Public Health
The hazards of Halloween

CMAJ 2000;163(8):1046

[News & analysis in PDF]

Reduce the risk on Halloween night.

Perhaps the little flower girl will get her wish on Oct. 31, when she and thousands of other excited youngsters don costumes, apply makeup and engage in the tricks and treats of Halloween. Over the course of the evening, vampires, ghosts and superheroes of all ages will parade through neighbourhoods, fire stations, school gyms and, not infrequently, hospital emergency departments in their quest for candies and sweets.

Health care workers who have worked in the emergency department on Halloween night know that it can be an exceptional evening for both ordinary and extraordinary presentations. Physicians need to keep their humour in check and proceed with a higher than normal index of suspicion in order not to miss the usual array of chest pains, syncopal episodes and abdominal discomforts disguised in overweight clowns, bedraggled witches, plump pumpkins and spindly carrots. The literature can assist with identifying some of the more unique risks of Halloween: ocular injuries from flying eggs,¹ flatus from Gummy Bears² and intestinal perforations from sewing needles.³

The last category of injury, which occurs when foreign bodies are purposely placed in treats, may be the most publicized Halloween hazard, but a review of available studies indicates that such events are quite rare and the risk may be exaggerated. Observational studies designed to assess the yield of routine radiologic screening of Halloween candy demonstrated the likelihood of finding a radiopaque item to be very low and reported no cases of significant medical problems.^4,5

Perhaps we are looking for risks in the wrong places. According to the US Centers for Disease Control and Prevention (CDC), in Atlanta, the main risks on Halloween night are much more pedestrian and obvious. Children are 4 times more likely to be struck by cars on Halloween than on other nights.⁶ An analysis of childhood pedestrian deaths in the United States from 1975 to 1996 revealed a fourfold increase in the number of deaths on Halloween evening when compared with the same period during all other evenings.⁶

The reasons for this are many and varied. Children are out in the dark wearing dark costumes, many of which restrict peripheral vision and hearing. They also are excited and distracted and tend to take the shortest rather than the safest route when crossing streets and negotiating traffic.

To reduce the risk of harm, the CDC has compiled a common-sense list⁶ of safety tips that should be reviewed before Halloween night.

Pedestrian safety

• Parents should establish a route for children in a known neighbourhood.
• Children should use flashlights, stay on the sidewalk, stop at intersections and cross intersections in a group.
• Motorists should drive slowly and look carefully for children on medians and in alleyways and driveways.
• Children should consider wearing makeup instead of masks, or wear masks that do not obscure sight or hearing.

• Parents should establish a curfew for older adolescents.
• Children should travel in small groups, be accompanied by an adult, visit only well-lit houses and remain on porches rather than entering houses.
• Children should know their phone numbers, carry coins for emergency telephone calls and have their names and addresses attached to their costumes.
• Rigid or sharp costume knives or swords should not be used.
• All treats should be brought home so that parents can inspect them.
• Adults should prepare for trick-or-treaters by clearing porches, lawns and sidewalks and placing jack-o'-lanterns away from doorways and landings. — Erica Weir, CMAJ

1.	Fiore PM, Wagner RS. Halloween hazards: ocular injury from flying eggs [letter]. N Engl J Med 1988;319:1155.
2.	Breitenbach R. Halloween diarrhea: an unexpected trick of sorbitol-containing candy. Postgrad Med 1992;92:63-6. [MEDLINE]
3.	Conforti FP, Smego DR, Kazarian KK. Halloween appendicitis: pin perforation of the appendix. Conn Med 1987;8:507.
4.	Cappell C, Eberly S, Paul R. Routine screening of Halloween candy: Helpful or hazardous? Ann Emerg Med 1993;22:1541-4. [MEDLINE]
5.	Calvanese J: Should we x-ray Halloween candy? Revisited. Vet Hum Toxicol 1988;30:165-9. [MEDLINE]
6.	Childhood pedestrian deaths during Halloween — United States 1975–1996. MMWR 1997;46:987-90.

Copyright 2000 Canadian Medical Association or its licensors