By Laura Romano, D.O., hospitalist at Cook Children's Medical Center- Fort Worth

 The season of the Great Pumpkin, falling leaves, and fun Halloween costumes has officially arrived! My kids are so excited to show off their Halloween costumes this year. If you see a Fairy Princess and Thomas the Tank Engine wandering around your neighborhood, make sure you say hi!

 As kids get ready for trick-or-treating, there are some important things parents can do to keep them as safe as possible! Here are some answers to some frequently asked questions about Trick or Treating!

 Prepare your little ones for Halloween

• Trick or treating can be fun, but slightly intimidating for little ones. Practice trick-or-treating with your kids. Have them come to your door and say “trick or treat!” and practice saying please and thank you!
• Practice handing out candy. Handing out candy is my daughter’s personal favorite. You MUST take candy from her before you are allowed to leave our yard. She will follow you.
• Talk about what they might see on Halloween and walk around the neighborhood beforehand.

For older kids

• Sending a responsible adult is always a good idea.
• Older kids who can go trick-or-treating by themselves should only visit houses they know and follow routes that are pre-approved by parents.
• They should avoid going by themselves or with just one other friend, and instead go in large groups.
• Arrange specific check-in times throughout the evening.
• If your teen is driving to a party, make sure they are driving slowly and know to watch out for little kids.

Trick or Treat: Give me something good to eat

• For little kids: Avoid candies or treats that are small and might be a choking hazard.
• Check the candy: Practice going through the candy haul with your kids before allowing them to eat any.
  • You want to look for candy that may have been tampered with or look-alike food items that might contain illicit substances like THC or CBD.
• Giving out candy: I always try to make sure we have a peanut-free option for kids! We keep a separate bowl with non-peanut candies like Skittles or Smarties.
• Allergies: Regardless of your child’s allergy status, inspect all candy before they eat any. You want to look out for food allergens like peanuts or candies that are made in nut-containing facilities.

Too much candy?

As a Reese’s lover, my answer is that there is never too much candy. However, as a mom, I try to remember that the combination of sugar, chocolate, and the excitement of Halloween can lead to an upset stomach. Try to limit the intake to just a few pieces on Halloween night.

Keep It Reel: Staying Safe in Costume

• If possible, avoid all black costumes, particularly if your kids are trick-or-treating later in the evening. Dark costumes can be hard to see in the evening.
• If your child is wearing a dark costume, make sure that your child is bringing a flashlight to help them be visible or wear glow sticks.

But whether it’s a long cross country trip in the car, boarding a plane or a day at the pool, soon you will hear tummies rumbling. Snack time! Snacks are meant to fill empty tummies just a little bit so they can make it to their next meal. But, what is a “healthy” snack?

Snacks should be less than 200 calories unless otherwise stated by your doctor or dietitian. They’re small, so make them count! When you pull over at the convenience store, look for nutrition-packed foods that have protein, fiber, and vitamins. This helps keep everyone happy on the road until dinner time, and gives your child nutrients they need to grow.

With all of the snack options out there, it can get confusing! So here is a short list of unhealthy and healthy snacks.

Unhealthy snacks:

1.Snack Cakes or Cookies

Despite their name, “snack” cakes and cookies are desserts, not snacks. These provide “empty” calories from sugar, meaning they provide energy but very little nutrition.

2.Candy or Candy Bars

Don’t be fooled by commercials! Eating a candy bar doesn’t help fill your child’s tummy. The high sugar from these items can make some kids feel sick if they’re eaten on an empty stomach.

3.Ramen Noodles

This includes Cup ‘o Noodles as well. One package of ramen noodles contains two servings, enough calories for a meal, and a day’s worth of salt. Yikes!

4.Chips

Takis, Doritos, and Hot Fries! Oh, my! These little fried chips give a lot of salt and unhealthy fat, but very little nutrition. This means your child is left hungry and going to the pantry for another snack a little while later.

5.Fast Food Meals or Gas Station Fare

Snacks are supposed to be small. Fast food sandwiches, hot dogs, and similar choices are “meal-sized”. These extra calories can lead to unhealthy weight gain in many children. If drive-thru options are all that are available, choose a yogurt parfait, apple slices, or other healthy options instead of a full meal.

*We recommend washing down your snack with water or 1 percent or fat-free milk. Sodas, juices, and other sugary drinks are too high in sugar and don’t give very many nutrients.

Healthy snacks:

Pump up snack time with lots of nutrition! Protein, vitamins, minerals, and fiber all add up to a happy tummy and healthier child.

1.1 small apple with 1 Tablespoon peanut butter

2.Celery or carrot sticks with 2 Tablespoons of hummus or low-fat salad dressing

3.15-20 small pretzels with 1 low-fat cheese stick

4.3 cups of air-popped or 94% fat free popcorn

5.1 slice of whole-wheat bread with 1 piece of low-fat turkey lunch meat and mustard

There are many other healthy options out there as well. Want more information about healthy snacks? Ask your child’s provider or dietitian!

Happy traveling and healthy snacking!

About the author

Lauren Williams is a clinical dietitian at Cook Children's. Through medical nutrition therapy, a Cook Children's pediatric dietitian can help prevent and manage diseases that affect your child's health, fitness and overall well-being.Cook Children's has registered dietitians and dietetic technicians on staff to help with your child's nutritional needs from birth all the way through the teen years. Click here to request an appointment.

Imagine you are 5 years old. It’s a beautiful day and you are stuck in the house with a fever. Your wonderful mother gives you little orange tablets that taste like oranges. You think taking these little tablets that look a lot like M&M’s will make you feel better really soon. What a wonderful Mom! Then she leaves the bottle with the little orange flavored tablets on the table just a few feet away. What would you do?

I was the child that decided if a couple of little orange things would make me feel better than the bottle of little orange things would get me well quicker and I could get back to playing with my friends. What I didn’t know was that there were enough tablets in that bottle to cause a very large overdose. After I took the pills, my mom noticed that I wasn’t responding to my name. I was nearly unconscious. So I was given a trip to the emergency room at our local hospital. I was fortunate that someone noticed and that it wasn’t something worse. 

A recent study in Pediatrics found that 640,000 emergency department visits were made in the U.S. from 2004 to 2013 because children were able to to get medication without adult supervision.

When I became a mother myself, I was very diligent in keeping medications away from little hands by keeping the medications in a high or locked cabinet. We can protect our children from an accidental poisoning at home by looking at things from their eyes. Everything that looks like candy is interesting to them.

Every year Cook Children’s receives more than 600 children due to poisonings. Seventy-five percent are medication related. Children can be accidentally poisoned by finding medication belonging to a friend or family member at their house or in their purse or bag. Or by getting into a cabinet that contains household cleansers like bleach or window spray. Remind your friends or family members to keep medication and household cleaners out of the reach of your children. Often Grandmother’s medication looks like candy, just like my little orange pills, or the cleanser bottle looks like lemon/lime drink.

Sometimes it’s as simple as not measuring a liquid medication correctly. Ask your pharmacist for a medication measuring spoon or oral syringe so you give the correct amount of medicine to your child. The spoons in your kitchen will not always measure the same amount as a medication spoon.

Also, make sure to keep the poison control number (1-800-222-1222) near your phone in case you need it.

Rosanne Thurman is director of Pharmacy at Cook Children's. Cook Children's pediatric pharmacists are available at the medical center to make sure your child's medicines are safe and effective.That includes helping parents understand what their child's medicine is for, the best times to take the medicine, the right dose, side-effects and any possible drug interaction with other medications that their children may be taking, such as other prescriptions, over-the-counter medications like cough syrup or antihistamines and herbals. They can even tell parents what food and drinks might cause an interaction.

Limiting how much Halloween candy your kids eat isn't as tricky as it seems. Stop them from getting too much sugar with these tips:

1. Eat a healthy meal. Kids who fill up before going trick-or-treating or to a Halloween party are less likely to eat too much candy.

2. Remember you're in charge of setting limits. "I let my kids eat a few favorite pieces on Halloween night and then save the rest for later," said Kim Mangham, M.D., a pediatrician with Cook Cook Children's. "After a week of enjoying a few pieces of candy each day, we throw it away or freeze it."

3. Offer healthier treats. Hand out pieces of dark chocolate and small bags of popcorn, or avoid food altogether and give away small toys, pencils, erasers or stickers.

4. Focus on making memories. "Halloween is a fun, magical time," Dr. Mangham said. "Focus on costumes and decorations and play Halloween-themed games and spooky music rather than making it about the candy."

About the author

Kim Mangham, M.D., is a Cook Children's pediatrician at 1601 Keller Parkway in Keller, Texas. She earned her medical degree at University of Texas Southwestern Medical School in Dallas. She completed the pediatric residency program at University of Oklahoma Health Sciences Center in Oklahoma City. Her interests include breastfeeding education as well as disease and injury prevention. Dr. Mangham is board certified in pediatrics.

Cutting back on the candy 

Trick or Treat alternatives at Halloween have become more popular over the years. Fun games and other events replace some of the candy focus. Head off to the nearest Fall Festival or other child-friendly Halloween party instead of the usual neighborhood Trick or Treat candy run. Children with diabetes may need to substitute the candy they receive for a healthier snack or a lower carb snack, depending on their exchange value. 

Better choices with the candy. 

Not all candy is created equal. Some candies pack much higher sugar and calories per fun size serving than others. A quick Internet search has a number of articles and references on nutrition breakdown on different Halloween candies. Strategies such as choosing the “healthier” candy and limiting the amount of candy collected make progress towards a healthier Halloween. Also, stretching out the eating of Halloween candy over a week or more may help with candy becoming an after meal dessert or even being forgotten. Kids with diabetes may want to save their treats for meal time when they would normally get a dose of insulin. This prevents the need for adding extra insulin doses or shots. 

Hit the road 

Walking door to door in the neighborhood is not always possible, but when possible, it offers some calorie burn to soften the sugar rush of the Halloween haul. Practically, walking means fewer doorbells will be rung and probably less candy collected. It’s important to not have too much candy during this time of year, but enjoy Halloween. And of course, feel free to share any extra Kit-Kat bars with your favorite pediatrician, especially if he’s an endocrinologist who happens to be writing this particular blog. 

Enjoy the treats.  

Joel