COVID19 Update 4/28/2020

Hi Legacy family!

I hope this letter finds you and your family safely tucked away at home. I want to update you on what is going on at Legacy Pediatrics as we continue to maneuver through the COVID pandemic.

As of late, we have been seeing children ages 0-2 years old for their physicals in order to keep them up-to-date on important childhood vaccinations. Starting Monday, May 4th, we will be expanding what constitutes an essential visit to include children 0-5, 11, 12, 16 and 17 years of age who are due for physicals.

The reason for the change is to continue to keep everyone up-to-date on vaccinations. We do not need a preventable disease outbreak to occur (measles, meningitis, or whooping cough), while we continue to carry out the needed mitigation actions of staying home, wearing masks when out, and observing the six feet of social distancing.  The New York Times published an article discussing the necessity of continued vaccines.

Legacy Pediatrics will continue to require the following measures to ensure everyone’s health and safety:

  • Everyone will be asked to call the office at arrival and will be met at the door.
  • Anyone over 5 years of age must wear a mask
  • Everyone’s temperature will be taken before entering the office.
  • Only 1 parent/guardian may accompany the child/teen for their visit (with the exception of newborn visits).
  • Any sick visits will occur at the end of the day in designated “sick” rooms, long after all other visits have ended.
  • There will be rigorous cleaning of rooms between patients.

We are not allowing patients/families in the waiting room, and we ask that all forms be completed online before the visit, so that the time spent in the office is kept to a minimum. All physical forms will be sent through the patient portal prior to the scheduled appointment.

Lastly, we are available for visits other than physicals.  Those needing appointments will start as telemedicine visits, and in some cases, may turn into office visits when a hands-on exam is needed.

We have streamlined this process, and are confident that we can safely see an increasing number of patients for their routine physicals as we move through May and into the summer. Once we know that the numbers of COVID infections, hospitalizations, and deaths are decreasing, we will let you know how we will be handling the summer schedule with continued care to protect everyone’s safety.

Thank you for your patience and understanding.

Tips for Guiding Behavior While at Home

Let’s not sugar coat that having your children home full-time from school can be a challenge. However, it’s important to note that they may be struggling with this change as well. You may have noticed some unpleasant behaviors surfacing as the days pass. Those fun schedules they were excited about at first may not be doing the trick anymore. If you find your children acting out, don’t panic. There are some adjustments that can be quickly implemented that may give you, or your littles, some peace of mind.

If you have a toddler at home:

Do your best to keep their schedule as close to what is has been as possible.

You may need to ask the daycare for an outline of their schedule to keep it similar. Schedule = security. It is tough to be a toddler in times of uncertainty. Imagine having your entire environment and day to day schedule be changed and not be able to communicate how you are feeling about these changes. Providing a sense of safety and routine might be all your little one needs to control the random tantrums they may have started to perform. If your toddler has begun the “no” phase this may be a particularly challenging time to tackle that. But, the more you allow your child to say “no” (within reason) the quicker they will move past this stage of autonomy versus shame and doubt. A strategy to avoid a power struggle with your toddler is by giving choices. If you are making lunch and you say “What do you want for lunch?” Leaving this open ended allows for them to give an answer you may not allow- a popsicle! This can quickly turn into a power struggle of you saying no and the child becoming upset. Instead, try giving two acceptable choices and letting them decide. This gives them the power to make their own choice but you also will be happy with either answer. Example- “Would you like pb & j or grilled cheese for lunch? You choose!” You can do this with choosing activities, snacks, and even bedtime (“Should we read 1 or 2 books tonight? You choose!”)

If you have a preschooler at home:
They may be a little more vocal about the new feelings they are experiencing.

At first, they might have been really excited about being home all day with mom, dad, siblings, etc. As time has gone on you might feel like they are beginning to test some boundaries. Take a moment to think about all the friends, teachers, and extended family they might be missing. A great way to help them communicate these feelings is by talking about your own feelings, but at their level. At night you can take a few minutes to say, “Wow I really miss grandma and that makes me feel sad, maybe tomorrow we can call her! Are you missing anybody? How do you feel when you miss __? Do you want to write them a letter tomorrow?” Another great way to help your preschoolers understand the emotions they are having is a feelings chart. You can create your own by making two columns. The first says I am (emotion). You can pair this with a visual to help them visualize the emotion. Then, the second column can say When I feel (emotion) I can … and let your little one brainstorm ideas with you of appropriate things they can do when feeling that emotion. Always do this before an emotional outburst NOT during. Revisit this while your child is feeling happy so they will have it in their back pocket when they begin to get upset, sad, mad, etc. I have added an example of one of these charts below.

Example of a Feelings Chart:

Another great strategy is to create a ‘Cool Down Corner’ in your home. This should be a soft, quiet space that your child enjoys. This area should be used mainly when your child needs to cool off. If they are becoming overwhelmed by their emotions guide them to this area and give them the option to snuggle with a stuffed animal, read a quiet book, or maybe practice taking deep breaths. Give your child space, we all could use some space when we are overwhelmed! Then give your child the control to come to you when they are feeling better. Some sort of positive affirmation, whether it be verbal or physical, is always a good idea after your little one has cooled off. You want to reinforce the positive behavior of cooling off instead of letting a tantrum get out of control. Some examples include, a big hug, a high five, or saying “I really liked the way you took a break and calmed down”, “I still love you even when you are upset, are you feeling better?”

If you have a school-aged child at home:
It’s likely they are still adjusting to balancing learning from home, being around their siblings and parents constantly, and still finding time to play and
be a child!

You always want to set your child up for success. If space allows create a separate space for learning. Try not to bring the school environment directly into a space where they are used to playing and being creative with no boundaries. Much like how us as adults like to separate work life from home life your children are used to separating school from home. Your child may also need help communicating their needs during this time. For example, they may be feeling overwhelmed by being constantly surrounded by the same family members. You can help your child communicate that they need some space with a simple activity. Your child or you can design a door sign using words or symbols to express on one side “I need some space right now” and on the other side “I am ready to talk and spend time together” This way if your child is overwhelmed instead of having to verbally express this, they can simply go up to their room and switch their sign. Then, they have the independence to flip their sign around when they are ready. Do your best to respect their sign and their need for space. With boundaries of course. You can set some guidelines to when it is ok and not ok to be alone.

If you have a teen at home:
There is a good chance one of their biggest struggles is missing their social life.

Between sports, clubs, and other activities your teens are grieving a lot of the things they looked forward to. Luckily, there are several ways to connect through technology. Allowing them some private time to connect with their friends is important. If you are worried about screen time you can try ‘phone free meals’. This simply means eating together with your teen and not allowing phones at the table… including yours! You may also consider asking your teen what they look forward to doing once it is safe to do so. Make some tentative plans to give them and even yourself something to look forward to! You may also want to check in on your teenager’s feelings about the pandemic. I have linked an article written by a psychologist about how to help teens deal with anxiety that the coronavirus could be causing.

Final Thoughts:
Remember to take time for yourself! Your reaction to this situation will play a huge role in the way your child reacts.

Children are constantly watching the adults in their lives to see how to act and react. The way you talk about the situation will most likely turn into their view of the situation. There are many resources out there on ways to talk to your child about covid-19 and the impact it is having on everyone’s lives. I will link some of the resources below if you need help finding age appropriate ways to explain this to your kids. Deep breaths, you are doing the best that you can in a time of uncertainty. Remember- children are resilient, they will be fine!

Resources:

Kidshealth – How to talk to your child about Coronavirus

PBS – how to talk to your kids about Coronavirus

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.

Introducing access to the Patient Portal!

Legacy Pediatrics is excited to start giving parents and patients electronic access to their information. Here, you will be able to electronically request routine appointments, ask questions, request refills, get copies of school forms, etc. If you have not set up your child’s patient portal yet, please call our office (585-568-8330) during normal business hours to be guided on how to do it. We also can give you an instructional letter in person at your next appointment. Please note – if your child is 16 years of age or older, we will ask that they set up their own patient portal. This is a great way to encourage teenagers to start taking ownership of their own health, and also a way to keep things confidential and protect our patient-provider relationship with your child.

Watch a video to see what it’s all about

Legacy Partners with Rochester Clinical Research to Advance Pediatric Medicine

Rochester Clinical Research (RCR), the area’s premier clinical research facility, has inked one of its first pediatric site affiliations with Legacy Pediatrics. This new partnership will help deliver additional care options to Rochester families while advancing new medical treatments and improving the quality of life for children everywhere.

Until this year the majority of clinical studies carried out at RCR looked at new treatments for adult ailments such as migraines, joint pain, and obesity. Unlike studies that seek patients diagnosed with certain medical ailments, RCR also participates in a number of “healthy volunteer” trials to study the efficacy of vaccines.

Dr. Janet Casey, the managing physician at Legacy Pediatrics, has always had a strong desire to advance the body of knowledge on best practices in pediatric populations. Dr. Casey spent a number of years as a pediatric oncologist practicing at Duke University. Upon landing in Rochester she entered the general pediatrics field and continued her interest in research that was borne out of her work treating childhood cancer. Over the past ten years Legacy has taken part in many pediatric research studies including vaccine development and the diagnosis and treatment of acute otitis media – ear infections.

Continue reading

How To Support Our Kids After A School Shooting

Father Son Talk about Shooting

In the wake of yesterday’s school shooting, my heart breaks for the victims and their families of the Marjory Stoneman Douglas High School in Florida, the most recent victims of gun violence.  Like many of you, I find myself drawn to the constant news updates online, even as someone who routinely avoids the daily news.  As I continue to try to process this horrific act, my thoughts naturally shift toward my own children, who are elementary school-age.  This is sadly one of many school shootings in their lifetime.   As many experts have said, it’s wishful thinking that our children don’t know that these events occur.  We live in a digital age which allows us to go online and watch live feeds of events AS THEY HAPPEN.  Even if your children are not on social media or are not tech savvy, their friends and friend’s parents likely are and will certainly be talking about it. While we try to shield our kids from the media as much as possible, this event is likely to be the buzz of bus rides and lunchrooms all over the country.  I wonder how much my own kids will hear.   Continue reading

Let’s Talk About Sex, Baby

Yup, we are going there. A subject that makes a lot of parents (and their teenagers, too!) squirm. But, it’s a fact of life, and you should be talking to them about it. Because like it or not, there’s information everywhere. Good AND bad. And just like we talked to them about staying away from strangers, it’s our job as parents, to give them the right information so they can make the right decisions when it comes to sex. So, let’s delve into it.

Continue reading

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!!!