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updated 11/4/2003 7:30:51 PM ET 2003-11-05T00:30:51

Halloween originated from several customs, the earliest of which dates back to Ireland in the fifth century B.C. As we know it today, the Oct. 31 celebration is a fun way to dress up in sometimes scary costumes. But experts warn that precautions are needed to ensure that disguises are the only frightening things on All Hallows’ Eve.

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The No. 1 cause of injuries on Halloween night is accidental falls from tripping over hems of costumes, steps, curbs, or unseen objects, according to the National Safety Council. But even more startling is that four times more children are killed annually in pedestrian/automobile accidents on that holiday night than on any other night of the year, reports the CDC.

“The most important thing on Halloween is that children are escorted and watched. They have a great potential of running from in front of or behind a car,” says Richard Douglas, a Lewisville, Texas, Police Department community relations officer. “We prefer that the young ones are in from trick or treating before dark.”

Indeed, the CDC reminds parents that the return from daylight saving to standard time lengthens the period of darkness and that a number of other factors could put children in the path of a car. These include their short stature, inability to react quickly enough to avoid a car or evaluate a potential traffic threat, lack of impulse control, and distractions because of shouts from other children, eye-catching costumes, and urges to acquire the best candy.

“Children are so excited on that night that they aren’t using their normal safety sense,” says Kerri Totty, a certified hand therapist at Harris Methodist Fort Worth Hospital.

Totty deals with some of the injuries that children and their parents may receive during the days leading up to Halloween as well as on the holiday itself, such as cuts and burns related to turning a pumpkin into a jack-o’-lantern.

“We see a lot of kitchen knife injuries. These can be devastating because of the structures in the hand,” Totty tells WebMD. These include tendons, nerves, and arteries. She says that major therapy is required when the tendons and nerves are severed, often because a child or adult uses an inappropriate knife or uses one incorrectly. Physical therapy to prevent scarring from permanently disabling a hand can last for eight to 12 weeks.

“Usually these injuries happen because [people are] not paying attention to what they’re doing or they’re cutting toward themselves, or using the knife like an ice pick,” Totty says, adding that knives should be clean because the bacteria on it can cause a major infection in any cut.

For adults, the medical experts advise using sharp knives; small children should just draw the jack-o’-lantern design on the outside of the pumpkin with a marker and let someone older do the cutting. Youngsters who are old enough could use knives intended for carving pumpkins.

“With my own children, I let them use the special pumpkin cutters that have the serrated edges. These work as well as anything,” says Dr. Mark Mason, a plastic surgeon at Harris and also at the Cook Children’s Medical Center in Fort Worth.

Safety organizations warn parents and trick-or-treaters alike to be aware of other dangers:

The American Academy of Pediatrics says in order to avoid burns, use votive candles for pumpkins; give Halloween beggars colorful pencils, stickers, large erasers, or decorative shoelaces rather than candy; watch for signs of tampering such as small pinholes in wrappers or loose packaging; don’t give small children things on which they could choke such as gum, peanuts, hard candies, or small toys.

The U.S. Consumer Product Safety Commission says to make sure that any costumes are labeled “flame resistant,” and be careful where you place candles and lit jack-o’-lanterns. Three years ago, a 12 year-old Texas girl died of severe burns when her homemade costume brushed against a jack-o’-lantern candle. Costumes also should be light-colored and/or trimmed with reflective tape, as should trick-or-treat bags.

The nonprofit children’s health organization The Nemours Foundation says to stick with wrapped candy; fresh fruit is easily tampered with and may be covered with bacteria that could make you sick.

The Nemours Foundation also reminds you that dogs may be dressed up for Halloween also but children shouldn’t approach any animal even if they know it. Their costumes may frighten the dog, causing even the most docile animal to bite.

All of the safety and medical experts say to tell children to walk on sidewalks and cross the street only at corners; if they must walk in the street, walk on the side facing the traffic. Don’t wear costumes or shoes that could cause the child to trip or fall, such as mom’s high heels.

An adult should accompany any child under the age of 12, and children should have tags on the insides of their costumes with their name, address, and phone number in case they are separated from their group. Parents should know the companions of older children, and a curfew should be set. Instruct children not to go into strangers’ houses.

Trick-or-treaters should carry a flashlight if out after dark. Also, children should eat a good meal before going out and be instructed to not snack on candy they’ve collected until they get home and their parents have checked to make sure it’s clean and safe.

Instead of masks, use face paint that is labeled nontoxic. If a child must wear a mask, make sure the mask has holes for the eyes, nose, and mouth, allowing for proper ventilation and vision. Don’t put anything on a child’s head that will slide over his or her eyes. All costume accessories such as knives, swords, wands, or shields should be made of cardboard or a flexible material.

Adults should remember that children might be in the streets, alleyways, driveways, and on medians. Drive slowly. If you are driving children from house to house, let them out on the curb side of the car. And be sure to clear porches, lawns, and sidewalks of anything that someone might trip over.

Finally, therapist Totty says, “You have to be their eyes and ears to protect them. And don’t allow them to suck suckers when they’re running down the street!”

It’s a lot to remember, but it’s better to make Halloween a night for fright — not fear.

WebMD content is provided to MSNBC by the editorial staff of WebMD. The MSNBC editorial staff does not participate in the creation of WebMD content and is not responsible for WebMD content. Remember that editorial content is never a substitute for a visit to a health care professional.

© 2013 WebMD Inc. All rights reserved.

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