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Christopher Connolly, MD, MBA, MS, is a pediatric and medical genetics resident physician at Michigan Medicine.

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.

Pediatricians empower families of children with disabilities by promoting ABLE accounts, enhancing financial security and access to essential resources.

Empowering children with disabilities: A pediatrician’s guide to breaking financial and health barriers with ABLE accounts

Tyra Bryant-Stephens, MD, is a board-certified pediatrician; medical director, Asthma Prevention Program; chief health equity officer, Center for Health Equity, at Children’s Hospital of Philadelphia.

. 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 J. Wong, DO, and Tyra Bryant-Stephens, MD, outline strategies for controlling asthma as kids head back to school.

Tyra Bryant-Stephens, MD, Richard Wong, DO, break down asthma in the classroom

 is a UCLA-trained pediatrician and working mom. A nationally recognized child health expert, she has 25 years of experience caring for children. She is the author of several best-selling parenting books, including the American Academy of Pediatrics 

Caring for Your Newborn and Young Child: Birth to Age 5 and Your Baby’s First Year'.

 As a regular child health expert for numerous news programs and talk shows, Dr. Tanya communicates complicated medical issues into easily understood concepts, discusses breaking medical news stories, and tackles controversial parenting issues. She started Calabasas Pediatric Wellness Center to provide personalized and integrative comprehensive pediatric health care, and is also a member of 

Back-to-school season impacts children's mental health. Discover strategies for parents to support emotional well-being and resilience in elementary students.

Supporting mental and behavioral health for elementary school children

Michael Haller, MD, professor and chief, Pediatric Endocrinology, University of Florida.

Manufacturer MannKind has submitted a supplemental Biologics Application to the FDA for its inhaled insulin Afrezza.

Michael Haller, MD, discusses inhaled insulin and Afrezza data for type 1 diabetes

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

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How a hodgepodge of federal and state telehealth waivers creates compliance concerns for providers practicing across state lines.

Confusion with telehealth could create issues

**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.

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.

News

Case Studies

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

Pediatric experts emphasize the importance of asthma action plans, medication readiness, and school-based support to help children with asthma stay healthy and active during the academic year.

Planning and communication: Keys to helping children with asthma in school

As of the 2024 school year, asthma was one of the leading causes of school absenteeism and is a leading chronic illness among children and adolescents in the United States, according to the CDC. As children prepare for another year of learning, it is estimated that in a classroom of 30 children, 3 are likely to have asthma, with increased numbers among low-income populations.

Back-to-school wellness visits and check-ups are the time to remind parents of children with asthma about in-school scenarios to help their children deal with asthma. From treatment plans to planning medication times in the classroom to physical activity exertion during recess, parents must have the resources and an understanding of the condition to help their child maintain reasonable control of their asthma in the school setting.

 Primary health care providers can have a meaningful role in helping parents with their child’s asthma needs while they navigate the start of a new school year.

Challenges of dealing with asthma in school

Going from summer break at home back to the school setting can be difficult for children with asthma, due to environmental and scheduling changes. On top of natural changes to these aspects of the child’s life, when the bell rings again in the fall, inconsistent communication and an under-recognition of symptoms could contribute to increased asthma flares and symptoms.

“Children at school face several challenges in making sure that their asthma stays under good control, as compared to being at home, where family and children can minimize their exposures and triggers that may flare up their asthma,” said Richard J. Wong, DO, pediatric pulmonologist, Phoenix Children’s, in an interview with 

. “Additionally, while at school, some children may not have ready access to rescue therapies when they are symptomatic, either due to school policy, a lack of an asthma action plan, or stigma, such as bullying.”

Archives of Pediatrics and Adolescent Medicine

 in 2005, whose data showed that the start of the school year in September was associated with a 46% increase in pediatric asthma emergency department visits, particularly among grade school students.

The timing of medication in both the school and at-home settings can be a challenge for parents as well.

“Another challenge is the daily schedule, which may or may not account for whether they need to take their medications at a certain time,” Tyra Bryant-Stephens, MD, added. Bryant-Stephens is a board-certified pediatrician, medical director of the Community Asthma Prevention Program, and chief health equity officer of the Center for Health Equity at Children’s Hospital of Philadelphia.

“A common challenge we see is that getting ready for a busy school day can make it difficult for families to remember to give the morning dose of medication, even though they give the evening dose at home,” said Bryant-Stephens.

Challenges can also vary by age. Wong stated that young children who cannot articulate their symptoms must rely on teachers and school nurses to recognize these symptoms and intervene. He noted that middle school–age children can begin to have some freedom regarding taking some control of their medication management, though stigma could play a factor with adherence, leading to undertreatment of symptoms.

“[With] adolescents, parents are trying to encourage full independence of their asthma management,” said Wong. “Adolescents often underreport symptoms and feel like their controller therapies may not be necessary. They may think, “Why do I need to take this if I am feeling great every day?” This can lead to an overreliance on short-acting beta agonists because [those] relieve their symptoms most quickly. As a result, they miss doses and can easily have asthma flares.”

Provider communication can help parents and children with asthma

Parents must fully understand how asthma affects their child’s well-being, and that’s where the pediatrician’s role comes into play at the child’s next well visit. According to Bryant-Stephens, most schools require a medical form stating that children can receive medication at school, which the pediatrician may need to sign. Pediatricians should explain to parents that adapting the home environment to the school environment as much as possible can help with medication adherence and consistency.

“An asthma action plan or written asthma care plan is important for the school to have, as well as for home,” she stated. “It is really important that when children come for their well visit, they get everything they need for school. It is also important to ensure they have an inhaler for home and one for school. This requires understanding their insurance and talking to parents about how to best obtain these medications. In addition to their medication, they also need another spacer or holding chamber and another mask for younger children, making sure they have everything they need for school as well as home.”

Additionally, Bryant-Stephens noted 5 key aspects to review with parents at a well visit before the school year begins, which include the following:

Reviewing what they need from the provider

Ensuring the school checklist is complete

Making sure refills are readily available

Having access to the school nurse as an extension of the multidisciplinary team can streamline communication and medication adherence for the child during school hours. However, the availability of such nurses can vary widely across schools.

“School nurses are often isolated; they are the only ones in the school with health care knowledge,” added Bryant-Stephens. “We need to consider them part of the health care team, so children get the care they need during the day. Whatever we can do to foster communication and help parents see nurses as allies—not adversaries—is important. School nurses are not calling parents just to send children home because they are sick. They are allies in keeping children in school. The better the communication and collaboration, the better the student’s school experience will be.”

As the child with asthma navigates the long-term, inflammatory disease and all its challenges,

 some practical reminders could help quell symptoms and flare-ups. Simple reminders include pacing during physical activity and tracking medications daily.

“I often tell children to pace before and after exercise. We talk about slow warm-up and slow cool-down. An abrupt start or finish can trigger symptoms. Children can understand the idea of slowly working up to vigorous activity for 5 minutes and then slowly winding down instead of stopping abruptly,” said Bryant-Stephens.

Additionally, reminders related to the school environment that may not be front of mind for the child could make a difference, especially as the return to school and allergies can go together, potentially increasing the chances of asthma flare-ups.

“I often tell parents that if they take a vacation from allergy medications in July, they should restart them at the end of August so the child is less likely to have allergic symptoms that can trigger asthma. We cannot avoid colds—they will happen—but we can control other triggers,” said Bryant-Stephens.

“It is important to make sure enough refills are always present for families and to encourage the use of spacers with pressurized metered-dose inhalers, having enough for both home and school,” added Wong. “This ensures optimal medication delivery to help treat the child effectively if they are symptomatic.”

Managing asthma in schools. CDC. August 13, 2024. Accessed July 10, 2025. https://www.cdc.gov/school-health-conditions/chronic/asthma.html

Back to school with healthy lungs. American Lung Association. Updated November 20, 2024. Accessed July 10, 2025. https://www.lung.org/lung-health-diseases/wellness/back-to-school

Silverman RA, Ito K, Stevenson L, Hastings HM. The relationship of fall school opening and emergency department asthma visits in a large metropolitan area. 

Seth Orkand

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