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Halloween Safety

Dominique Chevalier
Holiday related injuries in children

• Labor day > Memorial Day > Fourth of July > Halloween
• Highest in children younger than 5
• Finger/hand, face, and head
• Lacs, contusion, fractures, sprains
• Majority are recreational, not-holiday specific

• Lacerations due to pumpkin carving

• Auto-pedestrian injuries
• Children 10-14 most frequently injured
• Finger and hand injuries most common
• 1/3 lacerations, 1/5 fractures
• More common on Halloween, but still mostly from activities other than
pumpkin carving
• 1975-1996: 4x number of pedestrian
deaths ages 5-14 on Halloween
compared to other nights
Auto-pedestrian injuries on
Halloween • Children distractible, shortest path
to next house
• Safety guidelines for Halloween
Safety • AAP

• Bright and reflective

• Well-fitting shoes
• Short enough to prevent tripping
• Caution with masks that limit vision
• Flame resistant costumes
• Accessories: swords, canes
• Avoid decorative contact lenses

• Mass spec costume cosmetics

• Ingestion and dermal exposures
• Adult occupational exposures exceeded levels in all cases
• Body paint enough to raise blood level of lead
• 12/95 seasonal products tested for lead were above legal limit of
Pumpkin Carving

• Child draws face with marker,

parents cut
• Consider flashlight instead of
• Don’t leave pumpkins unattended
Trick or Treat

• Buddy System
• Accompanied by an adult
• Flashlights
• Don’t go in a car/house for a treat
• Pedestrian injuries common
• Stay in group
• Stay on sidewalk
• IF no sidewalk, always walk facing traffic on edge of road
• Cars may not see you!
• Child sex crime rates on Halloween
• No difference Halloween versus other days
Think about foreign bodies

Study looked at 80 cases, most hoaxes,

Needle in caramel apples

Multiple studies to see if benefit to x-raying

Halloween candy
Halloween and Food Allergies

• Read labels
• Mini versions may have different ingredients
• Don’t take home-baked treats from strangers
Halloween Diarrhea
Sorbitol in candy

• CDC mnemonic
• S- swords and accessories should be short, flexible and soft
• A- avoid trick or treating alone
• F- fasten reflective tape to costumes, wear well fitting shoes,
• E- eat only factory wrapped treats
• E- Enter homes only with an adult. Only visit well lit homes. Don’t
take rides from strangers
• N- never walk near lit candles, and wear flame resistant costumes
General Safety

• Injuries are leading cause of death infants/children worldwide

• AAP, AMA, AFP, USPTF recommend injury prevention as part of well child visit
• Treat as a disease, cure is prevention
• Risk Factors
• Age-type of injury and risk
• Socioeconomic status
• Behavior
• Environment
Governing Bodies

• 1986 Injury Prevention Act

• 1992 National Center for Injury Prevention and Control (NCIPC)
• Injury Prevention
• Host-human body
• Vehicle or agent
• Physical Environment
• Sociocultural and political environment
• 90% injuries are predictable and preventable
• AAP- every well child visit should contain injury prevention
Poisoning in Children

• 4 million cases a year, 30,000 deaths

• 90% in home
• Cosmetics > cleaning products > analgesics > foreign bodies >
topical preparations
• Hazard products: iron supplements, antidepressants, CV meds,
methyl salicylate, hydrocarbons, pesticides
• Severe sx: sulfonylureas, CCBs, toxic alcohols, clonidine, opioids,
liquid nicotine
Preventing Poisoning in
• Primary Prevention
• Legislation, product engineering,
• Anticipatory Guidance
• Use least toxic product needed
• Storage
• Poison control 1-800-222-1222
• Safety latches/locks
• Keep out of sight and reach
• Don’t call medicines “candy”
• Get rid of old medications
Preventing Injury after Poisoning

Secondary • Poison control

• Education
Prevention • Decontamination (only in certain circumstances)

Tertiary • Antidotes
• Emergency medical services
Prevention • Inpatient care

• Halloween Tips from the AAP

• Halloween Health and Safety Tips- CDC
• D’Ippolito, A., Collins, C.L., Cronstock, R.D. Epidemiology of
pediatric holiday-related injuries presenting to US emergency
departments. 2010. Pediatrics.
• Childhood pedestrian deaths during halloween—United States, 1975-
• Chaffin, M. et al. How safe are trick or treaters? An analysis of child
sex crime rates on halloween. 2009