Q: My family has used a lot of hand sanitizer during the pandemic. Is there anything harmful in it?
A: Washing hands with soap and clean water for at least 20 seconds is the best way for children to get rid of germs, including COVID-19. If soap and water are not available, children can use hand sanitizer with at least 60% alcohol. However, ingesting hand sanitizer can cause poisoning in children, so be careful with it.
The American Academy of Pediatrics urges parents to keep hand sanitizers out of the reach of children. Don’t forget the travel-sized bottles of sanitizer in purses, diaper bags, backpacks, and cars. Parents and guardians should also supervise children aged 5 and under when using hand sanitizer.
Many hand sanitizers are made with alcohol or rubbing alcohol (ethanol, ethyl alcohol or isopropanol, isopropyl alcohol). Symptoms of alcohol poisoning include loss of balance, drowsiness, low blood sugar, seizures and coma and it can be fatal.
Children and adults have also been poisoned after using hand sanitizer containing methanol (also called wood alcohol, methyl alcohol, or methylated spirits). The US Food and Drug Administration has issued recalls for products containing methanol, which is toxic if swallowed or after repeated use on the skin. It can cause problems ranging from nausea and headaches to blindness, nervous system damage, or death. An FDA import warning also warns against products containing methanol and/or 1-propanol, another form of alcohol that should not be used in hand sanitizers.
As families have started to purchase more hand sanitizer during the COVID-19 pandemic, the National Poison Data System has seen many more reports of exposure to children. Many are for children aged 5 and under.
Health experts recommend using 60% to 95% alcohol hand sanitizer to kill the virus that causes COVID-19. Drinking alcohol usually has 5% to 40% alcohol. The FDA started letting companies that don’t normally manufacture hand sanitizer make and sell it during the pandemic. Before you buy or use hand sanitizer, make sure it has a label with the ingredients, warnings, and precautions. In addition, it is a good idea to consult the list of non-uses at www.fda.gov/handsanitizerlist.
To reduce the risk of injury from children drinking hand sanitizers, manufacturers must add ingredients to make them taste bitter. This important step will help prevent children from eating the product. However, the FDA has pointed out that some young people have tried drinking hand sanitizers that come from distilleries that haven’t taken the step of making them taste bad.
You can check for bitter ingredients such as denatonium benzoate (Bitrex); sucrose octaacetate; or butanol (also called tert-butyl alcohol). Current denatured hand sanitizers are made to taste bitter, but you should dispose of any old bottles of “denatured alcohol” that have toxic methanol added to them.
Be especially careful with hand sanitizers made with isopropyl alcohol (isopropanol) around children. These can be more toxic than those made with ethanol or ethyl alcohol.
Make your own hand sanitizer recipes, which are available all over the internet, may not be the best option for families. The FDA warns that hand sanitizer may not work if made incorrectly. There have also been reports of skin burns from homemade hand sanitizers. Call 911 immediately if your child has a breakdown, has a seizure, has trouble breathing, or can’t wake up after using or swallowing hand sanitizers. Otherwise, you can reach your regional poison control center by calling 1-800-222-1222.
If you are concerned about your child’s risk of poisoning, talk to your pediatrician. Your regional specialty unit for pediatric environmental health also has staff who can talk to parents about concerns about the safety of hand sanitizers.
dr. Kevin C. Osterhoudt is the medical director of The Poison Control Center at the Children’s Hospital of Philadelphia.
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