Behavior & Development • Oct 19, 2015

Keep the ER off your Trick-or-Treat Route!

I’ve spent many a Halloween night in the pediatric emergency room, haunted by princesses charged up on sugar and teen vampires Trick-or-Treat Safetywho tried more than candy. It’s not just the urban legends of poisonous candy and razor blades in apples that pose threats during Halloween. These are some real-life ghost stories, tales of mishap and mystery – mystery solved with medical science.

Ghastly Breathing

By 7pm on Halloween the little ones appear, gasping for breath. While some of these can be related to choking on candy pieces, when we get our first asthmatic, we know the night has just begun. The cool night air full of fall allergens will set off even a mild asthmatic. Every Halloween I hand out pediatric dragon-decorated masks that attach to nebulizers and blow smoking albuterol into little asthmatic lungs. We give grape flavored Orapred, a steroid to reduce lung inflammation. It seems more like a trick than a treat. Kids with asthma will often push it too far while trick-or-treating, trying to make it to a few more houses before they go home for their inhaler. If you have a child with asthma, be sure to give all their maintenance medications before you go out and bring your inhaler with you. Asthma shouldn’t keep kids from activities like trick-or-treating. Sounds like your little creature needs an asthma action plan.

That Blood Isn’t Part of My Costume

“I tried to fly but my cape didn’t work,” a little superman really told me, explaining his injury. Others trip over tails or long costumes while running on uneven sidewalks in dress-up shoes. Lacerations and abrasions fill my ER, and I get to work sewing up skin and dressing wounds. Time to change your costume to a mummy? The gauze wrap will look great. Not sure if your child needs skin glue or stitches? Here’s how to decide.

Vomiting Vampire

Halloween is a big night for teen alcohol and marijuana abuse. They come in vomiting, often still in costume. The saddest part is the parents, who often deny their child’s alcohol use. Marijuana use isn’t even taboo for some anymore– my patients openly discuss their marijuana use in front of their parents, denying the negative effects of this decriminalized drug. The very scariest are the heroin-using teens. The new face of heroin is a suburban adolescent, in the prime of life, not breathing. Frightening but true.

Nose-Picking Goodness

Out all night in the cool air, noses start running and kids start picking. It really is okay if your kids pick their nose (and eat it, too). The problem isn’t the picking, it’s the poor handwashing. Halloween launches the beginning of flu season, which merges with RSV season, and this year we have plenty of enterovirus and croup to add to the buggy mix. If you and your children don’t have your flu shots yet, it’s time. Not sure what bug your child has caught? Here’s how to identify and treat the most common pediatric viral illnesses.

Limping Princesses

Running in a princess dress and plastic high heels buys you a trip to the ER with a twisted ankle. Sorry, no glass slipper and princess wedding here. Halloween is a big night for orthopedic injuries in the pediatric ER. Poorly-fitted or badly-designed costumes, as well as masks can already make it hard for kids to see sidewalk paths, but they also distract the child from seeing a vehicle approaching when they walk into the street.

That’s Not My Real Eye

Costume contact lenses can make a costume really freaky, but they’re not fitted to the eye like prescription contact lenses. Eye injury can result from poorly fitted lenses, including corneal abrasions.

Stuck To My Teeth

It’s not just the sugar in the Halloween candy that attack the teeth, but it’s also the sticky stuff like the Milk Duds, caramels and Tootsie Rolls. These are capable of pulling out crowns and fillings and damaging braces and other dental work.

Too much candy? Here are 5 tricks to manage the piles of treats.

I hope you can use these real-life ghost stories to avoid your own trip to the ER this Halloween, and make sure your little ones don’t wind up with a frightening experience even bigger than ghosts and goblins. Be safe, everyone!


The original post was updated on 8/16/18 to reflect current recommendations.