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Dr Farber is a pediatrician in Woodbridge, Virginia.

Articles

"The financial cost should be minimal; if you can see 1 or 2 extra patients per month, the AI scribe should pay for itself."

Physicians give AI scribes a thumbs-up!

FDA approves recombinant VWF for pediatric von Willebrand disease, enhancing treatment options for children during bleeding episodes and surgeries.

FDA Approves First Recombinant VWF for Pediatric von Willebrand Disease

 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.

. 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.

Fewer than half of Medicaid-enrolled children with sickle cell disease in Michigan received dental care in 2022, new study shows.

Children with sickle cell disease face low dental care utilization despite elevated risks

David Brousseau, MD, MS, Pediatrician-in-chief, director of Research, Nemours Children’s Health

Brousseau stressed that timeliness is not just guideline adherence, but it meaningfully changed whether children can go home from the ED, according to study results.

David Brousseau, MD, highlights impact of timely opioid dosing in pediatric sickle cell pain

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

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It is estimated that about 20% of children and adolescents meet criteria for a mental health disorder, and a high percentage of these youths are impaired by disruptive behavior problems.

The Uncontrollable Child: Family and Educational Interventions

**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 August 20 at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

This case was provided by Andrew Faniku, MD, pediatric hospitalist at Scott & White Healthcare.

A 21-year-old primigravida female presented to the hospital in preterm labor, with an otherwise uneventful pregnancy except for a febrile illness after exposure to family members with measles a week prior.

She reported having fever, cough, conjunctivitis, and a rash that started on her face and spread to her trunk, consistent with measles. Her fever and symptoms had mostly resolved, except for her lingering rash that began six days earlier. In the delivery room, she still had fresh excoriation marks on her arms. She had not received any MMR vaccines.

Six hours after admission, the patient delivered a female infant via spontaneous vaginal delivery at 35 weeks’ gestation. The baby weighed 2410 grams, which was approximately the 50

 percentile for her gestational age. The baby had mild respiratory distress after delivery and briefly required supplemental oxygen via blow by during transitioning. Apgar’s of 8 at 1 minute and 9 at 5 minutes was given at delivery. The baby subsequently improved and was allowed to room in with mother without the need for NICU admission. Nursing staff noticed a rash on the baby’s back. 

Below, take your best guess at diagnosing this patient

 website on Wednesday, August 20 at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

News

Case Studies

Can you diagnose this rash in a newborn?

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? 

Puzzler poll: Can you identify this bite? 

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. 

Can you diagnose this patient? Take our poll and find out! Then check back for the full case, differential diagnosis, and correct diagnosis.

Diagnose this infant with an asymptomatic pearl-like nodule on the heel

“It’s not just about screen time—it’s about context,” says Richard A. Bermudes, MD, on guiding conversations in pediatric well care visits.

Richard Bermudes, MD, on discussing screen use and time at well care visits

Concerns about the impact of screen use on youth mental health continue to grow across the pediatric community. In this video interview, Richard A. Bermudes, MD, psychiatrist, chief medical officer at BrainsWay, and associate physician at the University of California, Davis, stressed the importance of keeping the conversation grounded in the broader context of adolescent well-being. 

“Speaking as a parent, and to give a little more context, I trained in family medicine and have done well care visits as a general psychiatrist as well. It’s a complicated world, and we are all worried about the effects of social media and screens on ourselves, and we are especially worried about kids. I think it has to be part of the conversation at well care visits,” Bermudes said. 

He noted that discussions about screens should not replace the fundamental questions providers already ask during well-care visits. “Much of what we discuss at well care visits is around questions such as: 'Do you have any concerns about mood or anxiety? Do you have any concerns about how your child or adolescent is functioning socially? How are they achieving in school or outside of school? Are they engaged in hobbies?' That same conversation hopefully was happening before screens, and it should continue now with screens included.” 

Bermudes also cautioned against an overemphasis on total time spent online. “The other interesting point from the study is that we got really hooked on total time. I can remember my parents having conversations about whether to have a television in the house. This is almost like the new generation’s version of that debate; can we function without screens? I don’t think we can eliminate them, it’s about how we are using them.” 

—rather than screen time alone—were most strongly tied to risks of suicidal ideation, suicidal behaviors, and internalizing or externalizing symptoms in youth. The study noted that while nearly one-third of children showed increasing addictive use of social media or mobile phones by age 11, while baseline screen time totals were not predictive of outcomes.

“We know that if we are using them, kids and adolescents may be socializing with friends and family across the United States. This happened during COVID, and it continues now. My kids are in college, and they still connect with their high school friends online at a certain cadence. Do I think that’s unhealthy? No. They get something out of it. But we need to really understand why our kids and adolescents are spending time online, whether dysfunction results from it, and whether they are experiencing impairment.” 

Ebert M. Addictive screen use tied to youth mental health risks. 

. June 19, 2025. Accessed September 2, 2025. https://www.contemporarypediatrics.com/view/addictive-screen-use-tied-to-youth-mental-health-risks 

Arcutis Biotherapeutics, Inc announced the submission of a supplemental new drug application (sNDA) to the FDA, seeking to expand the indication for roflumilast (Zoryve) cream 0.3% to treat plaque psoriasis in children as young as 2 years of age. If approved, roflumilast cream would be the first topical phosphodiesterase-4 inhibitor treatment for this patient population, according to the company.

“Today, there are very limited FDA-approved treatment options for plaque psoriasis for children under 6, who often present with disease on sensitive skin such as the face and intertriginous areas,” said Adelaide Hebert, MD, professor and chief of pediatric dermatology at UTHealth Houston. “There is a significant unmet need for nonsteroidal options that can effectively treat plaque psoriasis over the long term. If approved, investigational Zoryve cream could be an important first-line treatment option for children as young as age 2.”

Arcutis has submitted an sNDA to the FDA for roflumilast cream 0.3% for plaque psoriasis in children aged 2 to 5 years.

Thomas J. Power, PhD

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