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Tina Tan, MD, FAAP, FIDSA, FPIDS—editor in chief of 

, professor of pediatrics at Northwestern University’s Feinberg School of Medicine, Infectious Diseases attending at Lurie Children's Hospital of Chicago, and president of the Infectious Diseases Society of America.

Videos

 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.

In this video, the last in a 3-part series, panelists discuss future directions in the field and the importance of multispecialty collaboration.

RX Review: Collaborating to strengthen RSV prevention efforts

In this video, part 2 in a 3-part series, panelists discuss clesrovimab's recent approval and gaps in clinician education.

RX Review: Expanding options and addressing gaps in RSV prevention 

In this video, the first in a 3-part series, panelists discuss recent advancements in RSV management.

RX Review: RSV prevention and pediatric hospitalization

. 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

The federal agency has assigned a target action date of January 31, 2026, for a decision. 

FDA accepts NDA for epinephrine sublingual film to treat type 1 allergic reactions

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

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Teen with painful papules and plaques is diagnosed with Sweet's Syndrome

A teen with persistent painful papules and plaques

**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

Michael O. Daines, MD, outlines key diagnostic criteria and treatment challenges for pediatric acute-onset neuropsychiatric syndrome (PANS), emphasizing the need for multidisciplinary care and improved treatment access.

  Michael Daines, MD, discusses pediatric acute-onset neuropsychiatric syndrome

Primary care providers may be the first line of defense for children with pediatric acute-onset neuropsychiatric syndrome (PANS), but diagnosing and managing the condition can present significant challenges, according to Michael O. Daines, MD, division chief of Pediatric Allergy and Immunology at the University of Arizona College of Medicine.

“I think there are 3 main hurdles that people in primary care hit with this disease,” Daines said. “The first is recognition,and if you can't find it, you can't treat it.”

PANS is a clinical diagnosis characterized by a sudden onset of obsessive-compulsive disorder (OCD) or severe food restriction, accompanied by at least 2 additional neuropsychiatric symptoms, according to Daines. These can include anxiety, mood changes, regression of skills, sleep disturbances, urinary symptoms, and movement or sensory issues.

“All of these things can be normal or caused by other things in children,” Daines explained. “So it is also essentially a diagnosis of exclusion, where you have to rule out other medical conditions before you go forward. The second threshold you really hit is trying to find a treatment team that is willing to take care of these kids,” he said. “They have a bio-behavioral background, so there are very few doctors that are good at treating both the immunology and the behavioral components.”

Successful management of PANS typically requires a multidisciplinary approach that incorporates both medical and behavioral therapies. In Daines’ clinic, this includes outreach to community pediatricians to help guide treatment for milder cases.

“A lot of the milder cases can be treated with other anti-inflammatories—things like naproxen—and treatment of infections that may be triggering the illness,” he said.

Ultimately, Daines encouraged general pediatricians to remain alert to sudden behavioral or psychiatric shifts in patients and to feel confident initiating a workup. 

“Ideally, this is going to be taken care of in a multidisciplinary manner,” he said. “But there’s a lot that primary care can do to identify and support these patients early.”

News

Michael Daines, MD, discusses pediatric acute-onset neuropsychiatric syndrome

Aaron Milstone, MD, MHS, emphasizes the role of pediatricians in educating families on infection prevention practices for infants in the NICU, where Staphylococcus aureus remains a serious threat.

Staphylococcus aureus risk in infants and neonatologist considerations with Aaron Milstone, MD

Aaron Milstone, MD, MHS, pediatric infectious disease specialist at Johns Hopkins Children’s Center and professor of pediatrics at Johns Hopkins University School of Medicine, emphasized the importance of pediatrician guidance and parent engagement in the prevention of 

 infections in the neonatal intensive care unit (NICU).

In a recent interview, Milstone explained that while 

 is a common cause of minor skin or eye infections in children, the infection can become life-threatening in vulnerable populations—particularly preterm infants during their first few weeks of life.

“For most primary care providers, this is not going to be a common topic,” Milstone said. “

 is incredibly common in children... but it rarely, in children outside of the hospital, is life-threatening. Babies in the first few months of life are really a unique population that is especially high at risk.”

Milstone co-authored a recent study published in 

 infections occurred at a rate of 37.6 per 10,000 infants across 315 NICUs between 2016 and 2021.1 Infants born with very low birth weight (VLBW)—under 1500 grams—made up just 12.7% of the population but accounted for 76.7% of infections and 90.4% of attributable deaths. The mortality rate among infected infants was more than five times higher than those without infection.

For pediatricians, Milstone pointed to opportunities to provide proactive guidance to families with infants in the NICU. 

“Pediatricians spend a lot of time providing anticipatory guidance for families,” he said. “They may already have a relationship with the family from an older sibling... so they’re in a unique position to help.”

Renewed focus into Staphylococcus aureus risk in infants, with Aaron Milstone, MD

One example is hygiene reinforcement for families with babies in the NICU. “We’ve previously shown in a trial that parents are a reservoir for spreading staph to babies, just like moms can spread Group B strep,” Milstone said. “So there are things pediatricians can recommend—like making sure they’re washing their hands, not visiting when sick, or wearing a mask to protect the baby.”

Milstone also noted that colonization screening and targeted decolonization protocols may offer future benefit for prevention. “There’s a growing body of literature showing that if kids are colonized with staph... there is an opportunity to treat or try to make that carriage go away,” he said. “The benefit of decolonizing a child as a prevention strategy may outweigh the potential risk.”

“When we talk about a 5% increase [in mortality], we’re talking about similar babies. When we compared similar children, the risk of mortality was about 1% in children that didn't have an infection, and more than 5% in those that did. So it wasn't just a 5% absolute increase, but it went from about 1% to 5%," he explained. "That is a huge mortality difference in similar babies that do or don't have infections, so the impact of this is great."

1. Fitch J. Aaron Milstone, MD, highlights persistent risk of Staphylococcus aureus in premature infants. Contemporary Pediatrics. June 5, 2025. Accessed June 12, 2025. https://www.contemporarypediatrics.com/view/aaron-milstone-md-highlights-persistent-risk-of-staph-aureus-in-premature-infants

2. Fitch J. Renewed focus into Staphylococcus aureus risk in infants, with Aaron Milstone, MD. Contemporary Pediatrics. June 6, 2025. Accessed June 12, 2025. https://www.contemporarypediatrics.com/view/renewed-focus-into-staphylococcus-aureus-risk-in-infants-with-aaron-milstone-md

John Browning, MD, highlights the importance of fragrance-free, steroid-free creams in managing atopic dermatitis safely and effectively in children.

How fragrance plays a role in atopic dermatitis treatments, with John Browning, MD

For pediatricians treating children with atopic dermatitis, safe and effective topical options are now more accessible and increasingly important to understand, says John Browning, MD, chief of dermatology at Children’s Hospital of San Antonio. 

“Pediatricians should be very confident to prescribe steroid-free creams,” Browning said. “They can and should do that when they see a patient.” In many cases, children first present with symptoms of eczema during routine visits or sports physicals, he noted, making the pediatrician the first opportunity for timely intervention.

Having a non-steroidal, fragrance-free treatment readily available “is great,” Browning added, particularly given the limited number of pediatric dermatologists. 

“Otherwise, those patients are going to suffer before they’re finally going to be seen by a pediatric dermatologist. Fragrance is a major player in both irritating atopic dermatitis, but also in causing allergic contact dermatitis,” he explained, and noted that in children with eczema, even common daily products like cleansers, shampoos, or moisturizers can be problematic. 

“People with atopic dermatitis have a lower threshold for irritation from fragrance. If you look at the top 10 list for cutaneous allergies in children, fragrance is going to make that list every single time,” Browning said. 

He urged pediatricians and caregivers to look for products labeled “fragrance-free” rather than simply “unscented,” which may still contain masking fragrances. “Oftentimes it doesn’t even list fragrance, it may use a funny word like ‘parfum’,” he said. “Even things like essential oils should really be avoided if you’ve got a child with sensitive skin and eczema.”

Browning highlighted the December 16, 2024, 

FDA approval of tapinarof cream 1% (Vtama)

 in December 2024, which is indicated to treat atopic dermatitis in patients 2 years of age and older.

“This product is fragrance-free. It’s not irritating to the skin. It doesn’t have harmful preservatives or things like petroleum jelly,” he said. “Thankfully, now we’ve got newer products that don’t have some of the harmful ingredients.” 

Tapinarof cream 1% demonstrates positive long-term results for atopic dermatitis in patients 2 years and up

Editor's note: A relevant disclosure for Browning is Organon

1. Fitch J. FDA approves tapinarof cream, 1% for atopic dermatitis patients 2 years and up. Contemporary Pediatrics. December 16, 2024. Accessed June 11, 2025. https://www.contemporarypediatrics.com/view/fda-approves-tapinarof-cream-1-for-atopic-dermatitis-patients-2-years-and-up 

2. Ebert M. Tapinarof cream 1% demonstrates positive long-term results for atopic dermatitis in patients 2 years and up. Contemporary Pediatrics. March 10, 2025. Accessed June 11, 2025.  https://www.contemporarypediatrics.com/view/tapinarof-cream-1-demonstrates-positive-long-term-results-for-atopic-dermatitis-in-patients-2-years-and-up 

Ramilo, a clesrovimab clinical trial investigator, breaks down the recent FDA approval for the newest monoclonal antibody to protect against RSV disease in infants.

  Octavio Ramilo, MD, reacts to the FDA approval of clesrovimab for RSV prevention

FDA approval of clesrovimab (Enflonsia; Merck)

 marked another advancement for the prevention of respiratory syncytial virus (RSV) disease in infants, especially during their first RSV season. The decision adds another tool for providers and clinicians, and continues the momentum seen in recent years regarding RSV and FDA-approved preventive measures. 

Nicolas Llosa, MD

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