All posts by Dr. Casey

Legacy Pediatrics is Growing!

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Legacy Pediatrics is excited to announce that Dr. Silverstein will be joining the Legacy family this Fall. Dr. Silverstein grew up in Rochester, NY, and is excited to be joining the amazing team at Legacy Pediatrics. She completed her undergraduate degree at Cornell University and earned a Bachelor of Science in human biology health and society with a minor in global health. She attended New York College of Osteopathic Medicine for medical school. She returned to Rochester to complete her pediatric residency and chief year at the University of Rochester – Golisano Children’s Hospital. Prior to starting at Legacy, she completed additional training in pediatric nephrology at the University of Rochester. She is board certified in Pediatrics.

As a Doctor of Osteopathic Medicine (DO), Dr. Silverstein received specialized training in Osteopathic Manipulative Treatment (OMT), which involves using hands-on techniques to diagnose, treat, and prevent illness or injury. She is passionate about providing holistic and evidence-based care for all her patients.  

Dr. Silverstein lives in Brighton with her husband, Dr. Edward Shanley, and her son, Owen, and they are expecting a second son this June. 

Please help us welcome Dr. Jennifer Silverstein to the Legacy family.

Covid Update Spring 2023

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There are a few Covid updates as we move into Spring and Summer 2023.

  1. The Covid-19 pandemic State of Emergency is being lifted on May 12 th . With that change
    families whose children receive health insurance through Child Health Plus, or any
    “Option” plan will have to establish eligibility and re-enroll in your health insurance
    plan.
  2. During the state of emergency, the cost of any covid related care was covered and did
    not require a copay. After May 12 th , the cost of any PCR or antigen testing will now be
    submitted to your insurance or if you have a high deductible plan and have not met your
    deductible you will be responsible for the cost.
  3. The FDA and CDC simplified the Covid-19 vaccine schedule. Only the bivalent Covid
    vaccines will be administered for all doses of the vaccine. The bivalent vaccines cover
    both the original and the Omicron strains of Covid-19. Any future Covid booster
    recommendations are not yet known.
  4. We continue to require anyone over 2 years old to wear a mask in the office. There is a
    lot of illness in the community, and we don’t want anyone getting sick because of a visit
    to the office. Thank you for your cooperation with this.

Awwwww Spring

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Spring has arrived in Western New York, so Spring allergies are starting, and I can literally feel it in my eyes. All indications are pointing toward a significant allergy season given our very mild winter. An allergy “season” when certain trees/grasses/weeds are blooming lasts about 6-8 weeks and you can follow the pollen count in our community at www.Pollen.com. 

Common allergy symptoms include:

  • Sneezing
  • Runny nose
  • Congestion
  • Itchy, red, watery eyes
  • Cough
  • Wheezing

There are many things you can do to help ease your child’s symptoms; they include:

  • Keeping the windows in your home closed.
  • Showering at night and washing hair to get the pollen out of the hair so they don’t sleep with it on their pillow all night.

Medications

Over-the-counter medications for allergies fall into 2 main categories:

  • Antihistamines – Can be taken on days when symptoms occur and are good for the itchy, sneezy, drippy nose symptoms.
  • Non-sedating: Claritin, Zyrtec, Allegra, and Xyzal can be taken in the morning.
  • Sedating: Benadryl is best taken at night.
  • Nasal spray: Astepro
  • Intranasal steroids – Should be started ideally at the start of the allergy season and continued daily throughout the season and are best for nasal congestion.

Approach treating your child’s allergy symptoms in a stepwise manner. Start with keeping the windows closed and showering and washing their hair at night before bedtime. If that isn’t enough, try using Benadryl at night. Add a nonsedating antihistamine or nasal steroid spray in the morning if the symptoms are still not tolerable. If your child has a lot of eye symptoms, an allergy eye drop like Zaditor or Pataday works well. Lastly, there are some days when the pollen count is so high that nothing will help moderate your child’s symptoms, when that happens stay inside and play board games!

Hope this helps you navigate the rapidly approaching allergy season.

COVID19 vaccines for children under 5 years old, finally!

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The CDC’s Advisory Committee on Immunization Practices (ACIP) voted 12-0 to recommend Moderna AND Pfizer-BioNTech COVID-19 vaccine for children ages 6 months to less than 5 years.

Vaccine administration

The Moderna vaccine is now available to children ages 6 months to less than 5 years as a primary series of two, 25-microgram (µg) doses administered four to eight weeks apart.

The Pfizer-BioNTech vaccine is now available to children ages 6 months to less than 5 years as a primary series of three, 3-µg doses. Dose 1 and dose 2 should be administered three to eight weeks apart, while the third dose should be given at least eight weeks after the second dose. 

Among children, a Covid vaccine induces a broader immune response when compared with the immune response from infection. In contrast with Covid infection, children vaccinated against Covid demonstrated a better immune response against alpha, beta, gamma, delta and omicron variants. The data shows the importance of vaccinating children who have already had a covid infection to prevent both severe disease and future infections.

Vaccine rollout

Legacy Pediatrics has received the Covid vaccines and are currently scheduling vaccination appointments.  Please call and ask to speak with a nurse, to make that appointment. 

Legacy Pediatrics will follow the recommendation that the same mRNA vaccine product should be used for all primary series doses. We are frequently asked if a child should receive other vaccines along with the Covid vaccine. The CDC recommends routine administration of all age-appropriate vaccines at the same time as the Covid vaccine.  If families would like to separate them, we will administer their scheduled well visit vaccinations, and have families return at a later date to start the COVID vaccine series.

Clinical trials

These recommendations to vaccinate children less than 5 years of age are based on clinical trial data. Moderna’s clinical trial was conducted from December 2021 through February 2022 (during the omicron surge) and involved 6,400 children. Pfizer-BioNTech’s vaccine clinical trial included 3,000 children and was conducted from June 2021 through April 2022 (while both the delta, beta and omicron variants were circulating). Both vaccines induced a strong antibody response and were well tolerated with minor side effects.

Lastly, why COVID-19 vaccines should be given to children

Between March 1, 2020, and April 30, 2022, 269 children younger than 1 year and 134 children ages 1-4 years died because of COVID-19.

More than 2 million cases of COVID-19 have been reported among children ages 6 months to 5 years. Children in this age group are at risk of severe illness from COVID-19, and more than half of all hospitalized children with covid infection ages 6 months to 5 years were previously healthy with no underlying medical conditions.

As always, reach out to us if you’d like to discuss vaccination in more detail. 

Spring is here!

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Greetings from Legacy Pediatrics. We hope everyone in your family is well. We all made it through another winter in Rochester and warmer Spring weather is on its way (hopefully). Here are a few things to remember as we transition from Winter into Spring:

  1. Spring allergies are beginning; I can tell because my eyes have been itchy off and on the past few weeks. Now is the time to start steroid nasal sprays if you use them to help control your allergies. Steroid nasal sprays like Flonase Sensimist take 1-2 weeks to start working so now is the time to start them. Over the counter non-sedating antihistamines like Claritin, Zyrtec, Allegra or Xyzal work well for most people. They do tend to become less effective after several months use and we suggest changing to another one when you notice a drop in effectiveness. Don’t forget to wash your child’s hair at the end of the day when the pollen count is high, so they don’t go to bed with pollen on their pillow.
  • It is tick season! Ticks are most active in the Spring and Fall months and some of the ticks in Monroe and surrounding counties carry the bacteria that causes Lyme Disease. A tick needs to be attached for at least 36 hours in order to transmit the bacteria and potentially cause Lyme Disease so doing a total body tick check on your child and you each evening before bed will help find ticks before they fully attach and become infectious. See our parent guide article about ticks for more details.

Enjoy Spring everyone!

Pfizer COVID19 vaccine available for ages 5-11

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We at Legacy Pediatrics and our families and patients have been waiting for this day to arrive for months. This week the CDC authorized the use of the Pfizer Bio-N-Tech Covid 19 vaccine for school age children 5-11 years of age. This authorization brings us another step closer to the end of the Covid 19 pandemic.

Legacy Pediatrics is proud to be playing a large role in the Pfizer vaccine study. I am privileged to be the principal investigator for the study at RCR and over half of the study participants in the 5–11-year-old age group came from Legacy Pediatrics! I cannot express how proud I am of the children and their families who stepped up to do something that was hard in order to help other children. I told the children repeatedly that what they were doing would help thousands and thousands of children around the world and that they were real heroes. Our Legacy children and all the children and their families who participated in this ongoing trial are making history and will be able to look back with pride on their role in making the vaccine available to children their age.

The trial in 5–11-year-old children used a dose of 10 micrograms (the dose for adolescents and adults is 30 micrograms) and looked at the ability of healthy children to develop a robust immune response by measuring antibody levels after the second dose of the vaccine.  The study participants’ immune responses were excellent and achieved levels known to protect against serious illness from Covid 19. Additionally, the vaccine was 90.8% effective in preventing infection with Covid 19!! That is a tremendous level of protection!

There are two main questions I have been asked over the past several months leading up to the EUA authorization of the Pfizer Covid 19 vaccine for use in children 5-11 years old.

First, parents asked if it was necessary to vaccinate children in this age group because they usually don’t get very sick, thankfully. I point out that over 500 children have died from Covid 19 since the pandemic started just 20 months ago. That is over 10 times the number of pediatric deaths we typically see in a flu season. That is a lot of deaths that will be prevented by vaccination and absolutely tragic if your child happens to die from a vaccine preventable death. Second, parents have expressed concern about the development of myocarditis or pericarditis following vaccination. I think there are 2 important facts to consider when assessing risks of this extremely rare complication of the mRNA vaccines. First, the cardiac complications from the vaccine are mild and self-limited in nearly all cases and resolve quickly and in some situations do not need treatment. Second, Covid 19 infection is 40 times more likely to cause myocarditis or pericarditis than the vaccine and the cardiac problems are more severe and potentially longstanding or permanent.  If a parent is opting to not vaccinate their child because of concern about myocarditis or pericarditis, the parent is opting for the riskier choice of getting Covid 19 and having a much greater risk of the permanent cardiac complications.

The Pfizer Covid 19 vaccine is safe and effective in preventing severe illness, hospitalization, and death from Covid 19. Every member of the Legacy team and all our children are vaccinated, and we encourage everyone who is eligible to get vaccinated to help protect our families, loved ones and our community.

Legacy Pediatrics is growing!

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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 course 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.

Dr. Bandari with her son, Nayan

Fun Facts about Dr. Dominique Bandari:

Fact #1 – She loves to travel!  She has climbed Mt. Kilimanjaro, is trained to scuba dive, and has also been to over 40 countries!  Many of these adventures have been alongside her husband, Dr. Jathin Bandari – he is a urologist who works at Strong and is also the CMO of a biotechnology company. 

Dr. Bandari’s son, Nayan, age 2

Fact #2 – She has one son named Nayan!  He turned 2 in May.  His name means “The eye” in Hindi, which is funny since he has already needed a procedure for a blocked tear duct, and just got glasses!  He LOVES to be outside, no matter the weather, and has adjusted to daycare life since Dr. Bandari started with us. 

Dr. Dominique Bandari and her husband, Dr. Jathin Bandari in Whistler, Canada

Fact #3 – Dr. Bandari grew up in Nova Scotia, Canada.  She knows Polish (from her parents), learned French in school, and learned Spanish when she was living in Spain before starting college.  She is fluent in all 3 languages, and is happy to take on families who feel more comfortable speaking any of these languages during their appointments. 

Legacy Pediatrics Summer 2021 Update

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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

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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

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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!