Halloween should be a night filled with costumes, candy, and spooky cheer.
However, the holiday is also a busy time for hospitals around the United States. The U.S. Consumer Product Safety Commission estimates that between 2019 and 2022, emergency departments treated an average of 3,200 Halloween-related injuries annually. Many of these were among trick-or-treating children.
Spoiler alert: The culprit is not poisoned candy from strangers. The urban legend that your kid's Halloween treats could be tainted with illicit drugs, needles or razor blades is actually a myth that's been thoroughly debunked.
So what actually sends children to the hospital every Halloween and what are the real dangers that parents need to look out for? Pediatric emergency medicine doctors who are also parents share the riskiest Halloween-related activities they wouldn't let their kids do, how to avoid getting spooked by an accidental injury, and tips to keep kids safe this Halloween.
Ignore pedestrian safety rules
The biggest danger to children on Halloween is cars, TODAY.com previously reported.
Children are more than twice as likely to be hit by a car and killed on Halloween compared to any other day of the year, according to the U.S. Centers for Disease Control and Prevention.
That's because trick-or-treating usually involves dressing up and walking from house to house in the dark. Add in cars, distractions and sugar-fueled children running around, and there's a much higher risk of accidents and injuries, Dr. Karen Goodman, a pediatric emergency medicine specialist at Hassenfeld Children’s Hospital at NYU Langone, tells TODAY.com.
It's crucial for children and teenagers to follow pedestrian safety rules while out trick-or-treating on Halloween.
Children should always stay on sidewalks or paths and use designated crosswalks whenever possible, Dr. Lisa Gaw, a pediatrician with Texas Children’s Urgent Care, tells TODAY.com.
If children are walking on the street, the CDC recommends walking on the shoulder and facing traffic.
“Remind kids not run out in the street from between cars or cut across driveways because these are areas where drivers may not expect to see child,” says Gaw.
Distracted walking can also be hazardous, per the CDC — and trick-or-treating is already full of distractions. It's important to remind children and teenagers to avoid staring at their phones or wearing headphones while walking and crossing streets.
Trick-or-treat invisible to cars
Many Halloween costumes involve going to the dark side, literally. Whether it's a witch, vampire or Batman — these characters often require black or dark-colored clothing, the experts note. This can make it even more difficult for passing motorists to see children on and around streets at night.
An analysis of 42 years of data from the U.S. National Highway Traffic Safety Administration revealed that the risk of pedestrian death was 43% higher on Halloween and the highest relative risk was among children, according to a 2019 research letter published in JAMA Pediatrics.
It's important to always ensure your child is visible to cars, bikes, and other pedestrians, the experts note. If possible, dress your child in a brightly colored or reflective costume, says Gaw. Glow sticks or strips of reflective tape can also be added to darker costumes, shoes, or trick-or-treating bags to help your child stand out at night.
Going out without a flashlight
Just as it's important for cars to see children, it's important for children to see what's around them while trick-or-treating at night.
"Carry a flashlight and also make sure that you or your child is actually using it," says Goodman. Flashlights help illuminate sidewalks, streets and yards so children can see where they are going.
Lanterns are even better, she adds, because they provide 360-degree light around a person and are a bit more visible than a flashlight.
Lighting the way for children can help reduce the risk of falling or tripping over surprise steps or curbs, the experts note.
Wear a mask they can’t see in
Many masks or headpieces can obscure a child’s vision, making it harder for them to see cars or people around them — especially at night when visibility is already low, the experts note.
"If you have a mask covering your face with eyeholes, make sure you can actually see out of them — they need to be the right size and in the right place," says Goodman. If a child's vision is obscured, even just slightly, the experts recommend trying to make the eye holes larger or finding an alternative.
Parents should do a mask vision test before Halloween or while costume shopping as opposed to hours before trick-or-treating.
"(Children) may put the mask on right before or when they get outside and suddenly realize that they can’t see anything, but then they don't want to take the mask off," Goodman notes.
In lieu of a mask, children can wear face makeup, but always make sure the makeup is non-toxic and child-safe first, says Gaw. "I would test the makeup on a small area of skin and let it sit for a bit and see if your child has any kind of local skin irritation or an allergic reaction," says Gaw.
The U.S. Food and Drug Administration discourages use of decorative or colored novelty contacts due to the increased risk of eye injury.
Wear a costume they can’t walk in
Another common reason children end up in the emergency room on Halloween are injuries caused by trips, slips and falls.
Trick-or-treating already involves hurriedly running from house to house. Costumes that are too large, too long, or too uncomfortable can increase the risk of kids taking a tumble, the experts note.
Children should be able to move and walk comfortably in their costume and the shoes they plan to wear with it, says Gaw. “If it’s difficult for them to walk in the daylight, just imagine them trying to go trick-or-treating in the dark with it on.”
Goodman recommends parents do a practice run beforehand. "Make sure they are wearing it and try to walk around ... see if they can go up steps and down steps," says Goodman.
If a costume doesn't fit, a pair of scissors and a little creativity can go a long way. Parents can try cropping extra long pants or pinning costumes to allow children to move around more comfortably.
Get careless with pointy props
Many Halloween costumes involve props. Whether it's a sword, stick, spear or wand — anything with a pointy edge, even if it's plastic, can be hazardous, says Goodman. When children start playing around with props or get careless, these can end up in someone else's eye or cause injuries to the face, she adds.
On Halloween, children may behave differently than they normally would because they are in costume and trying to get into character, Goodman notes. Add in all the excitement and sugar, and the night could end in a fake sword fight faster than you can imagine.
Children can also wind up injuring themselves if trip and fall while holding a something with a pointed edge, says Goodman.
Props should be flexible and soft if possible. "Make sure they can actually hold it and it wouldn’t be dangerous if they poke themselves or someone else with it," says Goodman.
Go out unsupervised or without a plan
While the right age to let children go unsupervised tends to be a source of debate, many experts agree that children under 12 should go trick-or-treating with an adult.
However, preteens and teens often want to test their independence and go out with friends instead, Goodman notes. In addition to the usual Halloween hazards, older kids may get themselves into more risky scenarios — for example, parties with underage drinking.
Goodman recommends parents know their children's Halloween plans and give clear instructions and expectations for the night. Kids who are trick-or-treating without parents should also take note of their friends' costumes to avoid getting mixed up or losing their group.
"In general, you should know where your kids are, but especially on a night like Halloween, where not only can your kids themselves do something to get in trouble, but you don't know what everyone around them is doing to get in trouble," says Goodman.