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Tricks and Treats


It is that time of year when those of our friends in the ex-colonies are adorning their houses with the remnants of Cucurbita pepo, carved into the facsimile of long dead relatives. Over in Australia the celebration of All Hallows’ Eve has not hit American proportions but some children still go from door to door on the hunt for sugar based calories. An 80s childhood of watching appallingly good horror flicks has made me reluctant to let my children knock on the doors of strangers. Is it safe?

Should I have to worry about razor blades in the candy bars?

I’ve never seen it in either the UK or Australia. Still, there was a time when US emergency departments would be offering a free screening service for children turning up to their department laden with plastic pumpkins filled to the brim with wrapped confections. In one study (from 1992) that Dr Phibes could have conducted, several hospitals in Kentucky were contacted to review their practices.  Not one of the 454 children who had their stashes x-rayed revealed a dangerous foreign object except…

The investigators decided to make things more interesting. They inserted a 2 1/2cm sewing needle, vertically, into a toffee apple (candy apple) and sent it with volunteers to the study hospitals. One of the five study hospitals failed to find the needle, despite radiographic screening.  Given that the actual number of dangerous goods found was nil, routine x-ray did not seem to be a cost effective strategy.

Who would even put them there?

The idea that Halloween is a holiday for sadists only started being put about in the early 1970s. An enterprising team of researchers trawled through the databases of four major regional newspapers covering a 25 year period and pulled all reports that included acts of alleged Halloween sadism, by then a psychosocial construct. In the days before the internet they managed to find 76 incidents. The only two deaths reported were not, in fact, random acts of violence by strangers but acts of non-accidental injury by relatives.  Although actual reports were low, numbers of alleged acts increased, especially after the 1982 adulteration of extra-strength Tylenol capsules. A number of children reported that their sweets had been contaminated but when tested they were found to be drug and toxin free. It seems as if the idea of a razor blade in the Halloween candy is just an urban legend, after all.

So children can eat whatever they like then?

Not so fast… Too much sugar is not good for you, so some do-gooders may have decided to lace their selection with sugar-free, artificially sweetened sweets. This case report presents a case of severe diarrhoea induced by sorbitol in sweets and posits that there may be many more cases of candy cramps around the holiday season.

They may not want sweets anyway. Children are just as likely to choose small toys over candy according to this study. If parents can change their own enabling behaviour then they can reduce the calorific burden that their children are placed under.

And it’s not just the kids you have to worry about

One case report from my favourite non-medical journal this month, Australian Zoologist, tells the tale of a poor garden skink stuck to a half-melted candy – described as a yellow-and-white, banana-flavoured soft object). He/she/it could only escape with the passing zoologists’ help.

So perhaps they should just stay at home and watch a nice film then?

It really depends on what you are going to let your children watch. We know that children that spend a larger proportion of their time in front of television screens are more likely to be overweight.  It may not just be sitting on their backsides, barely using up calories, that is making them fat but what they are watching as well. A study, published in Obesity in 2013, analysed 10 minute segments of the top four top-grossing children’s films form 2006 to 2010 and rated then for health and unhealthy activities portrayed on screen. Examples of obesogenic behaviours included unhealthy snacking, exaggerated portion sizes, lack of physical activity, excess screen time and intake of high sugar drinks. The majority of the films watched showed sugary drinks (55%), exaggerated portion sizes (60%) and unhealthy snacks (75%). Unfortunately 70% of the films studied also portrayed stigmatising behaviour towards body size.

 “One must first master the highest level of Kung Fu and that is clearly impossible if that one is someone like you…That fat butt! Flabby arms!       

Master Shifu, Kung Fu Panda (2008)


Calvanese J. Should we X-ray Halloween candy? Revisited. Veterinary and human toxicology. 1988 Apr;30(2):165-9

Cappelle CA, Eberly S, Paul RI. Routine screening of Halloween candy: helpful or hazardous?. Annals of emergency medicine. 1993 Oct 31;22(10):1541-4

Best J, Horiuchi GT. The razor blade in the apple: The social construction of urban legends. Social Problems. 1985 Jun 1;32(5):488-99

Breitenbach RA. ‘Halloween diarrhea’ An unexpected trick of sorbitol-containing candy. Postgraduate medicine. 1992 Oct 1;92(5):63-6.

Schwartz MB, Chen EY, Brownell KD. Trick, treat, or toy: children are just as likely to choose toys as candy on Halloween. Journal of nutrition education and behavior. 2003 Aug 31;35(4):207-9

Throop, E. M., Skinner, A. C., Perrin, A. J., Steiner, M. J., Odulana, A. and Perrin, E. M. (2014), Pass the popcorn: “Obesogenic” behaviors and stigma in children’s movies. Obesity, 22: 1694–1700. doi:10.1002/oby.20652

Schvey NA, Puhl RM, Brownell KD. The impact of weight stigma on caloric consumption. Obesity. 2011 Oct 1;19(10):1957-62

Porter GP, Grills NJ. The dark side to Halloween: marketing unhealthy products to our children. The Medical Journal of Australia. 2013 Oct 21;199(8):528-9.[




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1 thought on “Tricks and Treats”

  1. Thanks, Andy!

    Stay safe out there, kids (however old you are)!

    I remember working in the ED as a clerk and tech “back in the day”, when not only was it expected that parents could come in for “a quick xray” of their childrens’ Halloween candy, but at some point we had misguided outreach “Open House” program that was advertised prior to the day. Talk about mission creep.

    Side note: if you’re really that terrified that your child could be ingesting razor blades, syringes needles, injected poisons, and all sorts of nasty things, then, instead of an ED visit that could cost >$1000 or films that could cost $100s, or time spent in the ED, or a weird set of priorities that you impress upon your child, why not take steps to obviate the fear (e.g. easy switcheroo with candy you’ve bought, or organize an event with people you know)

    Anyway, it’s a good reminder that we as medical folk don’t live in a vacuum — we live in the context of a very real, imperfect world with very real, imperfect people, such as ourselves.

    Thanks, Andy — ever topical and helpful. Stay safe out there — Samhain has always been known to be dark and full of terrors — and more importantly, have a peaceful All Saints Day tomorrow.