When Pediatrics in Review was first published 40 years ago, I was in diapers, and Visual Diagnosis was still 2 decades from conception. At its 20-year mark, I was unaware that Pediatrics in Review was beginning to publish content online. I was keenly aware of the shifting tides from traditional media to online information; after all, I was starting a career in multimedia production. However, I was still several years from discovering my second calling in pediatric medicine, so I was not yet a Pediatrics in Review reader.When I finally discovered Pediatrics in Review, it was the online version that worked best for my learning style. It has always been difficult for me to focus on reading textbooks, and the Pediatrics in Review search box solved that problem. I found that I could quickly access content relevant to my practice on demand, which made the topics come alive and allowed me to apply the knowledge to real patients.For Pediatrics in Review, the birth of online publishing opened opportunities to create additional material, and Visual Diagnosis was born in March of 2000. It was initially printed, but the format of a presenting image followed by the diagnosis and discussion allowed for a smooth transition to online-only publication. Dr Joe Zenel was the inaugural editor of this section and wrote the first article, titled “An Infant Who Has Fever and Rash.” Dr Zenel built the foundations of Visual Diagnosis and eventually became editor-in-chief. It is an honor for me to learn from him and to continue his legacy with the Visual Diagnosis feature.Dr Zenel concluded the first Visual Diagnosis article with this question: “…will the clinician-in-training recognize measles in the patient presenting with fever, cough, coryza, conjunctivitis, and a red maculopapular rash?” Given the fact that measles was eradicated from the United States in that same year, it was a valid question.Today, pocket-sized computers and excessive media hype can induce irrational fears in anxious parents. I suspect that many of you have received photographs via text message from parents asking if something looks like measles, a spider bite, or fungus. Luckily, for today’s clinicians and clinicians-in-training, there is a vast library of Visual Diagnosis cases available to access when you find yourself confronted with an unusual fever and rash. Pediatrics in Review will continue to move forward, adding to this library and offering expert content to pediatricians for many generations to come.