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Connecticut Children’s Medical Center, Hartford, Connecticut; and University of Connecticut, Farmington, Connecticut.

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.

Try to diagnose this patient with a history of receptive-expressive speech disorder and anxiety.

Full case - Anxiety: A diagnosis of exclusion

Thomas Crawford, MD, professor of neurology at the Johns Hopkins University School of Medicine.

. 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.

Thomas Crawford, MD, said SAPPHIRE trial data show apitegromab provides clinically meaningful strength gains for children with SMA by targeting muscle in addition to motor neurons.

Thomas Crawford, MD, highlights improved motor function with apitegromab for spinal muscular atrophy

Try to diagnose this patient with a history of receptive-expressive speech disorder and anxiety. 

Poll: Can you diagnose this 7-year-old with anxious episodes?

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.

Members of the Contemporary Pediatrics Editorial Advisory Board react to the Advisory Committee on Immunization Practices' September 2025 meeting.

Reactions to the September ACIP meeting surrounding MMRV and COVID

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

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**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

Bite injuries are a significant problem in the United States. Discriminating between human and animal bites and identifying those associated with child maltreatment is essential. Approximately 250,000 human bites and several million animal bites occur annually.

 There was also a reported increase in animal bite injuries during the COVID-19 pandemic.

 Despite their frequency, it can be challenging to distinguish between types of bites. There are also few detailed images and descriptions of cutaneous findings of human and animal bites in the literature. 

Additionally, though such injuries occur in various ways, pediatric providers must consider the possibility of child maltreatment. In the COVID-19 pandemic, there was also a documented increase in child abuse–related injuries.

 Though bite wounds are a less common cutaneous finding in child abuse,

 both human and animal bites may result from nonaccidental trauma or neglect. 

In the poll below, try to identify what caused this bite mark on the palm of a 16-year-old boy

Thank you for taking this Contemporary Pediatrics puzzler poll

Visit ContemporaryPediatrics.com on Wednesday, August 6, 2025, at 12:00 PM ET or later for many more bite examples in the pediatric population and how to distinguish between common animal bites and human bites.

"This [case] was prompted by the increases in child abuse and animal bite injuries during the COVID-19 pandemic, with the need to add to the limited descriptions of cutaneous findings of bites in the literature," wrote the authors of this case.

Bula-Rudas FJ, Olcott JL. Human and animal bites. 

. 2018;39(10):490-500. doi:10.1542/pir.2017-0212

Dixon CA, Mistry RD. Dog bites in children surge during coronavirus disease-2019: a case for enhanced prevention. 

. 2020;225:231-232. doi:10.1016/j.jpeds.2020.06.071

Kovler ML, Ziegfeld S, Ryan LM, et al. Increased proportion of physical child abuse injuries at a level I pediatric trauma center during the Covid-19 pandemic. 

. 2021;116(Pt 2):104756. doi:10.1016/j.chiabu.2020.104756

Kos L, Shwayder T. Cutaneous manifestations of child abuse. 

. 2006;23(4):311-320. doi:10.1111/j.1525-1470.2006.00266.x

Despite their frequency, it can be challenging to distinguish between types of bites. Can you identify the source of this bite mark? 

News

Case Studies

Puzzler poll: Can you identify this bite? 

At 32 6/7 weeks, a 1970-g child was born via meconium-stained vaginal delivery to a 37-year-old mother (gravida 2, para 1) who recently immigrated from India. The mother presented with preterm premature rupture of membranes for 11 hours prior to eventual vaginal delivery. 

Maternal history was otherwise notable for rubella nonimmunity, advanced maternal age, and a prior history of intrauterine fetal death 4 years prior. Prior to delivery, the mother received one dose of ampicillin given her unknown group B 

 status and a single dose of betamethasone to accelerate fetal lung maturity.

After delivery, the newborn was vigorous, with delayed cord clamping of 1 minute. The Apgar scores were 8 and 8 at 1 and 5 minutes of life, respectively. There was mildly increased respiratory effort in the delivery room, for which continuous positive airway pressure (CPAP) respiratory support was begun. The child was brought to the neonatal intensive care unit with CPAP of 5 and 30% fraction of inspired oxygen. 

Below, take your best guess at diagnosing this patient

E. coli with extended spectrum beta-lactamase

 website on Wednesday, September 10, at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis. 

A recently immigrated mother from India presents in preterm labor at 32 6/7 weeks and delivers a vigorous baby whose initial blood culture result is positive at 18 hours of life with gram-negative rods. 

Can you diagnose this infant with neonatal respiratory distress?

In this video interview, John Browning, MD, comments on the recent pediatric indication approved for ruxolitinib to treat atopic dermatitis.

John Browning, MD, reacts to the approval of ruxolitinib for atopic dermatitis in children

FDA approved ruxolitinib to treat atopic dermatitis in patients aged 2 to 11 years

In this brief reaction video, John Browning, MD, Chief of Dermatology at Children’s Hospital of San Antonio, explained the excitement surrounding another steroid-free atopic dermatitis treatment tool.

"I think it is very exciting to have another non-steroidal approved for kids with atopic dermatitis. [Ruxolitinib] has been approved in kids aged 12 years and older for vitiligo for some time now, so I do think that it is good to have multiple products approved that allow multiple options in treating atopic dermatitis," he said.

Ruxolitinib's expanded approval was based on data from the phase 3 TRuE-AD3 study (NCT04921969), a randomized, double-blind, vehicle-controlled trial that evaluated the safety and efficacy of the topical vs vehicle in children with atopic dermatitis aged 2 to younger than 12 years. The trial featured more than 300 patients who had an atopic dermatitis diagnosis for at least 3 months.

The trial met its primary endpoint, the proportion of participants achieving an Investigator’s Global Assessment Treatment Success (IGA-TS), defined as an IGA score of 0 (clear) or 1 (almost clear) with at least a 2-point improvement from baseline at Week 8.

Click here for additional approval details and more phase 3 data for ruxolitinib

"It's just so great to finally be able to get a 2A non-steroidal medicine as first line, which is what I think it should be," added Browning. "I don't think we should have to make patients try a topical steroid first and [potentially] have a rebound issue... it is just good to finally be able to start with these."

1. Fitch J. FDA approves ruxolitinib for pediatric patients with atopic dermatitis aged 2 to 11 years. June 17, 2025. Accessed September 18, 2025. Contemporary Pediatrics. https://www.contemporarypediatrics.com/view/fda-approves-ruxolitinib-for-pediatric-atopic-dermatitis 

2. Incyte Announces Additional FDA Approval of Opzelura (Ruxolitinib) Cream in Children Ages 2-11 with Atopic Dermatitis. Incyte. Press release. September 18, 2025. Accessed September 18, 2025. https://investor.incyte.com/news-releases/news-release-details/incyte-announces-additional-fda-approval-opzelurar-ruxolitinib 

Children diagnosed with COVID-19 gained more weight than COVID-negative peers, especially after diagnosis, during the pandemic.

Thao-Ly Phan, MD, MPH discusses weight lessons learned during COVID-19 pandemic

Children who contracted COVID-19 gained weight more rapidly than their peers during the pandemic, according to new findings published in 

. The study used longitudinal data from the National COVID Cohort Collaborative (N3C) to track body mass index (BMI) trajectories of over 11,000 children with a COVID-19 diagnosis, comparing them with a matched cohort of COVID-negative peers. 

Thao-Ly Phan, MD, MPH, medical director of the Healthy Weight and Wellness Clinic at Nemours Children’s Health and study coauthor, said the work builds on early pandemic observations.  

“We knew early on that the pandemic impacted weight for both children and adults,” Phan explained, noting earlier reports from Kaiser and the CDC that documented sharp rises in overweight and obesity among children. “I think now we’re starting to figure out why.” 

The study found that both COVID-positive and COVID-negative children gained weight during the pandemic, but those with COVID gained significantly more. On average, the COVID-positive group had a greater increase in BMI percentile compared to their peers, with the most rapid gain occurring after diagnosis. Non-hospitalized children saw greater increases than those who were hospitalized, a trend that held even after adjusting for demographics, baseline weight status, and observation period. 

“We contributed uniquely to the literature by asking: ‘Does having a diagnosis of COVID impact the weight gain that we know happened for all children during the pandemic?’” Phan said. Leveraging the N3C database—which harmonizes electronic health records from more than 90 US-institutions—the team was able to compare matched groups and evaluate weight trajectories before and after infection. Although the study could not determine the exact reasons behind the association, Phan pointed to several likely contributors.  

“Some recent studies have shown that children were more sedentary, had abnormal eating patterns, and experienced disrupted routines,” she said. “Altogether, I think this gives us a deeper picture of why children may have gained weight during the pandemic, and how we might prevent future weight gain in children."

Children diagnosed with COVID-19 gained more weight than COVID-negative peers, especially after diagnosis, during the pandemic. 

Thomas Crawford, MD

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