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Isabella J. Tan, is a third-year medical student at Rutgers Robert Wood Johnson Medical School.

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.

5-week-old with blood under the tongue 

. 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.

A review highlights the benefits and risks of artificial sweeteners in glycemic control, insulin sensitivity, and gut microbiota balance.

Artificial sweeteners show mixed effects on diabetes management

Discover the benefits of shea butter-based emollients in diapers, offering effective protection against diaper rash and skin irritation for babies.

Emollients for diapers? Yes! Type? It doesn’t matter!

Tapering adalimumab in inflammatory arthritis reduces flare rates and enhances recovery compared to abrupt discontinuation.

Sudden stop vs tapered adalimumab in IA: Which is best?

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

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A look at the highlights from the 30th annual Pediatric Pharmacy Association meeting.

Highlights from the 30th Pediatric Pharmacy Association Meeting

**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

As cannabis use among youth becomes increasingly common, pediatric primary care providers are more likely to see patients who use cannabis while also struggling with mental health disorders. Research shows clear associations with anxiety and depression, and up to one in five young users develop cannabis use disorder.

In this article, child and adolescent psychiatrist Dr. Blair Ritchie highlights what clinicians should know when supporting this population. Key considerations include monitoring for medication interactions, screening with tools like the CRAFFT, and applying evidence-based approaches such as family-based therapy, motivational interviewing, and CBT.

Dr. Ritchie emphasizes that PCPs don’t need to be substance use experts to help. By addressing comorbid conditions, providing guidance, and connecting families to resources, clinicians can improve outcomes for adolescents at risk.

As a follow-up to REACH’s article about youth cannabis use and harm reduction, we asked child and adolescent psychiatrist Blair Ritchie, MD, FRCPC, to walk us through what clinicians should know when diagnosing and treating mental health disorders among youth cannabis users. 

NOINDEX

NOFOLLOW

Managing mental health disorders in adolescent cannabis users

Many families face complex barriers to mental health care that go beyond getting a diagnosis or prescription. This can include lack of time, tight finances, geographic barriers, distrust of the medical system, and differing cultural and religious beliefs. Culturally responsive care gives providers a way to bridge those gaps and improve outcomes for children and families.

In this article, pediatrician and REACH faculty member Dr. Noor Jihan Abdul-Haqq shares practical strategies for empowering parents across diverse backgrounds. From asking families directly about their mental health beliefs, to prioritizing care when diagnoses feel stigmatizing, to connecting families with trusted community resources, her guidance centers on building trust and collaboration.

By practicing cultural responsiveness, clinicians can help parents feel confident, engaged, and equipped to support their child—transforming both care experiences and long-term mental health trajectories.

REACH faculty member and pediatrician Noor Jihan Abdul-Haqq, who has grounded her practice in cultural responsiveness, shares her top strategies and recommendations for REACH-trained clinicians to ensure parents from all backgrounds feel empowered and engaged in their child’s mental health care.

Culturally responsive parent empowerment & children's mental health

Millions of children in the U.S. lack adequate health insurance, creating major barriers to accessing mental health care. Primary care providers are often on the front lines of closing this gap.

In this article, pediatrician and REACH alum Dr. Natalie Robiou shares practical strategies for supporting under- and uninsured patients, including:

Screening early and often for mental health concerns

Using inclusive, multilingual screeners and resources

Navigating cost-saving options for prescriptions

Building connections with schools, community resources, and behavioral health navigators

Dr. Robiou also highlights how providers can sustain themselves in this challenging work and advocate for systemic change. With the right tools and community support, primary care providers can make a life-changing impact for children who might otherwise fall through the cracks.

REACH alum and FQHC pediatrician Natalie Robiou, MD, shared the most effective strategies she’s found for providing mental health care to families for whom insurance (or lack thereof) is a barrier.

Mental health care for under- or uninsured pediatric patients

From the moment they’re born, newborns — or, specifically, their immune systems — must learn to fight germs without harming their own tissues.

In a new study, Yale researchers found that one type of immune cell in newborns — a white blood cell known as a CD8+ T cell (or a cytotoxic T cell) — is “primed and ready” to fight. Within hours of sensing a threat, researchers say, these cells activate and mount a strong, albeit short-lived, defense.

The findings, they suggest, may offer critical insights toward developing new therapies or vaccines for infants.

“These findings help explain why babies respond differently to infections than adults,” said Nina Brodsky, assistant professor of pediatrics at Yale School of Medicine (YSM), pediatric critical care physician, and first author of the study. “By understanding how their immune system is programmed, we may be able to better predict — and eventually prevent — severe illnesses in infants, such as dangerous inflammatory responses to viruses.”

published in the journal Proceedings of the National Academy of Sciences

CD8+ T cells are critical for fighting viruses and cancer. But while there’s a lot known about how they work in adults, the role they play in newborns and infants has been less clear.

For newborns, the moment of birth marks a dramatic shift, as they move from a sterile womb to an environment full of microbes. Their immune systems must quickly learn to fight infections while avoiding excessive inflammation that could damage their developing organs. But how that balance is achieved — and why it sometimes fails — remains poorly understood.

For the new study, the researchers used blood from healthy young adults, ages 18 to 30, and from newborns, specifically cord blood collected during healthy full-term C-section deliveries.

The researchers isolated naïve CD8+ T cells (immune cells that haven’t yet participated in an immune response) for detailed testing of their metabolism, function, and features. They used techniques like transcriptomics to study which genes are active, flow cytometry to examine protein expression and cell characteristics, and metabolic testing to determine how the cells utilize energy. They also reanalyzed existing single-cell RNA sequencing data from fetal, neonatal, and infant naïve CD8 T cells to compare with their findings. 

Through these tests, the researchers discovered that CD8+ T cells, even at this early stage, are poised to fight infections in newborns. Within hours of sensing a threat, these cells switch on and use extra glycolytic energy and release powerful defenders like TNFα, a chemical messenger that induces inflammation. They also found that many of the CD8+ T cells die off after their initial burst, likely to prevent ongoing inflammation that could damage a newborn’s organs.

“This unique balance of speed and self-limitation, guided by specific genetic regulators, continues into infancy and may help neonates and infants fight infections while avoiding harmful inflammation during this vulnerable stage of life,” Brodsky said.

These findings suggest that babies are equipped with immune cells designed for both rapid protection 

 keeping the response in check. Ultimately, researchers say, this could guide new therapies or vaccines designed for early life. 

“Early life is a critical window for immune development,” Brodsky said. “By showing that these newborn immune cells are not weak or underdeveloped, but instead programmed for rapid but balanced responses, our study helps to reshape how we think about the infant immune system. This perspective may open doors to new strategies for protecting babies from infections worldwide.”

For the researchers, the next steps include exploring how early-life immunity changes over the first several years of life and what happens when things go wrong. Specifically, they want to study infants who develop severe viral infections or inflammatory complications to understand the response of their CD8+ T cells.

Other YSM authors include Carrie Lucas, associate professor of immunobiology; Liza Konnikova, associate professor in pediatrics, immunobiology, and obstetrics, gynecology, and reproductive sciences; and Oluwabunmi (Bunmi) Olaloye, assistant professor of pediatrics.

This study was supported by grants from the National Institute of Allergy and Infectious Diseases, the Hartwell Foundation, the Binational Science Foundation, the Cystic Fibrosis Foundation, the National Institute of General Medical Sciences, the Paul and Daisy Soros Fellowship, and the National Institute of Diabetes and Digestive and Kidney Diseases.

A new Yale study helps explain why babies respond differently to infections than adults.

Primed and ready’: How one fast-acting type of white blood cell fights off infection in infants

 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 September 24, 2025, at 3:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

Heather Boone, OMS-III; and Neil Cella, MD. 

A 12-year-old female with no significant past medical history presents to our Emergency Department with 3 days of right-sided neck swelling, which has progressively worsened. The patient notes some pain with chewing on the right side, which has led to decreased intake. The parents report no known fevers but note that other members of the family have recently been sick with a suspected viral illness. The family also reports that this is a recurrent issue that occurs 2 to 3 times a year and endorses that it began after her tonsillectomy procedure. They state that symptoms typically resolve after a course of antibiotics. She has been seen at an ENT clinic for these concerns in the past, with reportedly no solution. She has no other known medical diagnoses or surgeries and is not taking any medications. She lives with her parents and 3 siblings and is in 7th grade.

Her vital signs, including temperature, are within normal limits upon arrival. Physical exam is significant for an indurated, moderately-tender, swelling approximately 2 cm in diameter located anteroinferior to the mastoid process. An oral exam is unremarkable aside from reported dental discomfort elicited by right-sided bite testing. Some residual tonsillar tissue is noted. Upon consulting with the team, labs and imaging are ordered, including CBC, CMP, CRP/ESR, LDH, uric acid serum tests, and diagnostic ultrasound. The lab values demonstrate mild hemoconcentration (possibly due to living at high altitude) and a mildly elevated lymphocyte count. Ultrasound findings include limited images showing bilateral hypoechoic foci in the parotid gland and upper neck regions, and a broad differential is provided. Due to these nonspecific findings, a blood culture is ordered, which produces no growth.  

Norman E. Fenn lll, PharmD, BCPS

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