Pediatricians say trick-or-treating poses a low to moderate risk this year. These tips can help keep your kids safe.

• With COVID-19 cases down in most states, trick-or-treating is back on in many cities and towns.
• Pediatricians say there's still a risk for COVID-19 transmission during trick-or-treating.

This Halloween, the risk of COVID-19 transmission is still a concern for many parents, especially those of unvaccinated children. Because of that, it's important for parents to keep COVID safety in mind, even though case numbers are lower than last year's.

"I would take my children trick-or-treating with COVID-19 precautions in place and for a limited time," said Thanh-Tam Nguyen, a pediatrician and the medical director at CalOptima in Orange, California.

Keeping kids safe while trick-or-treating

This year, experts such as the American Academy of Pediatrics said trick-or-treating is safe, especially with a few modifications.

Despite that, Christina Sheridan, the department chair of pediatrics at Santa Clara Valley Medical Center in California, said there is still a risk that parents should be aware of.

"Trick-or-treating usually involves mingling into or past crowds and up to front doors," she said. That presents a mild to moderate risk of catching COVID, especially since most trick-or-treaters are too young to be vaccinated.

To minimize the risk, parents should follow these steps:

• Choose outdoor events. The risk of COVID transmission is lower outside.
• Consider the crowd. Choose smaller events and consider the behavior of those attending.
• Avoid eating. Events where people are eating and drinking will increase risk because attendees aren't masked all the time, Nguyen said.
• Check infection rates in your area. If your region is experiencing a spike, the risk of contracting COVID may be higher.
• Vaccinate eligible children. The best way to reduce risk is to vaccinate kids who are 12 or older.

Make masks part of the fun

Even before COVID, masks were part of Halloween fun, but this year they're extra important, Nguyen and Sheridan said. For maximum safety, kids should wear masks the entire time they're trick-or-treating or attending an event. At this point, that's not a big deal for most kids, Sheridan said.

Masks can be incorporated into costumes. But masks should never be painted, since the fumes can stay around. In addition, remember that decorative masks without a snug fit don't provide the same protection against COVID as masks designed for pandemic use.

This year, skip the face paint. Sheridan said. Although it's cute, it's often itchy and can make kids more prone to touching their face, which can increase the risk of infection.

When it comes to the best way to hand out candy, there are options. Sheridan suggested a self-help approach: Put out a bowl of candy and a container of hand sanitizer. Most kids would get the message that they should sanitize before taking candy.

Nguyen recommended having a gloved adult serve trick-or-treaters.

Remember non-COVID Halloween safety

Although COVID is the biggest concern for most parents, it's important to remember other Halloween safety considerations.

"Emphasis this year on COVID-19 precautions doesn't mean parents can forget the basics of being careful about maintaining physical safety, watching out for traffic, inspecting candy packaging, and checking toy safety," Nguyen said.

One thing many parents don't consider is hand safety and the risk of carving jack-o'-lanterns, said Daniel Gittings, a hand and wrist surgeon with Hoag Orthopedic Institute in Southern California.

"Halloween typically has 4,500 holiday-associated injuries per year, with many being hand and wrist injuries," Gittings said.

Young children should skip pumpkin carving altogether. Instead, let your kids paint pumpkins. For older children, Gittings suggested buying pumpkin-carving kits, which are generally safer than carving with a kitchen knife.

Deciding your comfort level

Having a Halloween candy hunt at home, making Halloween-themed treats together, or having a spooky movie night are all fun alternatives that are safer than trick-or-treating. Visiting a pumpkin patch or outdoor haunted house at off-peak hours can help you celebrate without the crowds. Ultimately, if you're not comfortable with trick-or-treating this year, it's OK to skip it.