All posts by Dr. Casey

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


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.


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:


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!


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.


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.



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.

Reasons Why My Grandmother Was So Smart


Photo by Jason Stare


I had a great relationship with my paternal grandmother. I was one of 6 grandkids and the “chosen one”. My brothers and cousins would all agree that I was my grandmother’s favorite. I think it was because I was born on my grandfather’s 60th birthday and I spent many wonderful days at their house just hanging out. As I grew up, I knew my grandmother was a cool lady and she lead by example; I learned a lot from her and I continue to realize how smart she was. As a mom and a pediatrician I use her sage advice every day. Let me tell you why I think she knew what she was talking about.

Continue reading

The Overprotected Kid

Overprotected Kid

One of the biggest joys of being in pediatrics is having the opportunity to watch children grow up! One of our jobs as pediatric clinicians is to help children and parents navigate the wonderful world of Parenting. One of my favorite phrases is, “Parenting starts at 3. Up to then it is caretaking, which is time consuming but straightforward. After 3 it is parenting which is time consuming and Continue reading

ACL Tears in Young Athletes – How Can We Prevent This?

Every year several of our young athletes at Legacy Pediatrics experience a significant knee injury. A torn anterior cruciate ligament (ACL) can be devastating to the athlete both physically and emotionally. The numbers of ACL injuries in young athletes, especially in teenage girls, is skyrocketing and a great deal of research is underway both to better understand the problem and to find a solution. A new study may help unlock this problem: increasing strength in supporting muscles and changing the warm up routines of young athletes before practices and games could greatly lower the risk of these athletes experiencing an ACL injury.

Continue reading

Ear Infections Linked to Drug-Resistant ‘Superbug’

An emerging “superbug” that causes ear infections in children and is resistant to multiple antibiotics can only be treated with an adult medication, researchers report. Read the full story here.

Two Rochester, N.Y., pediatricians report finding a multiple antibiotic-resistant strain of Streptococcus pneumoniae that caused ear infections in nine children in their practice over three years. The only antibiotic that was effective in treating these infections was levofloxacin, which isn’t approved by the U.S. Food and Drug Administration for use in children.

Continue reading