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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.

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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.

Survey finds 30% of children missing school due to anxiety miss over a week; experts urge early intervention and therapy to address school avoidance.

School avoidance linked to emotional distress in children, survey finds

Elizabeth Reichert, PhD, pediatric and adolescent psychologist, Stanford Medicine Children’s Health; co-director, Stanford Parenting Center.

Psychologist Elizabeth Reichert, PhD, encourages primary care providers to use validation and connection to support mental health during routine visits.

Managing mental health between specialist visits with Elizabeth Reichert, PhD

Aleece Fosnight, PA-C, urology specialist at Aeroflow Urology.

Hydration, timed voiding, and limiting bladder-irritating foods can help kids manage incontinence, says Aleece Fosnight, PA-C, in this Q+A interview.

Aleece Fosnight, PA-C, discusses bladder control issues and associations with food

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

Adolescent vaccination coverage improves for Tdap and MenACWY; HPV rates remain unchanged

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

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Pediatricians need to have informed discussions with parents and caregivers about procedures for their children requiring sedation or general anesthesia. This evidence can help with those decisions.

Looking at anesthetic neurotoxicity in pediatric sedation

**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 female 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 NICU 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 non-bulging, 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

Bite injuries are a significant problem in the United States. Discriminating between human and animal bites and identifying those associated with child maltreatment is essential. Approximately 250,000 human bites and several million animal bites occur annually.

 There was also a reported increase in animal bite injuries during the COVID-19 pandemic.

 Despite their frequency, it can be challenging to distinguish between types of bites. There are also few detailed images and descriptions of cutaneous findings of human and animal bites in the literature. 

Additionally, though such injuries occur in various ways, pediatric providers must consider the possibility of child maltreatment. In the COVID-19 pandemic, there was also a documented increase in child abuse–related injuries.

 Though bite wounds are a less common cutaneous finding in child abuse,

 both human and animal bites may result from nonaccidental trauma or neglect. 

In the poll below, try to identify what caused this bite mark on the palm of a 16-year-old boy

Thank you for taking this Contemporary Pediatrics puzzler poll

Visit ContemporaryPediatrics.com on Wednesday, August 6, 2025, at 12:00 PM ET or later for many more bite examples in the pediatric population and how to distinguish between common animal bites and human bites.

"This [case] was prompted by the increases in child abuse and animal bite injuries during the COVID-19 pandemic, with the need to add to the limited descriptions of cutaneous findings of bites in the literature," wrote the authors of this case.

Bula-Rudas FJ, Olcott JL. Human and animal bites. 

. 2018;39(10):490-500. doi:10.1542/pir.2017-0212

Dixon CA, Mistry RD. Dog bites in children surge during coronavirus disease-2019: a case for enhanced prevention. 

. 2020;225:231-232. doi:10.1016/j.jpeds.2020.06.071

Kovler ML, Ziegfeld S, Ryan LM, et al. Increased proportion of physical child abuse injuries at a level I pediatric trauma center during the Covid-19 pandemic. 

. 2021;116(Pt 2):104756. doi:10.1016/j.chiabu.2020.104756

Kos L, Shwayder T. Cutaneous manifestations of child abuse. 

. 2006;23(4):311-320. doi:10.1111/j.1525-1470.2006.00266.x

Despite their frequency, it can be challenging to distinguish between types of bites. Can you identify the source of this bite mark? 

News

Puzzler poll: Can you identify this bite? 

Then visit our website on July 23 at 3:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis. 

This case was presented by Umer Muhammad, MD; Neil Copeland, MD; and John Bishara, DO

A 23-month-old girl presented with a 3-day history of cough, rhinorrhea, and increased work of breathing. Initially, she was treated for bronchiolitis at an urgent care center, where a nasopharyngeal swab identified adenovirus. Despite initial treatment, the patient's condition worsened, and she required oxygen supplementation via nasal cannula for oxyhemoglobin desaturation. Her hypoxemia further deteriorated, necessitating an increase in oxygen supplementation (

On physical examination, the patient showed signs of respiratory distress. A chest x-ray (CXR) revealed opacities in the right middle and lower lobes. The patient's condition improved with supportive care, and she was discharged after several days in the hospital. 

However, 9 months later, due to recurrent wheezing, she was referred to the pulmonary service for further evaluation. A follow-up CXR, taken 3 months after the initial infection, demonstrated complete opacification of the right hemithorax, with a mediastinal shift to the right, as well as collapse of the right upper and middle lobes. 

Below, take your best guess at diagnosing this patient

Congenital pulmonary adenomatoid malformation (CPAM) 

website on Wednesday, July 23, at 3:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

Puzzler poll: Diagnose this 23-month-old with cough and rhinorrhea

This case was presented by Giridhar Guntreddi, MD, FAAP, FAPHM; Achuth Jayasankar Kondoor; Taylor Boske; Neelima P. Theella, MD; and Jayasree Vasudevan Nair, MD, MPH, FAAP. 

A healthy 12-month-old girl presented with one small skin lesion over the right heel (

) for one month. On examination, her right lateral heel showed a round, white, pearl-like, hard, tiny lesion with a smooth appearance without any redness or itching. The patient's mother denied any pain, swelling, itching, or fever. No significant travel, bites, or heel-stick injuries were reported in the history. No systemic symptoms suggested any underlying systemic diseases. The infant is closely monitored at subsequent well visits and rechecked. After 3 months, the child showed full resolution of the skin lesion over the heel area (

Below, take your best guess at diagnosing this patient.

click here for the full case presentation, differential diagnosis, and correct patient diagnosis. 

Diagnose this infant with an asymptomatic pearl-like nodule on the heel

Manufacturer MannKind as submitted a supplemental Biologics Application to the FDA for its inhaled insulin Afrezza.

Michael Haller, MD discusses inhaled insulin and Afrezza data for type 1 diabetes

On August 6, 2025, MannKind Corporation submitted a supplemental Biologics License Application to the FDA for its inhaled insulin Afrezza for a pediatric population indication, with a decision expected early in the fourth quarter of 2025, according to a financial report from the company.

The filing was based on data from the INHALE-1 study, led by Michael Haller, MD, MS-CI, lead author of the study and professor and chief of Pediatric Endocrinology at the University of Florida. The study evaluated the safety and efficacy of the inhaled insulin regimen as a replacement for rapid-acting meal insulin in children with type 1 diabetes (T1D). It included 230 patients aged 4 to 17 years, who were randomized to either inhaled insulin or rapid-acting analogue for meals, with a primary outcome of change in A

According to a press release from the American Diabetes Association's 85th Scientific Session, where data were presented at the June meeting in Chicago, findings indicated that inhaled insulin is safe and effective in children with T1D. Full study results, including a safety extension, have been submitted for presentation at a medical meeting sometime in the second half of 2025, according to MannKind.

"The primary outcome essentially showed non-inferiority of inhaled insulin compared to rapid-acting injected insulin," stated Haller in the video above. "This finding is slightly qualified by the inclusion of 1 patient who was highly non-adherent to their insulin regimen and was assigned to the inhaled insulin group. Including this patient in the analysis resulted in a non-significant p-value for non-inferiority. However, in a sensitivity analysis excluding this non-adherent [patient], the inhaled and injected insulin groups showed nearly identical outcomes in terms of hemoglobin A

Currently, Afrezza is being prescribed off-label for the pediatric population, with the adult population being the only FDA-approved indication for the inhaled insulin. Now, with a filing submitted to the federal agency, Afrezza is one step closer to a proper label pediatrics. 

Manufacturer MannKind has submitted a supplemental Biologics Application to the FDA for its inhaled insulin Afrezza. 

Lisa Wise-Faberowski, MD, MS, FAAP

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