The ABCs of Handwashing

It's National Handwashing Month and the holidays are quickly approaching, meaning children will be taking a break from school to spend extra time with loved ones. To keep everyone safe and healthy, we spoke with an infection disease expert from Boston Children's Hospital to learn more about how to help kids wash their hands and prevent the spread of COVID-19.

Dr. John Brownstein is the Chief Innovation Officer at Boston Children’s Hospital and a trained epidemiologist, specializing in developing methods and data sources in public health informatics for surveillance systems and statistical modeling to improve disease control and prevention. In addition to his role as CIO of Boston Children's, he is also a pediatric medicine professor at Harvard Medical School, a director of Boston Children's Hospital's computational epidemiology group and an ABC News medical contributor.

Can you provide the latest knowledge around COVID-19 in children? In what ways do COVID-19 symptoms present differently in children? What should parents look out for and when should they seek medical attention?

The role of children in the spread of COVID-19 is still not fully clear. Studies have provided a range of evidence, from children spreading the virus similarly to adults to having a much smaller role in community transmission. Nonetheless, children are susceptible to the virus and in a small number of cases can suffer serious outcomes. For those that do experience disease, the symptoms will present similarly to adults (fever, chills, shortness of breath, loss of taste and smell). However, parents must remember that we are in the height of respiratory virus season and many infections may represent other viruses, such as rhinovirus, RSV and influenza. When in doubt, the best course of action if your child has symptoms overlapping with those of COVID-19 is to hold off on in-person learning and speak to your child’s pediatrician about next steps. It is likely they will advise some combination of quarantine and testing to be certain.

What tips and tricks would you give to children to wash their hands?

Washing your hands is one of the best ways to prevent the spread of germs. It’s important that you wash your hands with soap and water for at least 20 seconds. To help kids wash their hands for long enough, you can tell them to sing “Happy Birthday” or the “ABC’s” twice while they wash. It’s also imperative that you wash all parts of your hands, including in between fingers, under the fingernails, your palms and the backs of your hands. It is especially important to wash your hands after contacting high-touch surfaces, before and after touching your mask, when your hands are visibly dirty, after coughing or sneezing, and before eating or touching your face.

Which is better - hand washing or hand sanitizing? Can you speak to the differences in techniques?

Washing hands with soap and water for at least 20 seconds is the best option but if it isn’t readily available or time is limited, then using hand sanitizer with at least 60% alcohol is acceptable. When used correctly, hand sanitizer can kill the virus that causes COVID-19, however it cannot kill all germs. Hand sanitizer also isn’t as effective when hands are visibly dirty.  

With some children back at school, what do you think a PCP can advise as a realistic approach to hand washing? How many times a day should kids wash their hands?

Time should be built into kids’ daily routines for handwashing. While there’s no specific number of times a day that kids should wash their hands, PCPs should advise handwashing especially at key times during the day such as after bathroom breaks, before lunch, or after playing outside. Children should be taught the proper method for washing hands and where soap and water isn’t readily available, they should be encouraged to use hand sanitizer, which should be made available in classrooms and throughout the school.

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