PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Little African American boy (6 years) going trick or treating on halloween, dressed as doctor, standing outdoors in front of house, smiling

5 Ways to Avoid Trick or Treating in the ER

Pretty much every writer and every news station does the usual bit on Halloween safety, right?

Like: check your candy for damaged wrappers, bring a flashlight to be visible in the dark, and don’t eat too much of the sugary candy all at once. Ok, great. Done and dusted.

But in fact we are not done here, friends, because you all have daringly chosen to come along on this digital health journey with a pediatric EMERGENCY DOCTOR. I’m not trying to overact this gig, but the Halloween calamities I see have tended to be on the more dramatic angle than a 6 year old who is overly energized due to excessive KitKat consumption. I’m going to share a few examples of things I’ve seen over the years (personal details removed) in order to highlight some other prevention measures to consider.

ANAPHYLAXIS

That time (or 20) when a peanut-allergic child ate a peanut butter cup that was packaged differently than usual. A reasonable enough mistake to make, but a rookie one. Most of the parents of food-allergic kids are hypervigilant about checking the ingredients on all the treats prior to even putting them into the child’s bag, but occasionally these kinds of accidents happen. One particular child was out away from the house and the epinephrine autoinjector was also far enough away that symptoms progressed quickly and the child required emergency care.

Emergency-level lesson: The epinephrine goes along on the trick or treating, just in case. Additionally: have one of those teal pumpkins outside your house letting the community know that you offer non-food treats, like pencils or glow sticks or whatever, for those for whom the health risk of unknown foods is too great.

picture of a teal pumpkin

ANKLE FRACTURE (& other similar injuries)

That time when the awesomely cool mummy costume unraveled, and then a major trip and fall occurred. There are ankle fractures and there are ANKLE FRACTURES, and one that I’m recalling required a trip to the operating room for pins and fixing.

Emergency-level lesson: I really think a “trial run” of the costume is a solid idea, because then you’re much less likely to have the fun holiday ruined with an injury that requires operative repair. Or any other procedural repair. (This includes any sharp edge of costume additions that can cause lacerations.) So have your kids practice running in their costumes like their hair is on fire.

picture of a ghost

BURNS

Sometimes you’d think it’s the 4th of July with all the sparklers that people apparently save from that holiday just to ignite on October 31. People light those up and kids get burned. Happens to someone every time. Recall that these can heat up to very high temperatures very quickly and can cause burns to hands and eyes.

Emergency-level lesson: Pass on these. Use the glow sticks instead. Or a flashlight (see above).

INGESTION OF SOME SMALL PIECE OR TOY (or any other non-food item).

Someone inevitably gives out little tiny erasers or those plastic spider rings, and someone else always swallows one. Typically this is no big deal if it’s a little plastic thing, or even something kind of sharp: the body has an amazing ability to pass that stuff through the gastro-intestinal system without issue, but every now and then there’s a toy that includes one of those small button batteries, and that gets swallowed. And that’s an emergency, folks. In minutes those can cause permanent acid damage to the lining of the esophagus (swallowing tube) and stomach, and need to be removed as soon as possible, again in the OR.

Emergency-level lesson: Ingestion of non-food objects is often no big deal, but should have some kind of immediate assessment to determine if prompt medical attention is required. Poison Control is actually a great resource for this, and their number is 1.800.222.1222. I suggest you learn this by heart.

ASTHMA ATTACK

Let’s see…maybe I’ll recount the story of when some of that FunDip candy powder got inhaled and started an asthma attack , or some serious running through the neighborhood triggered a whole lot of wheezing…for children with breathing problems there are many potential reasons/exposures why they might get started with shortness of breath during trick or treating, and you don’t want to cut your fun short by having to go to Urgent Care or the Emergency Department for nebulizers.

Emergency-level lesson: Even if your child doesn’t wheeze regularly, if he has a history of wheezing and you have an inhaler/spacer, bring it with you. You never know who in the neighborhood will be giving out Pixy-Stix.

 

I hope these hot-takes from previous Halloweens at my work will get your safety wheels turning in advance of the upcoming fright night. With a little forethought, all you’ll be dealing with is managing the negotiation of how many candy bars can be consumed before bedtime and wheeling-dealing for what treats your child obtained that YOU can potentially consume yourself. I should probably write a separate how-to blog on that topic, because I am a PRO at it. Snickers bars?… why thank you very much, kid. Don’t mind if I do. Trick or treat.

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