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Meet the Editors

 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.

Articles

Adolescents from socioeconomically deprived families reported more eating disorder symptoms, highlighting disparities in risk and diagnosis.

Family socioeconomic position linked to eating disorder symptoms in adolescence

Piero F. Mejia, MD, is a pediatric pulmonary fellow at Johns Hopkins Hospital.

CPAP/bilevel PAP in the home setting

AAP issues new report urging early, routine screening for mental, emotional, and behavioral problems in pediatric care to improve outcomes.

AAP updates guidance on screening for mental, emotional, and behavioral problems in children

Results from a cross-sectional study find large proportions of obesity-related conditions in US youth are attributable to obesity and, to a lesser extent, overweight.

Obesity contributes substantially to chronic conditions in US adolescents and young adults

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

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Authors

Laura M. Sterni, MD, is an associate professor of pediatrics at the Johns Hopkins University School of Medicine.

**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

The American Academy of Pediatrics (AAP) has released an evidence-based immunization schedule that includes updates for the upcoming fall vaccine season regarding influenza, respiratory syncytial virus (RSV), and COVID-19.

A leading voice in vaccine recommendations across the pediatric population, the AAP comprises over 67,000 pediatric health care providers and, according to its immunization schedule announcement, has been working with other professional societies, payers, and organizations to develop evidence-based clinical guidance on COVID-19, flu, and RSV.

“The AAP will continue to provide recommendations for immunizations that are rooted in science and are in the best interest of the health of infants, children, and adolescents,” said Susan Kressly, MD, FAAP, president, AAP, in a statement. "Pediatricians know how important routine childhood immunizations are in keeping children, families, and their communities healthy and thriving."

As the fall season approaches, so do the typical infectious disease challenges for COVID-19, which continues to impact the pediatric population, including the most vulnerable population––those aged 6 months to 23 months. The AAP recommends that all persons in this age group receive a COVID-19 vaccine to protect against serious illness. Children under 2 years of age are particularly vulnerable to severe COVID-19, according to the academy, and should be prioritized unless they have a known allergy to a vaccine or its ingredients. 

Additionally, the AAP recommends that all children and adolescents aged 2 through 18 years receive a single dose of age-appropriate vaccine in the following risk groups: 

Individuals at high risk of severe COVID-19

Residents of long-term care facilities or other congregate settings

Individuals who have never been vaccinated against COVID-19

Individuals whose household contacts are at high risk for severe COVID-19

The academy is also recommending that the vaccine be available for children aged 2 to 18 years who are not part of the above risk groups, but whose parents or guardians desire to have the vaccine administered. 

"We extensively reviewed the most recently available data about COVID-19 risks in kids, as well as [the] safety and effectiveness of available COVID-19 vaccines. It's clear they are very safe for all populations," said Sean O’Leary, MD, FAAP, chair of the AAP Committee on Infectious Diseases, in a press release. "Among the reasons we decided to move to a risk-based recommendation for healthy older children is the fact that the hospitalization rate for young children and children [with] underlying medical conditions remains high, in line with rates for many of the other vaccine-preventable diseases for which we vaccinate." 

Aligning vaccinations with the start of a new school year

In May 2025, the CDC pulled the recommendation for routine COVID-19 vaccination among healthy children and pregnant women. Shortly after the updated guidance, the CDC changed course on the recommendation, stating that children aged 6 months to 17 years who are not moderately or severely immunocompromised may receive the vaccine in situations where the parent wishes their child to get the vaccine, along with clinical judgment provided by a health care professional on a case-by-case basis.

These initial changes from the CDC prompted the AAP and several other medical societies, in July, to 

sue the Health and Human Services department

In July, the AAP released its updated influenza recommendations via a prepublication. To read these recommendations as reported, 

The AAP recommended that all children aged 6 months and older receive an annual flu vaccine, unless they have a medical reason not to be immunized. The 2024-2025 influenza season was a high-severity season for individuals of all ages, according to the CDC, the AAP noted. The CDC reported 267 influenza-related pediatric deaths through August 2, 2025. Of those, 43.6% occurred in children without a high-risk medical condition.

Historically, up to 80% of influenza-associated pediatric deaths have occurred in unvaccinated or incompletely vaccinated children. Children younger than 5 years, especially those less than 2 years old, are especially vulnerable to severe illness, hospitalization, or death due to influenza.

RSV is the leading cause of hospitalization among babies younger than 1 year. The respiratory disease spreads easily through the air and through physical contact with germs. Immunizations for pregnant mothers and newborns provide antibodies that offer necessary protection. 

“Babies who become infected with RSV can get much sicker than older kids because their lungs and airways are so tiny,” said Kristina Bryant, MD, FAAP, a member of the AAP Committee on Infectious Diseases. “There are [2] ways to help your baby get ahead of this serious respiratory illness. Moms who get the RSV vaccine during their pregnancy can pass important antibodies to their developing baby through the placenta. Or new babies can get an RSV shot for RSV season. Well-timed RSV immunizations help babies stay healthy."

Nirsevimab and clesrovimab are FDA-approved monoclonal antibodies that are recommended to prevent RSV. The AAP noted that palivizumab, a shorter-acting monoclonal antibody, is no longer recommended for use. 

For RSV, the AAP recommends the following: 

Immunization for infants younger than 8 months who are born during or entering their first RSV season if the mother did not receive the vaccine during pregnancy, if the vaccination status is unknown, or if the infant was born less than 14 days after the pregnant mother received the vaccine.

Immunization for infants and children 8 months through 19 months of age at high risk of severe RSV disease and entering their second RSV season. High-risk infants include children with chronic lung disease or cystic fibrosis, those who are immunocompromised, and other groups.

For the full immunization schedule from the AAP, 

The American Academy of Pediatrics releases its own evidence-based immunization schedule. Press release. AAP. August 19, 2025. Accessed August 19, 2025. 

AAP releases evidence-based immunization schedule; calls on payers to cover recommendations. AAP. Press release. August 19, 2025. Accessed August 19, 2025. https://publications.aap.org/aapnews/news/32835/AAP-releases-evidence-based-immunization-schedule?searchresult=1

Fitch J. CDC: healthy children can receive COVID-19 vaccine via "shared clinical decision-making." 

. June 2, 2025. Accessed August 19, 2025. https://www.contemporarypediatrics.com/view/cdc-healthy-children-can-receive-covid-19-vaccine-via-shared-clinical-decision-making-

Fitch J. AAP, other medical societies sue HHS, Robert F. Kennedy Jr over vaccine practices. 

. July 7, 2025. Accessed August 19, 2025. https://www.contemporarypediatrics.com/view/aap-other-medical-societies-sue-hhs-robert-f-kennedy-jr-over-vaccine-practices

The AAP recommends that all children aged 6 months to 23 months receive a COVID-19 vaccine, as this group has the highest risk for severe infection.

News

American Academy of Pediatrics releases immunization schedule

Vaccination coverage with 1 or more doses of Tdap, MenACWY, meningococcal B vaccine; 3 or more doses of hepatitis B vaccine; and 2 or more doses of measles, mumps, and rubella (MMR) vaccine increased in 2024 among adolescents aged 13 to 17 years compared with 2023.

According to August 14, 2025, data from the CDC's 

), these increases highlight the progress in increased vaccination efforts in the adolescent population. 

Routine vaccine administration among adolescents

, the Advisory Committee on Immunization Practices (ACIP) recommends 3 routine vaccines to adolescents aged 11 to 12 years: 

Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap)

Quadrivalent meningococcal conjugate vaccine (MenACWY)

A booster of MenACWY should be administered at age 16 years. The report stated that the COVID-19 vaccine can be received and that those aged 16 to 23 years can receive the serogroup B meningococcal vaccine (MenB). Additionally, adolescents should receive an annual influenza vaccination and catch up on any missed childhood vaccines. Since 2023, ACIP has recommended that the pentavalent meningococcal vaccine (MenABCWY) can be used when both MenACWY and MenB are indicated at the same visit.

2023 vs 2024 vaccine coverage for Tdap, MenACWY, HPV

summarized coverage with these vaccines for 2024, not including influenza, COVID-19, and MenABCWY due to limited data. The report gathered data from the National Immunization Survey-Teen (NIS-Teen), an annual 2-phase survey that monitors vaccination coverage in the United States for adolescents aged 13 to 17 years. Phase 1 consists of a random-digit–dialed mobile telephone survey of parents or guardians (parents) in households with eligible adolescents aged 13 to 17 years. Phase 2 is a mailed survey to the adolescent's vaccination providers previously identified by the parent or guardian to obtain vaccine history.

The household response rate was 21.0%. Adequate provider data were received from providers for 42.8% of adolescents with completed interviews. These 2 rates reflect different types of response mechanisms. The household response rate measures participation by households that completed the household interviews, whereas the adequate provider data rate measures vaccination data availability among those who completed the household interviews.

"To address low response rates, nonresponse adjustments are incorporated in the weighting to reduce potential bias," wrote the 

authors. "In addition, statistical modeling techniques such as imputation and variance estimation methods are used to handle missing data and account for the complex survey design." 

Among adolescents aged 13 to 17 years in 2024, coverage increases compared with 2023 were as follows: 

≥1-dose Tdap: Increased from 89.0% to 91.3%

≥1-dose MenACWY: Increased from 88.4% to 90.1%

Coverage for other recommended vaccines also increased, as did catch-up vaccination in 2024 vs 2023, including for the following: 

≥1-dose MenB: Increased by 4.5% among adolescents aged 17 years

≥2-dose MMR: Increased by 1.3% among adolescents aged 13 to 17 years

≥3-dose hepatits B: Increased by 1.3% among adolescents aged 13 to 17 years

The authors noted that in 2024, 78.2% of adolescents aged 13–17 had received one or more doses of the HPV vaccine, and 62.9% were up to date with the HPV vaccination series, similar to 2023 estimates (76.8% and 61.4%, respectively). 

Overall, coverage of 1 or more doses of Tdap and 1 or more doses of MenACWY was 90% or greater in most states, highlighting progress in public health initiatives and activities to improve coverage. 

Among adolescents aged 13 to 17, coverage with 1 or more Tdap doses increased from 89% to 91.3% from 2023 to 2024. 

Laura M. Sterni, MD

Articles

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