All posts by Dr. Casey

Legacy Pediatrics is growing!

It is with great excitement that I announce the arrival of Dr. Dominique Bandari. Dr. Bandari has an international background hailing from Nova Scotia Canada. She attended college at Rice University and she played tennis on the women’s tennis team while taking a very challenging academic coarse load. Following college, Dr. Bandari received a Masters in Health Science and International Health at Johns Hopkins University and promptly put that degree to work while she worked for the World Health Organization in Warsaw Poland. Dr. Bandari returned to Canada for medical school at the University of Toronto, just across Lake Ontario from Rochester. She did her residency at Georgetown University Hospital and worked in primary care pediatrics in southern Pennsylvania for 3 years following her residency. Dr. Bandari has lived and travelled all over the world and is fluent in 4 languages! We think she is quite a wonderful addition to our team. Legacy Pediatrics is thrilled to welcome Dr. Bandari in January 2022.

Legacy Pediatrics Summer 2021 Update

Greetings everyone! The past 16 months have demonstrated that mask wearing really does decrease illness transmission! So many families have commented on the health of their children and the whole family. Well, the honeymoon seems to be ending, as everyone is getting out more and around more people sharing germs.

We are expecting a tsunami of illness with camps back in the swing and especially in the fall when school gets underway. We are seeing a good amount of fever, vomiting and diarrhea in the kids in daycare and plenty of typical colds in all ages. Kids have not been sick for well over a year!  Everyone is going to be experiencing plenty of “immune building experiences”, as I used to say when my kids would come home from daycare with their 1000th cold.

We do not know yet what the policies for illness and return to school and daycare will be in the fall, but if needed, we now can do rapid Covid-19 PCR testing in our office with a turnaround time of less than an hour.

Visit our website, www.legacypediatrics.com, and look under the Parent Guide for information on common childhood illnesses and conditions that will help you manage your child’s illnesses. As always, we are here to help and happy to see your child when ill.

~Dr. Janet Casey

COVID19 Update February 2021

Greetings Legacy Family. We are closing in on a full year since the start of the COVID 19 Pandemic and never in my wildest dreams would I have imagined what has transpired over the past year.

Legacy would like to give a huge shout out to all the kids, parents, teachers and staff who have all done an amazing job this school year. Transmission of COVID in schools is nearly ZERO due to everyone’s efforts. We have good data now that mask wearing by everyone at school results in schools being safe for everyone.  This gives us hope that schools will open up fully soon.

Legacy continues to see sick and well children safely, and we have a very efficient system in place to evaluate and test those kids who need COVID testing to return to school and daycare.  We continue to have same day sick visits for those who need them, and we enjoy seeing everyone come in for their routine physicals. April and May’s schedules are in the computer so if your school-age child has a birthday in those months, give us a call and book their yearly physical.

COVID vaccines and variants are common topics we discuss with everyone right now. Everyone at Legacy has now been vaccinated for COVID and we are all incredibly grateful to have that protection. We strongly recommend getting vaccinated when you are able. As we head into the spring and summer and as other vaccines become FDA approved, there will be greater opportunity to get everyone vaccinated. Starting next week those over 16 with a qualifying condition will be eligible to receive a COVID vaccine with a letter from their provider. We have letters ready to go so please give us a call if you think your teen or young adult may qualify for a COVID vaccine.

We are often asked when school-age children will be able to get vaccinated. In order for the vaccines to get FDA approved for use in children under 16, the vaccine companies have to do trials just like they did with adults to establish a tolerated dose and to show that the vaccines work. Luckily, Legacy is very involved with Rochester Clinical Research and the upcoming Pfizer vaccine trial for 5- to 11-year-olds will be starting in June. As the time nears, you will hear more about it and if you or your child is interested in participating, send us a message through your child’s portal page and we will put you on a list to contact when we have more information about the trial. Given the need for efficacy trials, the timeline for vaccinating school-age kids will probably be 1st quarter 2022.

Back to School 2020

The return to school this year is a bit more complicated than usual, the choice of all virtual or going back in person for a hybrid model was not in our vocabulary 9 months ago. A frequent question we hear is whether or not it is safe to have kids return to school and there really isn’t a single answer to this question as every family lives with different circumstances and risk tolerance. Each family needs to determine what works best for their kids and the family as a whole when choosing between a hybrid model or all remote learning. Whatever you choose, be confident that you are making the best choice for your family.

Here are some tips for a smooth transition back to school.

The kids have been home for a very long time and some are anxious to get back into school and some are anxious about getting back into school. Emphasize that schools are working very hard to have a safe environment with everyone wearing masks, social distancing and an amazing amount of plexiglass in some schools. Our community’s infection rate is very low, below 1%, so this is the perfect time to get school started.

Have a routine for each school day regardless if it is an in person day or a virtual learning day. Have a regular bedtime and wake up time. Do not let your adolescent become nocturnal as that leads to poor physical and mental health and poor school performance. Start the school sleep routine a week before school starts.

There will be new rules and procedures for dealing with illness in the schools. School nurses are being instructed to send home any child with symptoms that could be COVID-19. Unfortunately, there are many symptoms associated with COVID-19 including fever, cough, congestion, runny nose, sore throat, headache, fatigue, muscle aches, stomach ache, diarrhea and vomiting. Yep, that list is long and includes symptoms associated with nearly all illnesses kids get including allergies. As always, we anticipate the start of school to bring the start of colds/strep throat/viral illnesses, etc.  In the time of COVID-19 and social distancing and masking, we are also hoping illnesses won’t be as widespread and frequent as we are used to seeing. However, there will be a heightened sense of concern if your child does become ill. Expect your child to be sent home and to stay home until all symptoms resolve. Schools will be requiring a negative COVID-19 test in order to return to school after any illness, even strep throat. We will have an increased number of sick visits available each day to be able to see and evaluate each child. Additionally, we are doing our best to have enough COVID-19 swabs to be able to meet our patients needs.

If your child has seasonal allergies in the fall, start allergy medication now and continue it until there is snow on the ground or until your child’s allergy symptoms usually resolve. This is the year for everyone to get a flu shot, so make an appointment with us to get everyone vaccinated so that we have a mild flu season. We hope to have flu shots soon and will start with flu shot clinics as soon as we can. Getting the flu shot by the end of October should be everyone’s goal.

Regardless if your kids are doing all virtual school or going back to school with the hybrid model, having a confident and positive attitude for the coming school year is very important as our kids are listening to us. For the young kids going back to preschool or daycare, a quick confident goodbye is important. It lets kids know that you are sure they will have a good day and you are not worried about leaving them. The COVID-19 pandemic presents a situation where we can teach our kids a great lesson; we can’t control life but we can control our response to life. If we are upbeat and emphasize the positive then we are all much much happier and able to handle life’s difficulties. Here’s to a great school year!

COVID19 Update September 2020

It is always bittersweet to have summer come to a close. Legacy Pediatrics had a busy summer seeing many of you for physicals; it was great to check in with everyone and have a chance to share stories and observations about the pandemic.

As school gets underway, we anticipate the start of colds/strep throat/viral illnesses, etc.  In the time of COVID19 and social distancing and masking, we are hoping these illnesses will not be as widespread and frequent as we are used to seeing.  There will be a heightened sense of anxiety when your child DOES start that cough, fever, or runny nose, and we know that schools will be requiring an evaluation by us, AND a negative COVID test in order to return to school after a cold.  We have worked hard to get stocked with viral swabs to be able to test our patients to eliminate the need to go to urgent cares, and to meet the school’s criteria.   

We continue to have in place safeguards to keep everyone safe and healthy while in the office.  We ask that one parent or guardian accompany your child to the visit. You will be asked screening questions before your child’s appointment and the accompanying parent and child will have temperatures taken before entry into the main office. We ask that you and any child 5 and over wear a mask at all times while in the office.  Social distancing will be observed while in the office by everyone when not performing medical tasks.

As before, we are separating sick and well visits by time of day and limiting any time spent in the waiting room.

We are asking all families to activate their child’s portal page and those patients 16 years old and older to activate their own portal page so that all paperwork can be sent electronically to the portal page.

We want to thank all our families who are doing a great job managing during this challenging time. Keep up the good work everyone!

The Importance of Chores for Kids

With school out and we are all home with our kids for an undetermined period of time, let’s talk about chores and kids. Why do kids need to have chores to do around the house? There is good evidence that doing chores helps build self-confidence and is associated with decreased anxiety, depression and stress symptoms in children. Chores are work, and kids need to know how to work hard and how to persist at hard work. Working hard at something; chores, learning an instrument, school work, develops grit. Participating in chores also sends a clear message to kids that they need to contribute and they are a valued member of the family. If the parent is the only one doing the household work, kids may think of their parent as their servant and we definitely do not want that!

“Chores are work, and kids need to know how to work hard and how to persist at hard work.”

Dr. Janet Casey

The complexity and difficulty of chores should be based on the age of the child. For example, a child as young as 4 can help clear their plate and cup from the table after eating. A 5-year-old can wipe down the kitchen counters and table after a meal or sort laundry into colors (a great learning game as well). An 8-year-old can sweep the floor, make their bed or vacuum their room. With any new chore, it is important to show your child how to do the task and be available if there are questions or problems. Assistance in understanding how to do the chore is ok but you don’t want to get suckered into doing the work for your child. You also must resist the temptation to redo the work your child has done.

There are no specific guidelines for how many chores or how long a child should spend doing daily chores; however, a good rule of thumb is to expect a child 10 and under to spend 10-20 minutes a day and 20-30 minutes a day for teenagers. Longer tasks such as lawn mowing would be expected to be done on the weekends. Having rules such as chores before TV, video games or play time is a very good idea. As always, when there is a rule, stick to it as you are the boss.

Should you pay your child for doing chores? Payment for more difficult tasks or tasks that are not usual chores is a great way to help your child learn how to manage money.

Here is a list of tasks broken down by age:

Kids age 3-4 can:

  • Pick up toys
  • Set the table (not heavy or sharp objects)
  • Pick up the play room
  • Put clothes in the hamper
  • Pick up toys

Kids age 4-6 can:

  • Make their bed
  • Clear their dishes from the table
  • Empty trash cans
  • Clean their room
  • Sort laundry by colors

Kids age 7-9 can:

  • Vacuum or sweep the floor
  • Wipe down kitchen counters or tables
  • Load and start the washing machine and dryer
  • Load the dishwasher
  • Help with some cooking
  • Pack their lunch

Kids age 10-12 can:

  • Do simple yard work
  • Prepare a simple meal
  • Clean bathrooms
  • Wash windows
  • Fold laundry

Teenagers are capable of doing nearly anything around the house. Remember teens, and pre-teens for that matter, are capable of navigating the internet, video games or anything electronic without any difficulty so they can do some fairly complex chores around the house!

Brainstorm with your kids to develop a list of chores and post it in a visible location. Hold your kids accountable for their work and thank them for their contribution to the smooth running of the family.

Remember, when your kids are grown up, they will thank you for this; I promise!

Legacy Pediatrics COVID 19 Update 3/27/2020

We are nearly 2 weeks into the changes implemented due to the COVID19 epidemic and want to update everyone on the office and how we are managing our patients’ visits. Walk-in hours continue to be on hold indefinitely and all visits require a phone call to schedule. Well child checks that are considered “essential” continue for newborns, 1, 2, 4, 6, 9, 12, 15, 18 and 24 month-old’s in the morning.  All other ages who are due for a physical exam, are on hold for now. 

For well child checks, we are doing a combination of a brief in office visit for height/weight, vital signs, physical exam, and immunizations along with a telemedicine visit at home for the “talking” part of the physical. It has been so fun to see the kids in their “natural environments” and be able to assess development while they are in their homes.

We are doing telemedicine visits for all sick visits and bringing a small number of kids into the office after 3:00 if a hands-on exam is needed. All consultations and medication visits are occurring as telemedicine visits. We are very lucky to have had telemedicine visits well established at Legacy Pediatrics prior to the needed changes for the COVID-19 pandemic.

The kids have been out of school for about 2 weeks now, and we are continuing to see more and more kids with fevers. At this point, as the number of cases of COVID19 skyrockets in Monroe and surrounding counties, we have to assume any fever illness is COVID19 and requires the ill person to stay in isolation from family members until all symptoms are resolved for at least 7 days AND 3 days after the last symptom resolves. If one person is ill in the home, everyone else in the home must then quarantine for 14 days to determine if anyone else becomes ill. These are the CDC and Health Departments’ guidelines. We implore our families to stay home; keep your kids at home, play dates and outings with friends is spreading the infection which will lead to our hospitals being overwhelmed with patients.

Everyone has a role to play and a responsibility to do what is best for the community. Thank you so much for your help and partnership as we navigate this difficult time.

What’s New at Legacy Pediatrics in 2019?

Happy New Year to everyone from Legacy Pediatrics! We hope you all had a fun and restful holiday season. I wanted to update our families on some new things going on with us at Legacy Pediatrics in 2019.

One of the first things you will notice is our new logo! We are excited about our new branding! We used a local graphic designer (and mom) to help us get a better match for what we represent here at Legacy.

If you’ve been to the office lately, you may have noticed our brand-new floors and fresh paint on the walls! The winter salt and wet boots took a toll on our old floors and the new ones will hopefully wear better and with a new, modern look.

In terms of Legacy’s services, we are continuing our work in the important area of pediatric research. In fact we are currently enrolling 2 month-old children for a meningitis vaccine study and will soon start up a study evaluating a new rapid influenza test.

New in 2019 are updates to New York State daycare and school forms. We are formatting these into our EMR system and can print at your child’s physical. These forms will also be available to you on our Patient Portal (via our website) so you can download and print at your leisure.

Speaking of physicals, Legacy has started calling families when a child’s birthday is coming up to remind you to schedule your child’s physical. Everyone is programmed to get their infant, toddler and young child in for their physicals so that we can monitor development, answer questions and administer vaccinations. But once your child reaches school age, sometimes we forget! It remains very important that your child get a yearly physical around the time of their birthday. These appointments allow us to be able to check in with your child to monitor their school progress, emotional and physical health and administer vaccinations. There are a number of vaccinations that are tied to a specific age, so it continues to be important to schedule your child’s physical around the time of their birthday.

There is some confusion about the timing of physicals for pre-teens and teens who participate in school sports. Parents are occasionally told from schools to schedule the physical in July or August in order for their child to be able to participate in school sports. That is simply not true! The yearly physical is “good” for an entire year from the end of the month of the physical. For example, if your child is born in February, a physical done in February 2019 is “good” until the end of February 2020. Your child is eligible to participate in school sports for the Spring sports season that school year and the Fall and Winter sports in the following school year using that physical form. It’s also unrealistic for us to be able to do all school aged children’s physicals in just two months! Hence, our push to try to match up physicals with birthday month.

You will also find some interesting and pertinent articles given out at childhood physicals. Parenting is hard, so if we find some helpful information, we like to pass it along to you.

The last comment about physicals is that nearly all insurance companies cover one physical a calendar year for children, pre-teens and teens older than 14. We want to be the best “medical home” for your child and their needs and love to see them grow! Summers are our most popular time for physicals to be booked and therefore, can be busy and openings are less. We ask that you call and book your appointments a few months in advance, so we can accommodate everyone’s needs!

 

Norovirus Infection – The Stomach Flu

Norovirus

What is Norovirus?

Norovirus is the name for a group of viruses which cause acute gastroenteritis, aka “The Stomach Flu”. According to the CDC, Norovirus causes between 19-21 MILLION cases of the illness each year in the US and is the #1 cause of vomiting and diarrheal illness in the US. Anyone can contract the illness and unfortunately a person can become ill with the same virus more than once and up to 5 times in a lifetime. Cooler months are the peak time for Norovirus infections. Norovirus is not Influenza; influenza is a respiratory illness and Norovirus is a stomach and intestinal illness. The flu vaccine does not prevent this illness.

Symptoms:

The illness typically begins with acute onset of nausea and vomiting with diarrhea following soon afterward. The vomiting phase of the illness typically lasts 12-24 hours with frequent, up to every 20-30 minutes, of vomiting. Some people can have just diarrhea, while others will be hit with many symptoms. Below is a table of common symptoms of Norovirus infections:

Contagion

Norovirus is HIGHLY CONTAGIOUS!!! A sick individual can shed BILLIONS of viral particles while ill. Unfortunately, it can take as little as 18 viral particles to infect someone!!!

Someone ill with Norovirus is contagious from the moment they start to feel ill up to 3 days following the onset of illness. Some people can shed the virus for up to 2 weeks following the illness but it is not clear if they remain contagious the entire time.

The virus is found in vomit and stool and spreads very easily from hand to mouth. You can contract the illness from:

  • Eating contaminated food
  • Touching surfaces or objects with the virus on them
  • Direct contact with a sick person.

The time from exposure to onset of illness, incubation period, is 12-48 hours!

Treatment

There are no vaccines or medications to treat the illness so treatment is supportive while your immune system fights off the illness.

While ill, it is important to drink small quantities, about 1/2 oz, of clear fluid like Pedialyte, low calorie sports drink, oral rehydration fluid or clear juice frequently. Popsicles are an easy way to take in small amounts of fluid over time. Keep drinking small amounts even though the vomiting continues as there is absorption of the fluids which will prevent dehydration. Once the vomiting has resolved, slow advancement of the diet to soft foods is ok.

What not to do while still vomiting:

  • Drink a lot of fluid at once
  • Stop drinking
  • Eat food
  • Leave the house

When to bring your child to the doctor

Bring your child to the doctor if your child has been vomiting for more than 24 hours and is refusing to drink liquids, is too listless to drink or has not urinated at least twice in 24 hours. Please do not bring your child to the doctor when the vomiting starts as the virus can easily spread to many others. Call us if you have questions – our nurses would be happy to talk with you to see if it is appropriate to come into the office or stay home.

Prevention

Preventing exposure is critical to both prevention and containment of the illness. The most important preventive measure is GOOD HAND HYGIENE!

Here are some prevention tips:

  • Wash your hands with hot/warm water and soap. Be meticulous with getting all  parts of you hands and fingers.
  • Alcohol based sanitizers are ok if soap and water are not available but they do  not eliminate Norovirus from your hands.
  • Do not prepare food when ill.
  • Clean and disinfect surfaces using a bleach-based cleaner. If you don’t have a bleach cleaner, make your own with 1 1/2 cup bleach in 1 gallon of water.
  • Wash all contaminated clothes and linens immediately. Handle them carefully and use rubber gloves if available. Use the maximum available cycle length and at least hot water cycle if you can.

DO NOT SEND YOUR CHILD TO DAYCARE OR SCHOOL FOR AT LEAST 48 HOURS !!!

DO NOT SEND YOUR CHILD TO DAYCARE OR SCHOOL IF THEY VOMITED DURING THE NIGHT AND THEY FEEL BETTER IN THE MORNING; HE/SHE IS STILL CONTAGIOUS!!!

Legacy Pediatrics Research goes to South Korea

Incheon Airport - South Korea

Incheon Airport – South Korea. Photo credit

As many of you know, Legacy Pediatrics does clinical research in the area of ear infections in young children. Legacy Pediatrics is the #1 ear infection research site in the United States thanks to our wonderful families who participate in our research, and to the tremendous efforts of the Legacy Pediatrics staff, PAs, nurses and research coordinator. Since 2009, Legacy Pediatrics has published 79 papers on many topics relating to ear infections. Dr. Pichichero and I recently went to an international meeting on ear infections, which is held every 2 years, and presented some of the research from Legacy Pediatrics.

This past week, Dr. Pichichero and I traveled to South Korea to attend an international vaccine conference. We were invited to present some of the findings from our Ear Immunity Study. I presented the research results on the bacteria causing ear infections with data that is current and up to the minute. No one else in the world has this data so the audience was keenly interested in the information. I proudly told the audience that we currently have over 800 children enrolled in the study and we have had over 15,000 visits! The audience couldn’t believe that we have been able to enroll and follow so many young children and I told them that what we do is only possible because of the wonderful families who agree to participate in Legacy Pediatrics research. The bacteria that cause ear infections change over time and it is very important to follow the changes. Legacy Pediatrics provides data to the world, which contributes to the development of guidelines and policies for the treatment of ear infections and other respiratory bacterial infections in children.

Dr. Pichichero presented data generated by Legacy Pediatrics research that no other research site in the world has. The data he presented is very important for the development of a new vaccine for ear infections in children. Dr. Pichichero told the audience that our study kids have their blood drawn in order to study the immune response they make to ear infection bacteria when they are healthy, and, when they have an ear infection. Dr. Pichichero discussed details about the immune responses and how this information is very important for the development of a new vaccine. Many audience members were astonished that we have this information because it is so hard to draw blood in very young children. One questioner asked how we were able to do this. Dr. Pichichero again complimented our amazing families and their willingness to help develop the science that will help other children.

Our trip half way around the world was very successful! We represented Legacy Pediatrics well. Legacy Pediatrics is very unique! We are able to contribute to the health of children not only at Legacy Pediatrics but also around the world. None of it would be possible without the help of many people, and the most important are the kids at Legacy Pediatrics and their families.