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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.

The Committee is scheduled to meet on September 18 and 19 to discuss recommendations for several vaccines.

ACIP to meet for MMRV, Hep B, COVID vaccine proposed recommendations

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agency "tentatively concluded that its use has been abandoned by industry and that the color additive regulation is outdated and unnecessary."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

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

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Before turning to selective serotonin reuptake inhibitors (SSRIs) to treat anxiety and depressive disorders in children, check out the freely accessible, genotype-based, drug-dosing online knowledgebases for guidance.

Recommendations for prescribing SSRIs

**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?

Trofinetide (Daybue; Acadia Pharmaceuticals) treatment among 277 people living with Rett syndrome led to caregiver-reported improvements in symptoms, from behavioral symptoms to improvements in nonverbal communication, alertness, and social interactions, according to interim data newly published in the 

Developmental Medicine & Child Neurology 

According to a press release from Acadia, the interim data published are from the ongoing, caregiver-reported observational, online, and open-label LOTUS study. LOTUS is evaluating effectiveness and tolerability outcomes in patients with Rett syndrome who are prescribed trofinetide and are under routine clinical care in the United States. In addition to improvements in Rett syndrome symptoms, early insights into managing gastrointestinal symptoms were also reported.

, for patients 2 years or older with Rett syndrome.

The interim analysis included 227 individuals aged 1 to 60 years living with Rett syndrome who were followed for up to 12 months. Caregivers completed study-specific instruments developed by Acadia in consultation with Rett experts, including the Behavioral Improvement Questionnaire (BIQ) and the Gastrointestinal Health Questionnaire. 

Across BIQ responses, 71% to 90% of caregivers noted at least one new or maintained behavioral improvement following treatment. The most frequently reported improvements involved nonverbal communication (48%-71%), alertness (44%-70%), and social connectedness (33%-58%). Among the subset of patients with 12-month Quality of Life Inventory-Disability Questionnaire data (n = 33), the median change from baseline was 4.6 points (IQR, −0.2 to 10.2).


Caregivers reported diarrhea in 23% to 50% of patients between weeks 1 and 12 and in 26% to 38% from months 4 to 12. Most episodes were contained in diapers. Strategies used to address diarrhea included avoiding constipation medications, increasing fluid intake, adding dietary fiber, and using antidiarrheals. Normal stools in the 3 days prior to assessment were reported in 43% to 54% of patients during weeks 1 to 12 and 55% to 63% during months 4 to 12.

Median dosing reached 36% of the FDA-approved target dose at week 1 and rose to at least 80% by week 10.

“These findings from LOTUS help deepen our understanding of the potential outcomes associated with long-term treatment of Daybue in the real-world setting,” said Ponni Subbiah, MD, MPH, senior vice president, global head of medical affairs, and chief medical officer at Acadia, in a statement. “The data are supportive of what we’ve seen in [trofinetide] clinical trials and offer new scientific insights to clinicians that improvements in Rett syndrome signs and symptoms are possible among a broadly inclusive sample of Rett patients. It’s particularly gratifying to document improvements in adult patients, knowing that they may have waited decades without knowing if a treatment would become available within their lifetime.”

Discussing trofinetide data, FDA approval for Rett syndrome with Alan Percy, MD

Alan Percy, MD, discussed what the FDA approval of trofinetide (Daybue) has meant to patients with Rett syndrome aged 2 years and older.

, Alan Percy, MD, professor of pediatrics, neurology, neurobiology, genetics, and psychology at the University of Alabama at Birmingham, discussed the groundbreaking nature of the treatment,

 noting this was the first product that was developed and approved by the FDA for direct treatment of the signs or symptoms of Rett syndrome: "Other medications we use are for symptomatic care, but nothing has been available previously to direct at the basic underpinnings of Rett syndrome."

The pediatrician's role in prescribing trofinetide for Rett syndrome

Efficacy and tolerability among patients prescribed trofinetide for as long as 12 months were consistent with the phase 3 LAVENDER trial that supported FDA approval and the open-label LILAC, LILAC-2, and DAFFODIL studies, for which Percy was a lead author.

LAVENDER, a double-blind, placebo-controlled study that lasted 12 weeks, utilized the Rett Syndrome Behavioral Questionnaire (RSBQ) and the Clinical Global Impression of Improvement (CGI-I) as primary end points to measure the treatment's effectiveness. "What is quite remarkable is at the end of the first pivotal trial, 12 weeks, both the RSBQ and the CGI-I showed improvement," said Percy.

Click here for more on the phase 3 LILAC-1 and LILAC-2 studies.

Real world data from LOTUS study evaluating long-term efficacy and tolerability outcomes of Daybue (trofinetide) in patients with Rett syndrome published in developmental medicine and child neurology. Press release. Acadia Pharmaceuticals. September 12, 2025. Accessed September 15, 2025. https://acadia.com/en-us/media/news-releases/real-world-data-lotus-study-evaluating-long-term-efficacy-and

Cosand L, Mayman H, Downs J, Abler V. Real-world benefits and tolerability of trofinetide for the treatment of Rett syndrome: the LOTUS study. 

. Published online September 11, 2025. Accessed September 15, 2025. doi:10.1111/dmcn.16482

Krewson C. FDA approves trofinetide for treatment of Rett syndrome. 

. March 13, 2023. Accessed September 15, 2025. https://www.contemporarypediatrics.com/view/fda-approves-trofinetide-for-treatment-of-rett-syndrome

Fitch J. Discussing trofinetide data, FDA approval for Rett syndrome with Alan Percy, MD. 

. September 4, 2024. Accessed September 15, 2025. https://www.contemporarypediatrics.com/view/trofinetide-data-fda-approval-rett-syndrome-alan-percy-md 

According to new, real-world data for trofinetide, caregivers reported quality-of-life, alertness, and interaction improvements at 12 months of treatment.

LOTUS study: Trofinetide data show Rett syndrome symptom improvement

 highlight how timely opioid administration in the emergency department (ED) can reduce hospitalizations for children with sickle cell disease (SCD) experiencing pain episodes.

SCD is the most common inherited blood disorder in the United States, and acute pain is the leading cause of ED visits among affected children. Although guidelines recommend opioid treatment within 60 minutes of arrival, evidence linking timely administration to outcomes has been limited. 

David Brousseau, MD, MS, discusses timely opioid administration for children with sickle cell disease

The study findings underscore the importance of ED protocols designed to deliver pain treatment quickly and consistently. Researchers noted that avoiding unnecessary hospital stays can reduce infection risk, lower costs, and ease the burden on families while freeing up hospital resources.

In the Q&A section below, coauthor Ibrahim Gwarzo, MBBS, DrPH, MPH, of the Department of Pediatrics at Nemours Children's Health and the Sidney Kimmel Medical College at Thomas Jefferson University, breaks down the study findings. 

For complete coverage of the study, click here to view our previous coverage.

What do primary care providers need to know when it comes to SCD disease and pain experienced among the pediatric population?

 Primary care providers play an essential role in managing patients with SCD disease. Although the majority of acute pain episodes are treated in EDs, milder pain episodes are typically treated during outpatient visits. Additionally, primary care providers play other crucial roles in care coordination, chronic pain management, preventive care, and follow-up.

Can you explain the design of your study recently published in 

 and how the timing of opioid administration played a role in hospitalization?

Our study was cross-sectional in nature. We used a database of ED visits across several pediatric academic sites in the United States to examine the relationship between the timeliness of opioid administration and hospitalization for patients with acute, uncomplicated sickle cell pain.

Across over 7000 ED visits, we found that timely administration of both the first and the second opioid doses was significantly associated with lower odds of hospitalizations for children with acute, uncomplicated sickle cell pain. 

Specifically, receipt of the first opioid dose within 1 hour of ED arrival and the second within a 30-minute interval was associated with up to 38% lower odds of hospitalization.

With a lot of headlines in recent years surrounding opioids (mainly in the older population), can you explain why this condition may require opioid administration? And what should the primary care professional keep in mind when a patient is on opioids for pain related to SCD?

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

Masoud Salehi, MD

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