now available over the counter. While she noted limited direct counseling on this option, she explained its role in increasing access. “If that's the case, you know, those patients could really benefit from the O pill,” she said, particularly for adolescents unable to reach a provider. “It might not be the perfect option for them, but it is better than nothing, if what they want is to be on contraception.”

Long-acting reversible contraception (LARC) considerations

In counseling patients on long-acting methods, Menezes said she advises them about both FDA-approved durations and evidence supporting extended use. She emphasized respecting patient choice. “There’s some patients who definitely want it removed at the time that FDA says that it's supposed to be removed. And then there’s definitely some patients [who] are like, I don't want to have to do another procedure. Let's just keep it in, as long as you know, I'm protected against pregnancy. That's fine,” she said.

Recent reports on the risk of meningioma with certain injectable contraceptives have raised patient concerns. Menezes explained that while a French study noted an increased risk, the absolute risk remains low. “The risk goes from one in 10,000 in the general population to five in 10,000,” she said. Presenting the data in absolute terms often reassures patients. Still, she emphasized that final decisions should rest with the patient: “If that risk in their estimation is too high, it's not the right choice for them.”

Expanding contraceptive options for adolescents with Melissa Menezes MD

Disclosure: Menezes reports no disclosures.

Menezes M. What’s New in Contraceptive Care. Presentation. Presented at: American Academy of Pediatrics 2025 National Conference & Exhibition. September 26-30, 2025. Denver, Colorado.

New contraceptive options and counseling strategies aim to improve adolescent access and address patient-specific needs presentedat AAP 2025.

Expanding contraceptive options for adolescents with Melissa Menezes, MD

Diane Straub, MD, professor of pediatrics and section head for Adolescent Medicine at the University of Colorado and Children’s Hospital Colorado, discussed current challenges and priorities in adolescent sexual health at the American Academy of Pediatrics (AAP) 2025 National Conference and Exhibition.

“There has been an increase in all STIs recently in adolescents, except for HIV, which has been relatively stable,” Straub said. “The most common reportable STI is chlamydia. However, there are other STIs, HPV, [and] herpes that also have pretty high burden, that are not reportable illnesses, but are thought to also have pretty high incidence.”

According to Straub, current Centers for Disease Control and Prevention (CDC) recommendations for screening have remained consistent. “It’s still recommended to do routine screening in sexually active adolescent females and higher-risk adolescent males,” she said.

Straub emphasized the importance of patient-centered care. “It’s just really important to make sure that you’re doing a confidential history and finding out what sexual and reproductive needs that your patients have, and that can be a difficult thing in a busy practice, so it’s just something to really make sure to prioritize and ensure that it happens.”

Barriers to adolescent sexual health care

Straub noted that access to confidential care remains uneven across the country. “In a lot of places, there are many barriers, and those include a lack of access to comprehensive sexuality education. A lot of young people don’t really have—don’t think this is a salient topic, and don’t recognize their personal risk,” she said.

She added that legal and cultural pressures may further limit adolescent access. “There’s a movement in this country by some folks to really kind of decrease adolescents’ access to confidential care, and confidential care is incredibly important, because young people don’t get that care if they have to talk about it with their parents, or if the parents have to provide consent.”

Balancing confidentiality and parental involvement

Straub encouraged clinicians to navigate the delicate balance between supporting confidentiality and encouraging parental involvement. “We always ask young people about involving their parents and try to do that. I mean, it’s great to have a parent who’s involved and wants to really help the young person to navigate through this somewhat difficult landscape,” she said.

“The reality, though, is that a lot of young people aren’t quite ready to do that, and they still are at risk for STIs and other outcomes from sexual behavior. So it’s just really important to make sure that they have that access and to continue to support them until they might be ready to have that conversation with their parents.”

Diane Straub, MD, addresses STI screening and confidential care in adolescents

Straub D. Sexually Transmitted Infections: What’s Changed? Presentation. Presented at: American Academy of Pediatrics 2025 National Conference & Exhibition. September 26-30, 2025. Denver, Colorado.

Adolescent STIs are rising. Diane Straub, MD, MPH, stressed confidential care, routine screening, and balancing parental involvement at AAP 2025.

Infant feeding recommendations have undergone significant changes over the past 2 decades. “The 2000 guidelines actually recommended against feeding allergenic food. So we advised no milk until 1 year of age, no eggs until 2, no peanuts, or seafood until 3,” said David Stukus, MD, professor of clinical pediatrics and director of the Food Allergy Treatment Center at Nationwide Children’s Hospital and the Ohio State University College of Medicine in Columbus, Ohio.

By 2008, recommendations shifted, though they still did not actively promote early allergen introduction. A major turning point occurred with the Learning Early About Peanut (LEAP) trial published in 2015. “This was the first prospective, randomized clinical trial that took a group of infants and exposed them to peanut on a regular basis early in life, and compared them to a group of infants that avoided peanut, and what they showed after that trial was 81% reduction in peanut allergies in those infants who ate it on a regular basis,” Stukus said.

Since then, multiple prospective clinical trials and meta-analyses have demonstrated that introducing allergenic foods early and maintaining them consistently in the diet is both safe and effective for preventing food allergy.

Despite the evidence, many parents remain fearful or uncertain. Stukus advised clinicians to address concerns proactively. “Reassurance is the key, I think, some humility as well,” he said. He noted the importance of acknowledging how prior evidence differed from current recommendations. Pediatricians can integrate food allergy prevention discussions into routine visits, including newborn, 2-, 4-, 6-, and 9-month checkups. Handouts and consistent messaging can further support families.

True severe allergic reactions as a first exposure are rare, Stukus emphasized, and families should be reassured while also receiving practical advice on how to safely introduce allergenic foods.

Parents may request screening tests before introducing foods, but these should be discouraged without a clinical indication. “IgE tests are really designed to detect specific IgE, but they’re not designed to diagnose anything. We get a lot of false positives. Panel tests cause a lot of overdiagnosis, misdiagnosis, and really talking about the harm that comes from a wrong diagnosis,” Stukus explained.

In cases where parents insist, a focused discussion on specific concerns may help guide next steps. If testing is pursued, clinicians should clarify how results will be used and consider in-office food introduction when feasible.

Introducing allergenic foods only once is not enough. “It’s really intentionally keeping it in the diet consistently,” said Stukus. While strict dosing guidelines are not necessary, families can be encouraged to make regular inclusion part of the routine. Revisiting the topic at future visits is also important.

Many families never receive counseling on food allergy prevention. Stukus suggested systematic approaches, such as checklists or standardized handouts, to ensure discussions occur. “It takes effort, just like anything else that we do in medicine; it’s really making sure that you put this into your blueprint that you have for a visit,” he said.

Early allergen introduction, beginning in infancy and sustained over time, can safely reduce food allergy risk, said David Stukus, MD, at AAP 2025.

Jonathan Miller, MD

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