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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.

Get caught up with Contemporary Pediatrics! This list helps you navigate our top stories from the week, all in one place. 

Media and mental health, hemophilia approval, July FDA recap, and more

New CDC data show fewer kindergartners are fully vaccinated as exemption rates increased during the 2024-2025 school year.

CDC: Kindergarten vaccination decreases, exemptions increase 

A look back at the FDA submissions and regulatory decisions in the pediatric health care space from July 2025.

FDA news in pediatrics: July 2025

Take a quick look at everything you may have missed last month, including the top FDA approvals and latest clinical updates.

Top 5 pediatric health headlines you missed in July 2025

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

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Authors

 Labor was induced at term in a 29-year-old woman who had had an uneventful pregnancy. Her baby weighed 3575 g (7 lb, 14 oz). The neonate’s left arm was internally rotated with flexion at the wrist. He had a normal grasp reflex, but Moro reflex was incomplete. 

Shoulder Dislocation in a Neonate

**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

Elizabeth Reichert, PhD, shared practical tips for pediatricians to help families monitor teen media use and recognize early signs of anxiety.

Elizabeth Reichert, PhD, talks media exposure and mental health

As news headlines and social media clips reach children and adolescents at a near-constant pace, primary care providers are in a pivotal position to recognize signs that a young patient may be struggling emotionally. 

“You really do not have to be a mental health specialist to help identify early signs and support a child’s emotional well-being,” said Elizabeth Reichert, PhD, pediatric and adolescent psychologist at Stanford Medicine Children’s Health and codirector of the Stanford Parenting Center. 

Reichert advised providers to focus on observable behavioral changes—particularly those that reflect shifts in daily functioning.

“Things like changes in a child’s sleep, appetite, energy level, school performance, increased irritability, or withdrawal,” she said. “Withdrawal, in particular, can be a key sign, especially if a child loses interest in activities they previously enjoyed. We can also see increased worry or reassurance-seeking behaviors, such as frequent checking in or asking parents numerous questions. These behavioral indicators can be telltale signs that something emotional might be going on.” 

When assessing the impact of media exposure, Reichert encouraged providers to discuss screen habits with parents and caregivers. One of the most effective tools for monitoring content, she said, is to engage in co-viewing or co-scrolling. 

“Periodically watching what their child is watching, sitting with them, scrolling alongside them, and checking in can be effective ways to keep tabs on what they are seeing. Encourage them to pause and reflect: What is this media source? Where did it come from? How does this content make me feel right now?” 

These questions, Reichert said, can help children build healthier relationships with the media they encounter.

To promote emotional regulation and family connection, Reichert recommends setting boundaries. “Simple modifications, such as turning off autoplay on platforms like YouTube or Netflix, can help limit screen time,” she said. “My favorite strategy is creating device-free zones or times during the day when the entire family is off devices. Ideal times for this include dinner or just before bedtime.” 

Elizabeth Reichert, PhD, shares practical tips for pediatricians to help families monitor teen media use and recognize early signs of anxiety.

News

Vaccination coverage among kindergartners in the United States declined during the 2024–2025 school year while exemption rates rose, according to new findings from the CDC. Data from states and the District of Columbia showed decreases in coverage for all routine childhood vaccines compared to the previous year. Most states also reported year-over-year declines in protection against illnesses such as measles, polio, and varicella.

Click through the slideshow above to see vaccination numbers from the CDC for the 2024–2025 school year.

Alongside the drop in immunization rates, more kindergartners entered school with exemptions from 1 or more required vaccines. Exemption rates increased in a majority of states, with a growing number surpassing the 5% mark. These changes come as public health officials continue to raise concerns about declining community protection and rising vulnerability to outbreaks in schools and communities. 

"I was speaking with some colleagues at the CDC yesterday and this is really terrible," Tina Tan, MD, FAAP, FIDSA, FPIDS, editor-in-chief, 

attending, Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, told 

"It is a true indicator of the increase in vaccine hesitancy and antivaccination beliefs. The goal should be for all health care providers to work to find a way to slow down the number of infants and children not being vaccinated so that we can protect them against vaccine-preventable diseases," added Tan. "These diseases continue to circulate in the community, and being unvaccinated will place them at significant increased risk for getting the vaccine-preventable disease and possibly developing severe disease and complications." 

As families prepare for the start of a new school year, ensuring children are up to date on vaccinations remains a key public health priority, said 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, in a 

. Handy explained that linking vaccines to the school calendar has long been an effective way to prevent outbreaks of contagious childhood illnesses like measles and polio. These diseases often spread quickly in classroom settings among children encountering their first exposures.

“There was a way to link prevention to the age group that needed it the most, at the time they needed it the most, right when they were about to enter a crowded setting,” said Handy.

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

Handy noted that school-entry requirements serve as an important checkpoint, especially for families who may have missed routine care. 

“It is a nice pause to say, 'Let’s look back: have you missed anything? Do we need to catch you up?'” she said.

"We need to be strong advocates for the patients that we are privileged to provide care for," Tan added. 

New findings on vaccination coverage and exemptions among kindergartners (2024-2025 school year). CDC. August 1, 2025. Accessed August 1, 2025. 

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

. July 17, 2025. Accessed August 1, 2025. https://www.contemporarypediatrics.com/view/lori-handy-md-importance-vaccine-catch-up-before-school-year 

 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 July 23 at 3:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis. 

This case was presented by Umer Muhammad, MD; Neil Copeland, MD; and John Bishara, DO

A 23-month-old girl presented with a 3-day history of cough, rhinorrhea, and increased work of breathing. Initially, she was treated for bronchiolitis at an urgent care center, where a nasopharyngeal swab identified adenovirus. Despite initial treatment, the patient's condition worsened, and she required oxygen supplementation via nasal cannula for oxyhemoglobin desaturation. Her hypoxemia further deteriorated, necessitating an increase in oxygen supplementation (

On physical examination, the patient showed signs of respiratory distress. A chest x-ray (CXR) revealed opacities in the right middle and lower lobes. The patient's condition improved with supportive care, and she was discharged after several days in the hospital. 

However, 9 months later, due to recurrent wheezing, she was referred to the pulmonary service for further evaluation. A follow-up CXR, taken 3 months after the initial infection, demonstrated complete opacification of the right hemithorax, with a mediastinal shift to the right, as well as collapse of the right upper and middle lobes. 

Below, take your best guess at diagnosing this patient

Congenital pulmonary adenomatoid malformation (CPAM) 

website on Wednesday, July 23, at 3:00 PM EST or later 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.

Case Studies

Puzzler poll: Diagnose this 23-month-old with cough and rhinorrhea

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. 

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.

on Monday, January 6 at 12:00 PM ET for the full case presentation, differential diagnoses, and the correct patient diagnosis. 

This case was provided by Amar Davé, MD, FAAP and Pahroul Davé, APRN

A boy aged 10 years presented to the outpatient office with a history of painful nodules on the plantar surface of his bilateral feet 8 to 10 hours after spending time in a hot tub. He was unable to bear weight or put on socks and shoes due to his pain. The photos were taken soon after the painful and red papules appeared. The lesions affected the whole plantar aspect of both feet. Over the following 4 days, the nodules became less painful and red. 

Medical advice was sought on the fifth day of symptoms, and by this time, the child was improving clinically. He was stable with subcutaneous, mildly painful, fleshy nodules mostly populating the medial arch of the foot. His remaining clinical examination results were within a normal range. Further questioning of the child’s mother revealed that other children exposed to the hot tub experienced painful feet but without lesions. 

Due to the patient’s improving symptoms and the self-limiting nature of the illness, no tests or labs were ordered as the child was not acutely ill. No peer consultations or specialists were utilized.

Click here for the full case presentation, differential diagnoses, and the correct patient diagnosis, in a separate article.

The photos in this case were taken soon after the painful and red papules appeared.

Sangeeta Krishna, MD

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