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Not all the scares and frights and bumps in the night are imaginary on Halloween. Each year, thousands of people end up in the emergency room due to Halloween-related injuries.One of the biggest culprits may come as a surprise: It’s pumpkin carving, according to the U.S. Consumer Product Safety Commission. Falls while trick-or-treating and pedestrian accidents are also common, and children are more likely to be struck and killed by a vehicle on Halloween than on other days of the year.Related video above: Many People Worry About Razors in Halloween Candy, But There is Something Even WorseI spoke with wellness expert Dr. Leana Wen to learn about a few easy steps parents can take to reduce the likelihood of Halloween-related incidents, including carving injuries, burns and traffic accidents.Wen is an emergency physician and adjunct clinical associate professor at the George Washington University. She previously was Baltimore’s health commissioner and is the mother of two young children.What kinds of Halloween-related injuries are doctors seeing most often?Dr. Leana Wen: Emergency physicians see a predictable wave of Halloween-related injuries every year. The U.S. Consumer Product Safety Commission estimates that about 3,200 people are treated in emergency departments annually for Halloween injuries. Of those treated, about 1,400 are children.More than half of all visits are related to pumpkin carving. Adults may end up needing stitches after a knife slips while cutting a pumpkin’s tough shell. Children may also get in harm’s way if they reach across the carving area at the wrong moment. These injuries can involve deep cuts to the palm or fingers, sometimes severe enough to require tendon repair surgery.Trips and falls are the next leading cause, accounting for roughly one-quarter of Halloween-related injuries. These typically happen while children are out trick-or-treating. A few factors increase the risk of falls compared with other days, including unfamiliar roads, long costumes and dim lighting. Falls can also occur while putting up or taking down decorations.A smaller but still significant portion of Halloween emergency cases are due to injuries from decorations and costumes or food allergies. Candles placed inside pumpkins or near flowing costumes can quickly ignite fabric or synthetic wigs, causing burns. Costumes and makeup products or peanuts or tree nuts in candies can also trigger severe allergic reactions and rashes.What about motor vehicle accidents?Wen: A 2019 study in the journal JAMA Pediatrics looked at more than 40 years of national crash data to see whether Halloween is more dangerous for pedestrians. Researchers compared the number of people killed by vehicles on Halloween night with the number killed on the same weekday one week before and one week after. The study authors found a striking difference: Pedestrians were nearly twice as likely to be hit and killed by a car on Halloween compared with other days.The highest risk was among children ages 4 to 8, who were ten times more likely to be killed while walking on Halloween evening than on other days. The researchers concluded that pedestrian fatalities rise sharply during trick-or-treat hours, when more children are outside and visibility is low.What can families do to keep kids safe while trick-or-treating after dark?Wen: The most important step is traffic safety. Young children should always be accompanied by an adult, and families should stick to sidewalks or paths rather than walking in the street. Drivers have limited visibility at night, and many neighborhoods are crowded during trick-or-treat hours, so crossing at corners and looking both ways is essential.Costumes should fit properly and allow kids to move freely. Avoid baggy or overly long costumes that can cause trips and falls. Masks should not block vision or breathing; makeup or face paint is a safer alternative, though make sure any products used are nontoxic and labeled for use on skin. Be sure to remove all products thoroughly before bedtime to avoid irritation or allergic reactions. Visibility is another key factor. Adding reflective tape to costumes or bags, wearing bright colors and carrying a flashlight or glow stick can help drivers see trick-or-treaters. It also helps kids see where they are going on dimly lit sidewalks.At home, use battery-operated candles or glow sticks in pumpkins and decorations instead of open flames. Clear steps, porches and walkways to prevent falls. If adults are celebrating, plan ahead to make sure there is a designated driver. No one should drive after drinking on Halloween or any other day.How can parents and guardians prevent pumpkin-carving accidents?Wen: Unless you have been teaching your child how to cut up squash in the kitchen, the safest approach is to leave pumpkin carving to adults. Children can still take part by scooping out the insides with a spoon or drawing a design on the pumpkin for an adult to carve. Sharp knives are the main cause of Halloween hand injuries, so keeping them out of children’s hands is the best prevention.Once your jack-o’-lantern is ready, use battery-operated candles or glow sticks instead of open flames. If you do use a real candle, keep it far from curtains, decorations or anything that could catch fire, and never leave it unattended.With so much candy around, how much sugar is too much for kids?Wen: The American Academy of Pediatrics recommends that children age 2 and older consume no more than about 25 grams (about 6 teaspoons) of added sugar per day. For children younger than 2, the advice is to avoid added sugars entirely. One full-size chocolate bar typically contains around 20 grams of added sugar, nearly the entire recommended amount for an older child. Several small candies can add up quickly to the same amount.That said, one day of celebrating won’t harm a healthy child for the long term. Parents can decide in advance how candy will be handled, such as allowing kids to enjoy sweets on Halloween night and then setting limits afterward. It helps to talk about it beforehand, so expectations are clear. The key is to enjoy Halloween as a special occasion while helping kids learn that treats are fine in moderation, not an everyday habit.