Animal Allergies

Food Allergies

Allergy, Immunology, and ENT

Cardiovascular Diseases

Cardiology

Acne

Atopic Dermatitis

Dermatology

Emergency Medicine

Diabetes

Endocrinology

Formula

Nutrition

Obesity

Gastroenterology

Antibiotic Resistance

Bacterial Conjunctivitis

COVID-19

Influenza

Pneumonia

Sexually Transmitted Diseases

Vaccination and Immunization

Vaccines

Infectious Diseases

ADHD

Addiction

Antisocial Personality Disorder

Anxiety

Autism

Depression

Developmental/Behavioral Disorders

Psychiatry

Mental, Behavioral and Development Health

Concussion

Epilepsy

Headache

Neurology

Neonatal/Perinatology

OB/GYN

Pain

Drug Pipeline News

Pharmacology

Telemedicine

Practice Improvement

Asthma

Cystic Fibrosis

Respiratory

Rheumatology

News 

All News

PNP Corner

AAP News

Media

Around the Practice

Cure Connections

Expert Interviews

Insights

Medical World News

Peer Exchange

Peers & Perspectives

Podcasts

Webinars

Puzzler

Publications

Contemporary Pediatrics Journal

Supplements And Featured Publications

CME/CE

Resources

Handouts

Job Board

Conferences

Conference Coverage

Conference Listing

Partnerships

Subscribe

Editorial

Editorial Advisory Board

Writer’s Guidelines

Reference Guidelines

Meet the Editors

John Browning, MD, Chief of Dermatology at Children’s Hospital of San Antonio and Organon Health Partner.

Dr. John Browning Headshot (1).jpg

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.

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

 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.

New research highlights how differences in state laws may be linked to changing trends in pediatric firearm mortality across the United States.

Rise in pediatric firearm deaths linked to permissive state gun laws

Childhood adversity may raise endometriosis risk, with exposure to violence linked to a twofold increase, a Swedish study of 1.3M women finds.

Study: Childhood adversity linked to elevated risk of endometriosis

The phase 2 trial will be 4 weeks and evaluate investigational, once-daily roflumilast cream 0.05% in infants 3 months to less than 2 years of age. 

First infant enrolled in trial of roflumilast cream, 0.05% for atopic dermatitis in infants

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

About Us

Advertise

Contact Us

Terms and Conditions

Privacy

Do Not Sell My Personal Information

Contemporary Pediatrics – Clinical News & Pediatrician Practice Tips

Facebook

LinkedIn

Instagram

Clinical

Gynecology

Infectious disease

Mental Health

Oncology

Rheumatoid Arthritis

Sexual Health

View More

1rem

Authors

 A 4-year-old, previously healthy girl presented to a tertiary care children’s hospital emergency department (ED) with large, tense bullae involving up to 40% of her body surface area. The patient’s parents described a 12-day history of itchy, papulovesicular lesions that had progressed into large blisters.

Chronic Bullous Disease of Childhood

**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

Beginning in mid-May, the FDA, Health and Human Services (HHS), and the CDC outlined a new COVID-19 vaccine framework and announced on May 27 the removal of the vaccine from the CDC immunization schedule for healthy children and pregnant individuals. However, according to the CDC's Child Immunization schedule that was updated on May 29, healthy individuals aged 6 months to 17 years who are not moderately or severely immunocompromised can receive the vaccine through a "shared clinical decision-making process."

Below is a timeline recap of these changes and announcements. 

May 20, 2025: FDA announces new COVID-19 policy for children 

On May 20, 2025, the FDA announced a new COVID-19 vaccination regulatory framework for future seasonal vaccines and additional clinical trial requirements for approval of vaccines intended for healthy individuals. According to the framework, published in the 

), the FDA will use an immunogenicity basis to make favorable benefit-risk findings for adults older than 65 years, and for all persons aged 6 months and older with at least 1 risk factor that increases risk for severe COVID-19 outcomes.

 publication was authored by Martin Makary, MD, MPH, commissioner of the FDA; and Vinay Prasad, MD, MPH, director of the FDA's Center for Biologics Evaluation and Research, stated for healthy individuals aged 6 months to 64 years, with no risk factors for severe COVID-19, the FDA "anticipates the need for randomized, controlled trial data evaluating clinical outcomes," before biologics license applications for the vaccines can be approved.

Click here for more on the policy outline, as it was reported at the time of publication.

May 27, 2025: CDC pulls COVID-19 vaccine recommendation for healthy children, pregnant individuals 

Just a week after the new framework was announced, on May 27, 2025, HHS Secretary Robert F. Kennedy Jr. announced that the CDC had pulled the recommendation for routine COVID-19 vaccination among healthy children and pregnant women.

In a video posted to X, Kennedy Jr. stated the following: 

"I couldn't be more pleased to announce that, as of today, the COVID vaccine for healthy children and healthy pregnant women has been removed from the CDC recommended immunization schedule."

At the time of the announcement, multiple health care professionals 

about the recommendation removal and frequent changes to policies by federal agencies.

"The craziness never ends, and the recent change to the CDC immunization schedule regarding the COVID-19 vaccine and use in pregnant women and healthy children is complete madness," stated Tina Tan, MD, FIDSA, FPIDS, FAAP, in an interview with 

, president of the Infectious Diseases Society of America, an attending for Infectious Diseases at Ann & Robert H. Lurie Children's Hospital of Chicago, and a professor of Pediatrics at Northwestern University's Feinberg School of Medicine.

"COVID-19 infection can have extremely serious consequences in pregnant women, resulting in hospitalization, pre-term labor, pre-eclampsia, heart injury, blood clots, hypertension, and kidney damage," added Tan. "Not vaccinating them is sheer madness and will contribute to a significant increase in possible morbidity and mortality. Also, not vaccinating healthy children is completely inappropriate, given that some healthy children can have severe COVID infections with long-lasting consequences. This will make it much more difficult for practitioners as they will have to determine which of their patients are eligible for the COVID vaccine to determine how much vaccine to order and to determine if insurance will cover vaccine cost."

Click here for more reactions to the removal of the vaccine recommendation, as it was reported on May 27, 2025.

May 29, 2025: Updated CDC child immunization schedule 

As of May 29, it appears the CDC has again changed course on routine COVID-19 vaccination, stating that children aged 6 months to 17 years who are not moderately or severely immunocompromised may receive the vaccine in situations where the parent wishes their child to get the vaccine, along with clinical judgement provided by a health care professional on a case-by-case basis.

For clarity, the "Shared clinical decision-making" section 

"Ages 6 months–17 years who are NOT moderately or severely immunocompromised" 

"Shared clinical decision-making vaccinations are individually based and informed by a decision process between the health care provider and the patient or parent/guardian. Where the parent presents with a desire for their child to be vaccinated, children 6 months and older may receive COVID-19 vaccination, informed by the clinical judgment of a healthcare provider and personal preference and circumstances."

Following this statement, the childhood vaccine schedule continues, with recommendations for vaccination by various age groups.

"[The clinical trials could] be a major factor in delaying whether or not individuals are going to be able to receive the vaccine, and that that is not how this should be done, because we know these vaccines work," said Tan. "The vaccines are being reformulated every year to take into account the circulating subserotypes. We know the vaccines work, we know the vaccines are safe. To do [this is] really going to delay availability."

William Schaffner, MD, professor of Medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine, agreed with this sentiment, telling our sister publication 

, "So, the [FDA] regarding COVID vaccines has become very assertive in indicating which populations ought to be vaccinated going forward this fall," said Schaffner.

"That, to the minds of many of us, has the FDA getting into the CDC territory. The FDA looks at the effectiveness of the vaccine and its safety and then licenses it, and traditionally, then that vaccine has been left to the CDC advisory committee to make recommendations as to which populations ought to receive the vaccine. But here, just recently, the FDA seems to be, if you will, poaching on CDC territory. The mechanism that I've described, first the FDA and then the CDC, has stood in good stead for over 60 years. In the minds of many people, it ain't broke. Why do we have to fix it?"

As far as implementations and actual vaccination outcomes in the fall, Schaffner said it could be a waiting game.

"[These policies are] a little bit different than in the past, and changes always raise questions. There's that old saying, the devil is in the details. And so as these new policies come forward and are implemented, everybody will be looking at them very, very carefully." 

1. Child immunization schedule notes. CDC. Updated May 29, 2025. Accessed June 2, 2025. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-notes.html#note-covid-19

2. Tan T, Fitch J. Tina Tan, MD, discusses impact of FDA's stricter COVID-19 vaccine policy for children. Contemporary Pediatrics. May 23, 2025. https://www.contemporarypediatrics.com/view/tina-tan-md-discusses-impact-of-fda-s-stricter-covid-19-vaccine-policy-for-children

3. Fitch J. CDC pulls COVID-19 vaccine recommendation for healthy children, pregnant individuals. Contemporary Pediatrics. May 27, 2025. Accessed June 2, 2025. https://www.contemporarypediatrics.com/view/cdc-pulls-covid-19-vaccine-recommendation-for-healthy-children-pregnant-individuals

4. Parkinson J, Schaffner W. Federal government changes course again on COVID-19 vaccine policy. Contagion. June 2, 2025. Accessed June 2, 2025. https://www.contemporarypediatrics.com/view/cdc-pulls-covid-19-vaccine-recommendation-for-healthy-children-pregnant-individuals

In this article, we recap a timeline of recent federal agency changes to routine COVID-19 vaccination intended for the pediatric population. 

News

CDC: Healthy children can receive COVID-19 vaccine via 'shared clinical decision-making'

 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 Vasudevannair, MD MPH FAAP. 

A healthy 12-month-old girl presented with one small skin lesion over the right heel (Image 1) 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, 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 re-checked. After 3 months, the child showed full resolution of the skin lesion over the heel area (Image 2).

Below, take your best guess at diagnosing this patient.

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

Thank you for taking this Contemporary Pediatrics poll! Want more puzzler case studies? 

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 infant with an asymptomatic pearl-like nodule on the heel

 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 Wednesday, May 7, 2025 at 12:00 PM Eastern Time or later for the full case presentation, differential diagnoses, and correct patient diagnosis.

This case was provided by Akash Deswaney, MD, Neil Copeland, MD, and John Bishara, DO.

An 18-day-old female presented to the ED with concerns of apnea, cyanosis, and decreased feeding. The mother reported intermittent cyanosis of the lips, pale-appearing skin, and suspected apnea episodes. Since birth, Mom states patients had retractions since birth, which the PCP reassured her was normal periodic breathing. She had nasal flaring and grunting a couple of days after discharge from the nursery. Mom has noticed she breathes quickly, in the 60s or 70s at times.

Initial vitals in the ED showed hypoxemia, tachypnea, and fluctuating oxygen saturations were between 65-100% on room air. A chest X-ray is shown (

Click here for the full case presentation, differential diagnoses, 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. 

Robert Peterson

Articles

Latest Updated Articles