Spring is here!

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

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!

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

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!

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.