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Richard Auchus, MD, PhD, professor of pharmacology and internal medicine, University of Michigan.

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Articles

. 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.

Richard Auchus, MD, PhD, highlights data showing that crinecerfont use in children with CAH can improve metabolic outcomes.

Richard Auchus, MD: Crinecerfont's positive weight-related outcomes in children with CAH

 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.

“While our study is small, its results are powerful and have implications not only for MIS-C, but potentially for long COVID,” said lead author Lael Yonker, MD. 

Larazotide safe, could improve MISC symptoms as adjuvant therapy

Many families face common potty training challenges, including anxiety and setbacks, highlighting the need for patience and personalized strategies.

Study: Potty training challenges common, with anxiety and setbacks affecting many families

Achieving the primary endpoint, 44.6% and 54.3% of patients treated with upadacitinib (15 mg and 30 mg) reached 80% or more scalp hair coverage.

Alopecia areata data: Upadacitinib demonstrates improvements in scalp hair coverage

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

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A 3-year-old boy with white patches on the trunk first noticed shortly after birth.

White Patches on a Young Boy's Trunk

**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 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. 

Can you diagnose this patient? Take our poll and find out! Then check back for the full case, differential diagnosis, and correct diagnosis.

News

Case Studies

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

The American Academy of Pediatrics (AAP), an organization made up of more than 67,000 pediatricians, pediatric medical subspecialists, and surgical specialists, has released its influenza vaccine recommendations for the 2025-2026 season.

According to a press release from the long-standing pediatric health organization, the AAP recommends that all healthy people 6 months or older be vaccinated against influenza. Both a policy statement and accompanying technical report have been published online in 

, with final versions pending for the October 2025 issue of 

The AAP said its statements and technical reports are written by medical experts, reflect the latest evidence in the field, and go through "several" rounds of peer review before approval from the AAP Board of Directors and publication in 

Ahead of the 2025-2026 influenza season, the AAP recommends the following, copied from the AAP website:

Any vaccine that is licensed and appropriate for age and health status can be administered as soon as possible in the influenza season without preference for one product or formulation. Options include inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV), and live attenuated influenza vaccine (LAIV).

For those aged 6 months to 8 years, the individual should receive 2 doses if it is the first time they are being vaccinated against influenza, or if they have only received 1 dose of flu vaccine, ever, before July 1. These doses are given 4 weeks apart.

The vaccine should be offered to children as soon as it becomes available, particularly for individuals who require 2 doses. Ideally, recommended dosing should be received by the end of October for optimal protection prior to influenza season.

Vaccination should not be delayed to receive a specific product, including a thimerosal-free product. Recently, the US Health and Human Services Department adopted 

recommendations made by the CDC's Advisory Committee on Immunization Practices (ACIP) to remove thimerosal from all influenza vaccines distributed throughout the United States

 The AAP noted safety of thimerosal-containing vaccines is highlighted in its full technical report.

Vaccination for influenza is also recommended by the AAP for all pregnant individuals, during any trimester of gestation. The AAP stated the vaccine, when given during pregnancy, protects the newborn in the first months of life, up to 6 months, through transplacental passage of antibodies. 

Lastly, the AAP recommends that LAIV should not be used for immunocompromised individuals with certain chronic medical conditions.

Of the 253 influenza-related pediatric deaths through June 21, 2025, 42.7% occurred in children without a high-risk medical condition. 

As the school year comes closer and schedules begin to change, vaccination plays a pivotal role in keeping children safe, as echoed by several pediatric health care providers. 

"Children are more likely to get sick during the school year because they are in such close proximity to each other in class, over lunch, and in play areas,” said Kristina Bryant, MD, FAAP, a member of the AAP Committee on Infectious Diseases, in a statement. "Getting children vaccinated is like giving their immune system a book that teaches their bodies to recognize and resist a disease. Immunized kids are healthier kids who can focus on growing, playing, and learning.” 

, Lori Handy, MD, MSCE, associate director of the Vaccine Education Center and attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia, echoed the importance of vaccination as the school year approaches, with now serving as a good opportunity to schedule vaccines.

"Parents may not realize they missed that 4-year-old visit. Maybe they have 3 or 4 kids, and it is hard to keep track of all the well care their children need,” Handy said. “So it is a great time to pause and make sure children are protected and ready to enter a crowded setting where they can learn and not contract a new infection.”

The AAP noted influenza symptoms include fever; chills; headache; body aches; fatigue; sore throat; dry, hacking cough; stuffy, runny nose; vomiting; and loose stools. 

“Each year, it is possible that flu, COVID-19, and other common viruses will spread at the same time,” added Bryant. "Sometimes, the vaccine is not an exact match with the strains in the community. But the vaccine still can protect against serious illness.” 

American Academy of Pediatrics releases influenza vaccine recommendations for 2025-26 season. News release. American Academy of Pediatrics. July 28, 2025. Accessed July 28, 2025. https://www.aap.org/en/news-room/news-releases/aap/2025/american-academy-of-pediatrics-releases-influenza-vaccine-recommendations-for-2025-26-season/ 

Fitch J. HHS to remove thimerosal from all influenza vaccines in the US. 

. July 24, 2025. Accessed July 28, 2025. https://www.contemporarypediatrics.com/view/hhs-to-remove-thimerosal-from-all-influenza-vaccines-in-the-us

Fitch J. Lori Handy, MD on importance of vaccine catch-up before the school year. 

. July 17, 2025. Accessed July 28, 2025. https://www.contemporarypediatrics.com/view/lori-handy-md-importance-vaccine-catch-up-before-school-year 

AAP recommends all healthy children 6 months or older receive influenza vaccine

According to results from a randomized clinical trial that evaluated emollient intervention in infants not selected for risk of atopic dermatitis (AD), daily emollient application before the age of 9 weeks reduced incidence of AD at the age of 24 months.

According to the study authors led by Eric Simpson, MD, MCR, from the Department of Dermatology at Oregon Health & Science University in Portland, AD imposes a global health burden for children and can be a risk factor for developing food allergy and asthma.

Atopic dermatitis phenotypes and allergic disease development in children

Those who develop AD early in life can carry a risk of developing allergic comorbidities, sleep disturbances, behavioral changes, and mental health disorders and can experience bullying or stigma associated with AD.

"The objective of this current study, the Community-based Assessment of Skin Care, Eczema, and Allergies (CASCADE trial), was to determine whether once-daily, full-body emollient initiated within the first 9 weeks of life can reduce the cumulative incidence of AD in a community-based population not selected for risk," wrote Simpson and investigators.

The trial was a randomized, decentralized pragmatic clinical trial that featured 1247 infant-parent dyads from 25 community-based pediatric and family medicine clinics that are members of 4 statewide practice-based research networks. 

Dyads were broken up into one of 2 groups: a daily, full-body emollient application daily moisturizer group that started by 9 weeks of age or a control group that did not use emollient. Physician-diagnosed AD recorded in medical records by 24 months of age was the primary outcome of the study.

"In the primary analysis, the risk of diagnosed AD by age [of] 2 years in the intervention was compared with the control groups under an intention-to-treat assumption and missing outcomes were imputed using multiple imputation," wrote the study authors. "The relative risk (RR) was estimated using a generalized linear model with a binomial distribution and log link and reported 

 values from a 2-sided Wald test at the .05 level of significance. Risk differences [RDs] are presented using the 

 commands in Stata version 18 (StataCorp)."

Of the 1247 infants included in the trial, 44.3% were girls. The mean (SD) age at random assignment was 23.9 (16.3) days. At the 24-month mark, the cumulative incidence of AD was 36.1% (SE, 2.1) in the daily moisturizer group and 43.0% (SE, 2.1) in the control group, with an RR of 0.84 (95% CI, 0.73-0.97; 

 = .02). The effect magnitude was larger in the population not at high risk of AD (RR, 0.75; 95% CI, 0.60-0.90; 

A weaker intervention effect was observed for those who had a first-degree blood relative with atopic disease compared with children with a lower risk, though the interaction was not statistically significant. Additionally, protective effect of emollient was modified by a dog in the house, as a stronger effect of protection was observed of the intervention in a subset of families (RD, −14.2; 95% CI, −23.2 to –4.6) than in those without any pets (RD, 0.3; 95% CI, −9.6 to 10.3). 

Skin infections, a secondary outcome, occurred at lower rates in the daily moisturizer group compared with the control group (19.8% vs 21.1%; RR, 0.94; 95% CI, 0.74-1.20) with no statistical difference between groups.

Findings suggested that routine use of emollients for AD prevention could be an approach for families, as 64% of participants reported using emollients before study enrollment.

The study enrolled infants not selected for risk, a population that has been studied few times with regard to emollient intervention.

Matthew Knisley, DO

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