We're excited to share some of the fun and spooky happenings from this week. We had a spook-tacular time celebrating in many ways:

• Pumpkin Painting Patient Event: On Wednesday, our patients in Fort Worth were invited to use their imagination and decorate and paint a pumpkin.
• NICU's Cutest Costumes: Our tiniest patients in the Neonatal Intensive Care Unit celebrated their first Halloween in style! Families dressed their babies in adorable costumes, including a fisherman, Winnie the Poo and his friends, a fitness gal, Stitch, and a festive little one!
• Patient Treat-or-Treating Event: Our patients and their families at Cook Children’s Medical Center – Fort Worth and Cook Children's - Prosper went trick-or-treating and our employees showed off their Halloween spirit by dressing up in creative costumes!

Halloween is a fun time where kids and caregivers can let their imagination take hold. Children and adults alike dress up as various characters. A mix of spooky and fun costumes will adorn the streets of North Texas this year, and Cook Children’s Health Care System wants to make sure families are not spooked by any preventable mishaps.

Sharon Evans, trauma injury prevention manager and Laura Romano D.O., hospitalist at Cook Children's, share their expert tips to stop the scariest spooks of the night: preventable injuries.

Pedestrian safety:

Research shows children do not have the cognitive ability to safely cross the street, unsupervised, until they are ten years old.

Evans shares that most pedestrian injuries occur between 3 p.m. and 7 p.m., especially as Daylight Saving Time ends. Pedestrians who are distracted (on the phone, listening to music, etc.) are four times more likely to be injured or killed.

Evans emphasizes that parents are role models and can set a good example by putting down the phone when walking.

“Follow the same rules you want your child to,” said Evans.

• Look left, right, and left again before crossing the street. Then remind them to continue looking until safely across the street.
• Watch for cars backing out or pulling into driveways.
• Put phones, headphones and devices down when crossing the street. It is particularly important to reinforce this message with teenagers.

Dr. Romano adds these pedestrian safety tips for everyone:

•  Make sure your child stays on the sidewalk and crosses at crosswalks or at corners.
• Slow down: Remember to drive very slowly, particularly when coming home from work in the evening.

Trick-or-Treat: Staying Safe in Costume

Your child’s costume should prioritize visibility and mobility to prevent common trip-and-fall injuries.

•  If possible, avoid all black costumes, particularly if your kids are trick-or-treating later in the evening, as dark costumes can be hard to see.
• If your child is wearing a dark costume, make sure that your child is bringing a flashlight or wearing glow sticks to help them be visible.
• Make sure to purchase costumes that are labeled “flame-retardant”. For any DIYers, nylon and polyester are materials that are known to be flame-retardant.
• Use caution with wigs, masks, or other accessories that may cover your kids’ eyes, nose, and mouth, making it difficult to see or breathe.
• Prevent falls by avoiding ill-fitting shoes and costumes that may become tripping hazards.
• Only use make-up products that are “non-toxic”. Test a small area of their skin a few days before use.
• The use of colored contact lenses could lead to eye infections or injuries—stick to only prescription contact lenses!

Tips for Teens

• 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 parents preapprove.
• Trick-or-treat in large groups, not alone or with just one other friend.
• 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.

Families had a spook-tacular time Thursday evening at the Las Vegas Trail Neighborhood Health Center! Cook Children’s Health Plan hosted a trunk-or-treat event on Oct. 30, offering a variety of activities, games, and resources. It was an opportunity for families to meet neighbors and connect with community partners who are at the core of providing critical health care and social services at this health care hub.

Little ones enjoyed music, games, face paintings and a trunk-or-treat. There were food creation demonstrations, a food truck and activities, as well as free education and resources from community partners focused on family health and safety.

The Las Vegas Trail Neighborhood Health Center is home to a variety of partners to support you and your family’s needs. On Thursday, families learned about the resources available.

“Events like these are a blessing because you get to learn new information," Liza Salinas said, mother of two. “We're having fun. It's all about them (the children).”

The Cook Children’s Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant County service area, including nearby counties. The plan covers essential services like primary care and pharmacy services, plus offers extra benefits and assistance for families. Go here to learn more and read how your family can join.

The Cook Children’s Neighborhood Health Center at Las Vegas Trail is here to help care for children from infancy to the transition into adulthood. Health care services offered include well checks, immunizations, school and sports physicals, injury treatment and care for both short-term illnesses and longer-lasting conditions.

The community partners at the Las Vegas Trail Neighborhood Health Center include:

●      Cook Children’s Neighborhood Health Center at Las Vegas Trail, where children can establish their medical home with a pediatrician for regular checkups and sick visits.

●      Cook Children’s Health Plan: Sky Ramos, CHW, is the organization’s first-ever clinic-based community health worker (CHW). Ramos provides in-person guidance and helps visitors navigate the health care system, connect with community resources and access Medicaid services.

●      Cook Children’s Center for Community Health, which aims to increase access to preventative services for under-resourced populations and drives initiatives to focus on oral health, mental health, asthma, injury prevention, healthy lifestyles, and caregiver support. Dana Walraven, Strategic Partnerships Manager, works at the LVT Neighborhood Health Center to make connections in the community.

●      JPS Health Network Health Center, where adults and children can receive preventative health care, chronic disease management, annual exams and health screenings.

●      West Aid Food Pantry, a food bank open to the community.

●      The Fort Worth Police Department’s storefront which is where officers can build relationships with the community they serve.

●      Nutrition programs at the Demonstration Kitchen are led by a certified Cook Children’s dietitian, Maya Rashad, MPH, RDN, LD. She is the Nutrition Program coordinator at the center.

●      The Workforce Development Program, created to equip those enrolled in the program with the skills they need to succeed in the workplace.

●      Go here to read further details about all of the clinics and programs at this location.

View participating partners/organizations at the trunk-or-treat event below.

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.

We're excited to share some of the fun and spooky happenings from this week. We had a spook-tacular time celebrating in many ways:

• Beetlejuice-Inspired Haunted House: Our Child Life Zone at Cook Children’s Medical Center – Fort Worth was transformed into a thrilling haunted house inspired by the iconic movie, Beetlejuice. Young patients were involved in creating this spooky experience, and they even joined in the fun to scare our staff! 
• NICU's Cutest Costumes: Our tiniest patients in the Neonatal Intensive Care Unit celebrated their first Halloween in style! Families dressed their babies in adorable costumes, including a firefighter, a skeleton, and even a little Harry Potter! 
• Patient Treat-or-Treating Event: Our patients and their families at Cook Children’s Medical Center – Fort Worth and Cook Children's - Prosper went trick-or-treating and our employees showed off their Halloween spirit by dressing up in creative costumes!

Halloween is a magical time as children dress up to be whatever they can imagine. While your little vampire, princess, or superhero prepares to gather all the candy possible, consider how to make this spooky night spectacular and avoid mishaps.

“Trick-or-treating is what my kids are most looking forward to this year, as I’m sure most kids are,” said Laura Romano, D.O., a hospitalist at Cook Children’s Medical Center – Fort Worth. “However, as a mom and a pediatrician, I know that there are things that we need to do to keep our kids safe this holiday!”

Sharon Evans, trauma injury prevention coordinator at Cook Children’s, also emphasizes the importance of safety.

“We worry about kids tripping and falling as they run in their costumes, but mainly that they may be hit by a car as they are out trick or treating,” Evans said. “Twice as many kids are struck by a car on Halloween than on any other day, so it’s vital you are not distracted while you’re driving.”

Ramon L. Kinloch, M.D., a pediatrician at Cook Children's Pediatrics Forest Park, says this is his favorite time of year.

“I’ve always enjoyed decorating, dressing up and trick-or- treating, but what makes it extra special, is the fact that both my wife and I get to celebrate our birthdays,” Dr. Kinloch said. “She’s a Halloween baby!”

Dr. Kinloch, Dr. Romano and Evans shared a few tips for families to consider before heading out with their little trick-or-treaters.

Tips for Street and Traffic Safety

• Stay on sidewalks when possible. When on the street, walk facing traffic.
• When crossing the street, only cross at corners. Look left, look right, and then look left again for any cars before crossing. Never assume the vehicle is going to stop. Do not run across the street!
• If you are driving, please drive slowly in residential neighborhoods. Be careful when pulling out of your driveway and making turns at intersections. Turn your headlights on.

Tips for Responsible Supervision for Younger Children

• Parents and caregivers need to actively supervise their children. This means no phones, socializing, or drinking. Carry flashlights and be aware of your surroundings.
• Parents and caregivers need to be within arm’s reach of their child at all times. Hold hands when crossing the street.
• Consider putting a nametag with your home phone number on the inside of the child’s costume in case they get lost.
• Accompany very young children to the door to help with picking candy.

Tips for Teenagers

• Trick-or-treat in large groups, not alone. Only visit houses with porch lights on and never to go inside a house.
• Remember to follow pedestrian safety tips. Carry a flashlight or be sure to place reflectors on your costume. Stay off cell phones while walking across the street.
• Parents and caregivers, make sure you know the exact route your teenager will be going and how long they’ll be gone. If they don’t have a cell phone, let them borrow one. Arrange times to check in with your teenager.
• If your teenager will be driving, encourage them to drive very slowly and watch out for children. Consider picking up and dropping off your teen.

Candy Inspection and Allergy Tips

• Inspect all candies before your child eats them.
• If your child has an allergy, be extra cautious to read labels for the presence of anything that may be a trigger for your child. If you’re unsure, discard the item—better safe than sorry!
• Look out for food allergens like peanuts or candies that are made in nut-containing facilities.
• Some candies and gums can be choking hazards for your little ones depending on their age and development.
• Look for candy that may have been tampered with or candy that is potentially a “look alike” food item that might contain illicit substances like THC or CBD.

Tips for Carving a Pumpkin

• Only adults should hold the carving knives.
• Keep all sharp objects away from kids when carving pumpkins.
• Instead of carving, allow children to use markers or paint to draw faces, or pictures, then an adult can carve the pumpkin.
• Give little kids other jobs to keep them busy, like scooping out the insides or helping to clean up.
• Work in a well-lit area and always have an adult supervising.
• Consider the use of a battery-operated flameless candle, flashlight, or glow stick to illuminate your jack-o’-lantern. 

Costume Precautions

• Wear light-colored costumes that have high visibility at night. Increase visibility by adding reflective or glow-in-the-dark tape or paint to their costume or trick or treat bag.
• Make sure to purchase costumes that are labeled “flame-retardant”. For any DIYers, nylon and polyester are materials that are known to be flame-retardant.
• Use caution with wigs, masks or other accessories that may cover your kids’ eyes, nose and mouth making it difficult to see or breathe.
• Prevent falls by avoiding ill-fitting shoes and costumes that may become tripping hazards.
• Only use make-up products that are “non-toxic”. Test a small area of their skin a few days before use.
• The use of colored contact lenses could lead to eye infections or injuries—stick to only prescription contact lenses!

As you prepare for a night full of fun, we wish you and your family a safe and happy Halloween!

Joe Holland sketches out and builds the elaborate designs every October that transform his son’s wheelchair into the vehicle of Ben’s choice. Now in the 10th year of this Holland family tradition, Ben has wowed the neighbors with wheelchair costumes such as the Batmobile, pirate ship, fire truck, Hogwarts Express, an X-wing starfighter and an army tank.

“Ben is no longer known as the little boy with special needs. He’s known as Ben, the boy with the cool costume,” said his mom, Amber Holland.

Joe and Amber say the wheelchair decor serves as an icebreaker to open up conversations with people who might not feel comfortable around wheelchairs or children with disabilities. When Ben goes trick-or-treating around their Burleson neighborhood, they say, the costumes invite people to approach. Kids his age discover that Ben’s into the same things they like… Harry Potter, superheroes, Star Wars.

“A wheelchair can be intimidating for a lot of people,” Amber said. So in 2012 she suggested matching the wheelchair to the costume Ben wore at Halloween. “I asked my husband, ‘Do you think you could build a costume around the wheelchair? That way Ben is just like everybody else.’”

Ben’s story at Cook Children’s began at just two days old, when Teddy Bear Transport brought the newborn for treatment for brain damage that occurred due to lack of oxygen at birth. Doctors initially gave the grim prognosis of only months to live or a persistent vegetative state. But he far surpassed the medical predictions.

Joe recently shared Halloween photos in an email thanking the Cook Children’s neurology staff for their excellent care then and now.

“Yes, there have been some challenging times throughout the years, especially those first two, but this department has been with us every step of the way!” he wrote. “Everyone has always been incredible to our family and has treated my little boy like a superstar! Because of this incredible staff along with many others in the Cook Children’s network, my son is able to experience this kind of joy year after year!”

Just as Joe and Amber hoped, their email made the neurology team smile. We hope you smile too reading about one family’s example of celebration and inclusion.

Cardboard, Duct Tape and Love

Ben isn’t verbal, but he communicates through body language that the people who know him best can read. For instance, he indicates yes and no by the direction of his eyes. His parents describe him as a funny trickster and cartoon fan. He loves Halloween.

Construction of the wheelchair costumes every year involves the whole family. Ben approves the theme. Joe draws up and executes the plan out in the garage. And 9-year-old Lucy and 5-year-old Emma pitch in, painting, in enthusiastic support of their big brother. Joe admitted he’s no carpentry expert; rather, “I’m a determined dad.”

He aims to make the structures lightweight, steerable, and visible with special features such as accent lights and pretend steam from dry ice. The wheelchair rides on a platform base, and it’s configured so that Ben can see out. This year’s costume? Quidditch Stadium (for you Muggles, quidditch is the sport played by witches and wizards on flying broomsticks in the Harry Potter series).

“Joe’s the mastermind… a lot of cardboard, a lot of duct tape, a lot of paint and a lot of love,” Amber said.

They estimate that Joe works 72 hours on each wheelchair costume. Amber remembers when the family built the pirate ship, which was the first year Ben got excited. “He was fully aware of what was going on. He was so pumped,” she said.

Ahead of every Halloween, their neighbors start inquiring about Ben’s costume choice because they’re excited for him. The festivity and fun of his decked-out wheelchair attracts, educates and equalizes. And it prompts people to ask questions about Ben, an interaction that Joe and Amber welcome. The costume takes away the wheelchair’s shock factor, they said.

“I think it’s opened up people’s eyes. You see a child in a wheelchair sometimes, but you don’t realize how much they can do and how much they can convey,” Amber said. “People really have their aha moment. ‘Oh, this little boy has all these diagnoses but he still likes the same things I like. I can still say hi to him. I can still come up and talk to him.’”

Ben continues to receive care at Cook Children’s for needs such as medications to control seizures and pain. His parents expressed particular gratitude to Fernando Acosta Jr., M.D., the pediatric neurologist at Cook Children’s who has treated Ben all along. They shared the progression of Halloween photos to show just how far Ben has come. As his mom puts it: “He’s just a typical little boy really, who happens to have a lot of extra atypical needs.”

Heck yes I am.

Because…candy.

Candy my children will eventually forget about and I will enjoy.

Last year, things seemed pretty new and scary when it came to COVID. We were still figuring out how it spread, how kids were affected, and the COVID vaccines weren’t yet available. I was nervous about things, especially because we have loved ones we see often that are immunocompromised.

This year feels a bit different.

All of my adult family members have been vaccinated, and some even with the boosters recently. Also, we know a little more about how COVID is spread – and it seems to be a minimal risk outside in small groups.

So, we’re Trick or Treating this year! Huzzah!

Some ways we’re gonna try to keep it safe –

1. Trick-or-treating with a smaller group - just the neighbor’s kiddos this year, rather than the 8-house block party parade that always seems to form.
2. We’re going to try to incorporate masks into our costumes, at least if we are in a crowded area. Super easy to attach kitten whiskers or a mustache on there!
3. We’re gonna try to avoid those crowded doorways crammed full of kids, and wait our turn to run up to the front porch.

Ways that you, my Candy Supplier, can make things safer for us:

1. Sit outside at a table with treats! It’s a great way to get to know folks and chat. Not to mention enjoy the beautiful weather we’re having.
2. Pre-package treats so that the kiddos don’t all rummage their grubby hands into the bowl!
3. Turn off your porch light if you’re not feeling well. And eat those 30 Twix bars for me.

Have fun this Halloween!

And as my hero Ted Lasso said, "You know how they say that 'youth is wasted on the young?' Well, I say don't let the wisdom of age be wasted on you. I just came up with that. I feel pretty good about it.”

Stitch-a-Wish, the volunteer sewing, knitting and crocheting group for Cook Children's, generously provided the most fragile babies with original designs, such as a pumpkin, candy corn and Mr. Incredible. 

The Centers for Disease Control and Prevention (CDC) is discouraging trick-or-treating nationwide, calling it a high-risk activity for spreading COVID-19. They’re also dissuading trunk-or-treat events (where treats are distributed from trunks of cars in parking lots), indoor parties and haunted houses.

So why are these Halloween favorites considered high-risk?

“We know outdoor activities are much safer than indoor activities,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children's. “The problem is coming in close contact with people you’re not around regularly, like family members.”

She says masks have been very beneficial in slowing the spread of COVID-19, but warns of a recent rise in cases in Fort Worth and surrounding areas.

“Tarrant County has had an increase in COVID-19 cases over the last couple of weeks, and our positivity rate is hanging around 10% or 11%, which is pretty high,” she said. “The State of Texas is several percentage points below that right now. So now is not a good time to increase face-to-face contact locally.”

As of Oct. 5, 672 people had died of COVID-19 in Tarrant County, and nearly 45,000 others have recovered from the virus. With the current uptick, Dr. Whitworth says maintaining six feet of distance from other people is critically important, regardless of the activity.

“When you talk and exhale, you have droplets come out of your mouth and your nose that you don't see. There are a lot of them and they typically fall within three feet, but not always. You may talk louder or you may cough and they might travel farther. This is why the recommendation is to stay six feet apart” Dr. Whitworth explained. “It is less risky if you're outside because most of those droplets are diffused away and diluted outdoors. Of course, it’s even safer if you can wear a mask.”

In case you’re wondering, she isn’t talking about a Halloween mask. Dr. Whitworth says typical Halloween masks have openings for the mouth and nose, which defeats the purpose of stopping the spread of droplets.

But Halloween doesn’t have to lose all of its magic. Rayne Delgado, program coordinator for the Child Life Zone at Cook Children’s, has suggestions on how to make Halloween fun and safe for children this year.

“There are a lot of things families can do instead of trick-or-treating, like scavenger hunts in the house, family movie night and games.” Rayne said. “Pinterest also has a ton of craft ideas that meet all budgets.”

Here are some specific ideas Rayne shared with us:

Sensory fun

• Make Halloween slime and add googly eyes or critters in it
• Create sensory boxes filled with Halloween candy to find
• Build sensory bins with things like fake spider webbing, dyed-spaghetti noodles, soapy water, black beans, crushed graham crackers, un-popped popcorn, dyed rice, and Halloween trinkets (If age-appropriate)

Cooking activities

• Pumpkin face homemade pizza
• Dessert pizza using Halloween candy
• Carmel apples
• Ice cream cone witches hats
• Mummy hot dogs

Games

• Play Halloween-themed bingo
• Create a family mystery game with a play on Clue.
  • Using different rooms in your house, family members are the characters. Swap weapons for costumes.
  • Try to figure out which family member stole what piece of candy from what room, while wearing which costume. (This can also be done virtually with children and their friends. Switch rooms to each other’s houses.)
• Create an escape room in the house.
  • Start with one envelope that needs to be solved. That leads to another with another puzzle and so on until you find the bucket of trinkets/candy.
• Have a costume contest
  • Find things in the house to play dress up with. Who can be the most creative or silliest?

(We have provided templates in the 'Downloads' section of this article.)

1. Remind your kids about street safety. You might be surprised to learn that the most common injuries during Halloween are pedestrian accidents. Safe Kids Worldwide reportes that children are more than twice as likely to be hit by a car and killed on Halloween than any other day. Make sure you and your kids look both ways and keep looking as you cross the street. Cross only at cross-walks while using traffic signals and never dart out into the street or cross between parked cars. Children should always walk on sidewalks or walking paths.

2. Join kids under age 12 for trick-or-treating.

3. Make sure your kids can be seen. Safe Kids suggest adults should "carry glow sticks or flashlights, use reflective tape or stickers on costumes and bags, and wear light colors to help kids be seen by drivers."

4. .Help ration out appropriate portion sizes. It's easy to get carried away and inhale a whole bag of Halloween candy in one night. Help your child avoid this by limiting their portion sizes to an appropriate amount.

5.  Make sure your kids can see and be seen. Check masks and Halloween costumes to be sure your child can see well before going out trick-or-treating. Also, choose bright costumes and/or consider putting reflectors on their costumes or candy bags so that drivers can see your children easier. Make sure your child has a flashlight while out trick-or-treating.

6. A parent should always accompany children younger than 12 when they go out trick-or-treating. If older children are mature enough and are planning to go alone, have them go out on a planned route that you agree upon ahead of time. These kids should always stay in groups, carry a cell phone for easy and quick communication and stay only in well-lit areas. Teach kids never to approach cars or go inside homes for candy.

7. Check out their costumes. Make sure that costumes and shoes fit well, and that there are no sharp edges so that if they trip, they don’t inadvertently hurt themselves. Also, try to pick out costumes, wigs or accessories that are specifically labeled as flame resistant.

8. Do a test run with make-up. Make-up is a great alternative to masks, but test it out on a small patch of skin ahead of time so that you’re not surprised with any scary reactions on Halloween.

9. Avoid decorative contact lenses. Teens may want to use decorative contacts, but be careful. Contacts are NEVER one size fits all and can cause inflammation and/or infections if not used properly, so it’s just not worth the risk.

10. Slow down and be alert! Safe Kids warn that "kids are excited and may dart into the street. Turn on headlights early in the day to spot kids from further away."

Here are a few more safety tips from Safe Kids. 

Happy Halloween!

The children who knock on your door may be walking up your steps with special developmental or health needs to keep in mind.

"Halloween should be a fun time for all kids, particularly young kids. Homes should be a welcoming place for trick or treaters who come to have fun and get candy," Joy Crabtree, Psy.D., a licensed psychologist and clinic manager for Cook Children's in the Northeast Clinic and Southlake. "Please keep in mind that a lot of children, particularly young children, may have anxiety issues and can be easily frightened. Keep this in mind when decorating your home, yard, and even in what you choose to wear in terms of a costume when you answer the door for trick or treaters. Halloween night should not be viewed as a time to frighten young trick or treaters, in my opinion. Kids are out to have fun and get candy, not looking to visit a haunted house!"

Kat Davitt, a Child Life specialist at Cook Children's, reminds us to not make assumptions about the age of a child based on their size. An older child or teen with special needs may still want to trick-or-treat. "The best clue about their special developmental needs would be a parent close by a child or teen who we may think at first sight is too old to be trick-or treating," Davitt said.

Speaking of adult supervision, Sharon Evans, Cook Children's Trauma Injury Prevention/Outreach coordinator, reminds grownups to be careful tonight.

She recommends:

• Active adult supervision.
• Put electronics down.
• Keep your head up and walk, never run, across the street.

Evans asks parents to follow the same safety measures they do the remainder of the year that they do on Halloween. She says she sees too many kids riding around in the back of a truck or the cargo area of an SUV.

"There is lots of research to show a child does not have the cognitive ability to cross the street by themselves until they are 10 years old," Evans said. "A child with special needs may require active adult supervision at an older age. However, on Halloween when kids are already excited and then you add a ton of sugar, and a costume that can obstruct a child's vision, we have to be especially attentive. Have fun, but keep the safety rules in place."

Children with food allergies can have a particularly challenging time during all holidays, including Halloween. Their desire to feel included in the rite of passage that is trick-or-treating doesn’t always mesh well with the risk of getting food that could harm them.

Many of the most common food allergies are frequent ingredients in Halloween treats (nuts, milk, egg, soy and wheat).

"Over the past few years, there has been a movement toward providing non-food options for trick-or-treaters," said Justin Smith, M.D., a Cook Children's pediatrician. "You can designate your house a food-allergy friendly house by painting a pumpkin teal or for those of you are aren’t as crafty, you can print out this flyer and tape it to your door."

Being a parent is tough. We want you to know that you are not alone. We've compiled tips, resources and practical advice on a variety of safety and prevention topics designed to help you raise a safe and healthy family.

"Parents may think buying costumes that are too big allow children to wear the costumes for several years, but outfits that are too big can cause falls," said Dana Walraven, manager of Community Health Outreach at Cook Children's and coordinator of the Safe Kids Tarrant County Coaltion.

Use these tips as your kids are preparing for Halloween:

1. Select costumes that fit well.
2. Trick-or-treat with your children.
3. To help drivers see kids in the dark, put reflective tape at the top and bottom of costumes. This lets drivers better see your kids' height and movement.
4. Use face paint instead of masks so trick-or-treaters' vision isn't blocked.
5. Plan a familiar trick-or-treating route on safe, well-lit streets, use sidewalks and cross the street at intersections.
6. When crossing the street, use the crosswalk and make eye contact with the drivers so you know they see you and your group.
7. Use a flashlight or glow stick to light the way.

For more safety information

Being a parent is tough. We want you to know that you are not alone. We've compiled tips, resources and practical advice on a variety of safety and prevention topics designed to help you raise a safe and healthy family.

Poisoned candy?

We’ve heard these scary tales since we were little kids. Parents make sure you check your kids’ candy before they begin munching on their treats, but know that many of the stories you’ve heard are meant to scare your little brother.

Are there some particular dangers you should be aware of for the last day in October? Yes! Here are a couple of other Halloween treat issues you should know:

Food allergies

Children with food allergies can have a particularly challenging time during all holidays, including Halloween. Their desire to feel included in the rite of passage that is trick-or-treating doesn’t always mesh well with the risk of getting food that could harm them.

Many of the most common food allergies are frequent ingredients in Halloween treats (nuts, milk, egg, soy and wheat).

Over the past few years, there has been a movement towards providing non-food options for trick-or-treaters. You can designate your house a food-allergy friendly house by painting a pumpkin teal or for those of you are aren’t as crafty (or are just too lazy or don’t have enough time), you can print out this flyer and tape it to your door.

Listeria in caramel apples

Besides being a risk for ripping my front teeth out, caramel apples can harbor Listeria. Remember Listeria, you guys? It’s why I haven’t had Blue Bell in months. According to a recent study from the American Society for Microbiology, it seems that when the apple is punctured by the popsicle stick, the small amount of juice that comes out can become infected with Listeria.

Listeria is a particular concern for pregnant moms, the elderly and newborns so please don’t let your newborn munch on a caramel apple.

Some stores are pulling caramel apples off the shelves in response to this study.

Halloween can be a great time of fun for all kids.

For more information, check out our Halloween safety page.

Halloween can be a particularly challenging time of year for families and children dealing with diabetes. Whether a family is dealing with type 1 or type 2 diabetes, there are important health decisions to be made about handling the seasonal free flow of candy.

Type 2 Diabetes

Recent stats report 23 million people in the U.S. have type 2 diabetes. While most of those people are older adults, there are still many children who are at high risk for developing type 2 diabetes.

Obesity is a central problem in type 2 diabetes. With all the tempting treats, it’s no wonder that the average adult weight gain from Halloween until New Years is estimated at 5-7 pounds.

Therefore, it is essential to have a healthy game plan in preparation for Halloween and the other end of the year holiday.

Type 1 Diabetes

Obesity is not as often a central problem in children with type 1 diabetes; however, healthy snack/candy choices are still of prime importance. There’s a common misconception that people with type 1 diabetes can’t eat candy or other sweets. Those with type 1 diabetes can eat candy, but they must take insulin for the carbohydrates in the candy. Finding the right balance between healthy snacking and insulin dosing for candy is a real challenge for children and families dealing with type 1 diabetes.

Asking a veteran type 1 diabetes parents about their approach to Halloween is always a good idea. Amy Ohmer (@NatSweetSisters), a mother of two children with type 1 diabetes was kind enough to share some advice.

There are several wonderful ways in which families can handle Halloween. I prefer to tell parents to continue previous traditions, post diagnosis, expecially with older children or children with older siblings. First, this sends a message that type 1 diabetes will not change anything and secondly, there is no better time than the present to practice some real life carb counting/dosing skills.

If the plan is to go trick-or-treating, remember that the goal is to amass as much candy as possible, not necessarily to eat all of it. After bringing home the candy, counting the amount, and choosing their favorites, our kids are ready to part with much of it. There are several organizations that accept leftovers from food banks to senior centers.

Another great reminder is that Halloween candy is the perfect carb snack for low blood sugar treatment. A running joke amongst our parenting group is that this is the time where we can stock up on free carb snacks!!!

One year, our children sold candy back to us in exchange for "Halloween bucks" to buy things at a silly store that we set up in our living room. Every ten pieces of candy, provided a Halloween buck. At the end, they received a book, some dollar store items and a new Barbie doll. They loved that even more than the candy.

Finding the Balance

Not all candy is created equal. A quick check of nutrition breakdown on different Halloween candies helps children and adults pick “healthier” candy.

A recent research study gives some needed perspective for parents on children’s eating habits. The research examines different strategies to help children manage their food choices. Eating strategies that included structure, consistency, and clear communication between parent and child created the best success in helping children make better food choices long-term.

The lifelong goal for children and families is making consistent healthier choices in both the kinds and amounts of food eaten.

Halloween should be a fun time for all children, including kids with diabetes. Once again I’ll go back to Amy for good advice for us all:

No matter what parents choose to do with their children, they should take a deep breathe, relax and enjoy the event, whether it is trick-or-treating, bobbing for apples or enjoying donuts and cider. Halloween is truly a fun family event.

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