Shobha Bhaskar, MD: Yeah, hi, I'm Dr. Shobha Bhaskar. I'm a Pediatric Hospitalist with St. Louis Children's Hospital and Washington University School of Medicine, and I'm also a MomDoc.

Melanie Cole, MS (Host): As autumn approaches, it brings a unique set of hazards that can pose risks to children. We're talking about how the changing season introduces specific dangers and offering practical advice on how to keep your little ones safe. Welcome to MomDocs, the podcast from St. Louis Children's Hospital. I'm Melanie Cole.

Dr. Bhaskar, I'm so glad to have you with us today. Please just start by telling us some of the things that you have seen in your practice that make us realize that there are risks in the autumn that we may not think about.

Shobha Bhaskar, MD: Yeah. Hi, Melanie. Thanks for having me on this. So with autumn and the fall season, you know, it's the beginning of the holiday season. And it's a great time to get together with friends and family and do all these holiday activities and enjoy the festivities, but also as a physician who's working in the ER, I do see a surge in the cases I'm seeing in the ER, mostly related to accidental injuries, accidental ingestions, and a lot of times with food allergies.

So, with the Halloween time, we see injuries related to candies and trick or treating and pumpkin carving activities and fall. People doing a lot of these fall activities outside, playing with the leaf piles getting ready for the weather getting colder, you know, getting the pools closed and automobile antifreeze laying outside. You know, the list is endless, but we do see a lot of these injuries and cases that we see in the ER.

Host: Okay, so let's dive into some of these. Let's talk about pumpkin carving because I will tell you, when my kids were little, it used to scare me trying to push a knife through the very hard squash of a pumpkin. It's thick. It's hard. And then they developed those knives for kids that seemed to be safer. It always scared me.

Shobha Bhaskar, MD: Yeah, so, with pumpkin carving, we see a range of injuries in the emergency room. It can be real simple abrasions to superficial lacerations and sometimes deep tissue injuries, which might need even surgeries and months of rehab. And most of the time we see kids who are injured by getting access to these sharp instruments lying around. That's with the younger kids. And the adolescents who are allowed to do the pumpkin carving, usually present with hand and finger injuries from these sharp instruments. And like you just mentioned, it's mostly when the sharp instruments get lodged in the flesh of the pumpkin and they're trying to pry it out.

And it dislodges suddenly, and I've seen some pretty bad facial and eye injuries too. Uh, yeah, and a lot of times it's the sharp instruments which come out on the other side and injures the hand that is trying to stabilize the pumpkin. It goes through the skin and comes right through the hand on the other side. So it's a range of injuries that we see, and just following some basic safety measures can really prevent a lot of these.

Host: I'm getting the memory wiggles. I even one year wanted my kids to just draw on the pumpkins because I was so nervous. And my husband's like, come on, I'm right here. I'll help them do the big part. So what do we do to safely carve pumpkins?

Shobha Bhaskar, MD: Yeah, sure. Like I mentioned, it's basic safety measures that we can take. Making sure that the activity is happening in a clean, well lit place. Make sure there is no moisture on the floor, that can cause a risk for tripping. You're carrying these heavy pumpkins and carrying these sharp instruments, that itself can be a risk for injury.

And like you said, having the younger kids getting involved in the safer aspects of the pumpkin carving, like drawing the pattern on the pumpkin, or cleaning of the pulp and the seeds, or just decorating the carved pumpkins, you know, that's something that you want to get these younger kids involved in.

And making sure that the really young ones, like the infants and toddlers, are not even in the vicinity. And the adults, when they're actually doing the activity, making sure that they are using the instruments away from the face, and making sure there is nobody around them and they're using these instruments.

And like you just mentioned, a sharper instrument is not necessarily a good one. We actually have these pumpkin carving kits available, which are not as sharp. And even if there is injury, it's not like a deep tissue injury that can be sustained from them. So just being aware of the kind of instruments being used is really important.

Host: Now, we don't typically think of pumpkins and gourds that pose dangers, but what should parents do if their children have ingested a part of a decorative pumpkin or gourd? Are these things poisonous?

Shobha Bhaskar, MD: These decorative pumpkins and gourds are not necessarily toxic to the body. It is not like poisonous, so to speak, but they're just not palatable. You know, it's a lot of water content, they're stringy the skin is too thick and just not ideal for cooking. But when it is left outside after the carving activity, it can get contaminated with bacteria.

It's organic material. It's sitting outside, exposed to humidity and high temperature if it's sitting outside in a closed area, and it can easily get contaminated within a few hours. So that can cause food poisoning symptoms. And depending on the type of bacteria that has contaminated it, like, if it is, like, clostridium botulinum, it can cause like a potentially dangerous condition with the toxin mediated neuromuscular illness of food poisoning.

The other thing is kids who gain access to these can also accidentally choke on parts of these if they gain access to this. So although they're not necessarily dangerous or toxic, kids can be harmed by gaining access or eating these.

Host: Well, the squirrels seem to like them, especially after Halloween. Now, you mentioned earlier antifreeze. I mean, are you still seeing that? Do people still put antifreeze and deicing agents in their cars? Is this something that you see in the ER and something we should really be aware of?

Shobha Bhaskar, MD: Oh, absolutely. We see quite a few cases of accidental ingestions with antifreeze. So with the fall weather, the weather is getting colder and people are closing down the pools, it's usually a lot of cases are related to the pool antifreeze, which I have seen personally. And also the automobile windshield wiper fluid is also the antifreeze liquid.

So basically antifreeze is a combination of liquid alcohols. It's ethylene glycol, propylene glycol and methanol. And these are extremely dangerous chemicals. These are water solubles, but when it gets into the body, even in small amounts, it can cause a lot of serious side effects. It can change the chemistry in the blood. It can have some serious side effects on the kidneys and the brain and can be potentially life threatening.

So, that's something that the parents have be careful about. And the other thing is, the natural taste of ethylene glycol is sweet, so if the kids gain access to these chemicals, it kind of lends itself to be consumed in larger quantities and has a setup to cause some serious side effects.

Host: Wow, that's pretty scary. So what is the best way to store these things? How can they, you know, make sure their kids don't get into them?

Shobha Bhaskar, MD: So whether it's antifreeze or pool chemicals or garden chemicals, these are best stored outside the house in the garage and preferably on cabinets higher up on the shelves where the little kids cannot gain access to them. And making sure that these child proof t tightly closed. I cannot tell you how many times I've seen kids come in with accidental ingestion from containers which have these child safety caps, but the parents have just not closed them tightly.

So they don't work unless it's been used properly. So making sure that they are tightly closed. And some of these chemicals, just not the antifreeze, you know, other garden chemicals which are being used around this time. Some of these come in resealable containers and those are not kid friendly or childproof.

So adding another additional layer of safety by using like a slider tab that you can get, those are childproof. So just being aware of that, making sure it's not accessible and they're in childproof containers.

Host: So some more outdoor hazards as we think of leaves and jumping in as kids into the pile of leaves. When I was an adult, I started thinking, it's like using a slip and slide in the summer. You think, well, what's on the lawn? And you're going to go sliding on the lawn. And if there's like a can top or a piece of glass, boy, you could get cut up pretty bad.

But the same when with leaves. Tell us a little bit about when kids are playing around these fallen leaves, as it starts to get wet and they could get moldy. Are there specific signs we should be looking out for in these leaves? Tell us about that.

Shobha Bhaskar, MD: So, you know, like you just mentioned, fall weather, it's beautiful outside. Leaves are changing color. The weather is just perfect. So, families tend to spend a lot of time outside enjoying this weather. But, dried leaves can pose a lot of inherent risks with injuries and falls and mold exposure, like you just mentioned.

So dried, I do see quite a few cases of injuries, actual physical injuries from the sharp edges of these dried leaves, just like paper cuts. I've seen kids playing in mold, like these piles of leaves come in with some pretty deep lacerations. Yeah, sustained from the edges of these dried leaves. The other thing is, these dried leaves are slippery.

I've seen a lot of kids or even adults fall and come in with accidental injuries and falls and fractures and injuries from slipping on dried leaves. And people are trying to rake these leaves and dispose them off. And they're working with some heavy instruments, sometimes sharper instruments. The rakes can have the sharp edges. And if they're not put away promptly, kids can gain access to them and that can also become a risk of injury. And sometimes you have animals and bugs in these big piles of leaves and kids are jumping into these piles and can be exposed to animal bites and bug bites.

And the one thing you mentioned, mold, fall is a season which is big on mold and dust allergy and some people with asthma and seasonal allergies are really sensitive to mold. So, you have to watch out if the leave piles are wet or soggy or black and that can be something which is carrying mold in it and that can trigger their asthma and allergies.

Host: Well, we know Halloween's coming up. And so this is a question we get every year. What are we looking for in the candy? Just give us a general overview of Halloween safety.

Shobha Bhaskar, MD: Sure so Halloween safety can itself be a whole topic for discussion to honest.

Host: It can. It can be a whole podcast on its own, yeah.

Shobha Bhaskar, MD: Absolutely. But if you're just focused on mostly the trick or treating aspect, I usually tell my parents, one thing to make sure is if the parents or an adult caregiver can make sure they've inspected everything that's been collected by the kids during the trick or treating process, that's the most ideal thing to do.

I know it's not practical, but it is necessary to instruct the kids not to ingest these or consume these candies when they're handed out and preferably bring it home and so that it's been inspected by the parents before they can consume it. And when parents are inspecting these candies or kind of looking over these; the main thing to watch for is if the wrapper or the packaging is compromised in any way. If you see rips, tears, even pinholes, I would just get rid of those candies. And if it's a packaging that you've never seen before, if it's a type of candy that you've never seen or heard of before, you definitely don't want to have your kids consume those.

And the other thing is portion control. We see so many cases when the kids have overeaten the candies and come in with stomach upset. If possible, try to portion control these candies for a few days or weeks. And one other thing is, a lot of times people hand out little toys along with candies during trick or treating. Make sure that there are no small objects or toys which can be potentially risks for choking hazard for your young kids.

Host: I remember the days when my mother used to inspect our candies, but that was just so she could take the Heath bars and Butterfingers before we got to them. You know, it's the best time to really get all the good candy, but I agree with you if it's something you don't recognize, and that's kind of sad that we don't get to use the homemade popcorn balls. And some people would make brownies, and those kinds of things are really not safe anymore because we don't know what went into them. So that's really good advice. Now, as we get ready to wrap up, I'd like you to give us some general safety tips about household chemicals and household items that really should be stored out of children's reach and what you want parents to know about the steps that they should take if they suspect their child has been exposed to a harmful substance or gotten poisoned, just give us some general safety tips.

Shobha Bhaskar, MD: Sure, sure. So, overall, making sure medications, pool chemicals, garden chemicals, pesticides, those are really stored away such that the younger kids cannot access them. You know, kids in general cannot access them and it cannot become a risk for accidental ingestions and injuries.

It's very important. Of course, if it is medicines, make sure it's in the medicine cabinet. Higher up, that, that way the younger kids cannot reach them. If someone in the family is on any kind of controlled substance for a medical condition, make sure they are in locked cabinets. And like I mentioned, you know, making sure the pesticides, the fertilizers, the pool chemicals, garden chemicals are stored in the garage in higher up shelves on cabinets is important.

And being careful with the garden instruments so that they are stored properly that they cannot become a risk of injury for the kids outside. And when I usually, when I discuss the major categories for things to make sure that the home and environment is childproof for parents; it's like six to seven things, major categories I kind of go over.

Common things which we tend to ignore. Plastic bags. You're doing a lot of shopping during the holiday season and the plastic bags, the shopping bags can easily become a suffocation hazard for the young kids if they, and they love to play with those. If they get it over the head, it can become a suffocation hazard.

Pet toys and foods, just be careful. Those are pellet like. They can easily become a choking hazard. And kids who are crawling can easily gain access to them from the pet dishes. And remote controls, batteries in the remote controls or in the small toys, that can easily become a risk for accidental ingestion or choking.

Especially the little button batteries are extremely corrosive and immediately they have to be removed by a bronchoscopy or an endoscopy. So just be aware of those. Placing another layer of tape over the battery flaps really helps. And we went over the cleaning chemicals. And another thing is beauty products. And stuff like sunscreen, sprays, hairstyling products, and equipment like curling irons and hair straighteners, have seen quite a few cases of burn injuries that come in, especially there is a surge during holiday season. People are getting ready, rushing off to parties, and they leave these instruments which can become a risk for burns and injuries.

 And one thing which is kind of my favorite to stress on is handbags. There are so many things that can become a risk for choking, accidental ingestion in our handbags. We are rushing, coming in through the door, kind of leave the handbags easily accessible to the kids and you can have coins in them, paper clips and pins and little caps of your lip balms. You could have like Tylenol and Ibuprofen or sometimes your prescription medications, which the kids can gain access to. So kind of thinking about these on a constant basis. What I tell parents is childproofing is not a one time thing.

You have to revisit them and kind of think about it time to time and make sure you're checking on things around the house from time to time, and also it's very situational. If it is the time of holidays, the risks are different. If you have people visiting, the risks can be different. And friends and family visiting might not have the same safety concerns or, you know, they might not be thinking about the same things that you are thinking regarding childproofing. They might leave lighters or alcohol or their prescription medications lying around. So just thinking about those and making sure they're put away is extremely important.

And another thing I would like to add is what to do if there is some accidental ingestion or injury. If you think that there is even a slight risk of accidental ingestion, the poison control number, calling Poison Control is a great resource. I think every parent should memorize the number to Poison Control 1-800-222-1222. Call them. Great resource. Usually, the call is answered by trained nurses, pharmacists, or physicians, depending on who's on call. They'll tell you, they can go over what symptoms to watch for, how long to watch for, and when to go to the emergency room. And the other thing you can do is if you want to just talk to your Pediatricians Exchange, call and discuss the child's symptoms, if it is mild symptoms. And of course it's never a bad idea to get your child checked out if they have severe symptoms, coughing, wheezing, trouble breathing, changes in mental status, anything like that, just go to the nearest emergency room immediately or call 911.

Host: What great advice. Parents, you have to share this episode with your friends and your family on your social channels because Dr. Bhaskar has just created an amazing list of safety precautions that we all need to think about when there's little ones around, especially at this time of the year.

Thank you so much, Doctor, for joining us and sharing your expertise. For more advice and articles, please check out the MomDocs website at Childrensmd.org. That concludes another episode of MomDocs with St. Louis Children's Hospital. Please remember to subscribe, rate, and review MomDocs on Apple Podcast, iHeart, Spotify, and Pandora.

I'm Melanie Cole. Thanks so much for joining us.