Hand sanitizer and kids: safe use at home and at school

Hand sanitizer is in every backpack, classroom and car cup holder now, and for good reason: it kills many germs in seconds when there’s no sink nearby. For young children, though, the risks aren’t about germs. They’re about a bottle of strong alcohol that smells nice, sometimes looks like a snack, and often sits right at a toddler’s eye level. Here’s what the evidence says and how to use it safely.

Why sanitizer and small children don’t mix

Most hand sanitizers are 60% alcohol or more. That’s what makes them work, and it’s also what makes them dangerous to swallow. Health Canada’s advice for families is built around accidental swallowing: it says sanitizer should be stored away from, and out of sight of, children under six, and used only with an adult watching.

Small children are more vulnerable than adults for simple reasons: they weigh less, so a mouthful is a much bigger dose for their size, and they put everything in their mouths. Scented or brightly coloured gels, and pouches or bottles that look like juice or candy, make that more likely. Health Canada specifically warns against sanitizers in squeeze pouches or containers that resemble food or drinks.

How often it happens

We couldn’t find recent Canadian figures just for hand sanitizer, but the overall picture is clear. Health Canada reports that poison centres handled more than 215,000 cases in 2020, and more than a third involved a child aged five or under.

The best detailed data come from the United States. A 2017 report from the Centers for Disease Control and Prevention (CDC) counted more than 70,000 hand-sanitizer exposures in children aged 12 and under reported to US poison centres from 2011 to 2014. About 91% involved children five or younger, and almost all of those were swallowed. Most children had no symptoms or only mild ones such as vomiting, but a few had serious effects, including low blood sugar, seizures and coma. No deaths were reported.

The same report found a second pattern in older children, aged 6 to 12: a larger share of their exposures were intentional, and exposures in that group dropped in the summer, which the authors linked to school-year use.

The eye risk nobody expected

During the pandemic, sanitizer dispensers appeared at the doors of every store and mall, and a new problem showed up. A study in JAMA Ophthalmology looked at children’s eye exposures reported to French poison centres. From April to August 2020, sanitizer accounted for 9.9% of chemical eye splashes in children, up from 1.3% in the same months of 2019.

Why? The researchers pointed to dispenser height. Most automatic and pump dispensers sit about one metre off the ground, which is right at a small child’s face. Of the 16 children admitted to a Paris eye hospital in 2020, eight had ulcers on the surface of the eye, and two needed surgery.

So: help your child use public dispensers, pump it into their hands yourself, and teach them never to lean in under the nozzle.

Soap and water first

Sanitizer is the backup, not the first choice. Health Canada says washing with soap and water for at least 20 seconds is the preferred way to clean hands, with an alcohol-based sanitizer when a sink isn’t available.

The CDC adds that sanitizer works less well on hands that are visibly dirty or greasy, doesn’t remove all germs (norovirus, a common cause of stomach bugs, is one example), and doesn’t remove chemicals. After outdoor play, before eating and after using the toilet, a sink is better.

For kids, handwashing also has a practical bonus: there’s nothing to swallow. If your child’s hands get dry and sore from frequent washing, a plain, fragrance-free moisturizer afterwards helps. You can see hand care products for options.

Using sanitizer safely at home and at school

If you use sanitizer with children, these habits cover most of the risk:

• Store it high up and out of sight, like any medicine or cleaning product.
• Apply it yourself for young children: a small amount in their palms, then help them rub it over all surfaces of both hands.
• Rub until completely dry. The CDC says this takes about 20 seconds, and hands shouldn’t be wiped or rinsed before the sanitizer dries. A dry hand is also less likely to transfer sanitizer to the mouth or eyes.
• Skip products that look or smell like food or candy.
• Check the label. Health Canada says children should not use sanitizers made with technical-grade ethanol, and the label will tell you which kind of alcohol a product contains.
• If your child takes sanitizer to school, send a small container that doesn’t look like a snack, and talk with them about what it’s for and why it isn’t to be tasted or played with.

The CDC also asks caregivers to supervise young children using sanitizer, especially in schools and child care, to prevent swallowing.

What about alcohol-free sanitizers?

Alcohol-free sanitizers take away the main hazard in a swallowing accident, which is the alcohol. But they still contain active ingredients that aren’t meant to be swallowed, and the CDC recommends sanitizers with at least 60% alcohol for killing germs. We compare the two in more detail in a separate article. Whatever type you choose, the storage and supervision rules are the same.

If something goes wrong

• Swallowed: call a poison centre right away, even if your child seems fine. In Canada, 1-844-POISON-X (1-844-764-7669) connects you to your local poison centre 24 hours a day. In Quebec, call the Centre antipoison du Québec at 1-800-463-5060.
• Splashed in the eye: rinse gently with plenty of lukewarm running water for several minutes, then call a poison centre. See a doctor if pain, redness or tearing continues.
• Drowsy, hard to wake, having a seizure or struggling to breathe: call 911.

The main points: sanitizer is useful, but for young children it belongs up high and out of sight, it’s applied by an adult, and a sink comes first whenever there is one. Watch out for public dispensers at face height, and keep the poison centre number where you can find it fast.