Q: My family used a lot of hand sanitizer during the pandemic. Is there something harmful in it?
A: Washing your 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 a hand sanitizer containing at least 60% alcohol. However, swallowing hand sanitizer can cause poisoning in children, so be careful.
The American Academy of Pediatrics urges parents to keep hand sanitizers out of the reach of children. Don’t forget the travel-size disinfectant bottles in purses, diaper bags, backpacks and cars. Parents and caregivers should also supervise children 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, hypoglycemia, seizures and coma and can be fatal.
Children and adults have also been poisoned after using a hand sanitizer containing methanol (also called wood alcohol, methyl alcohol or methylated spirits). The United States Food and Drug Administration has issued recalls of 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 alert also warns of products containing methanol and / or 1-propanol, another form of alcohol that should not be used in hand sanitizers.
Because families have started purchasing more hand sanitizer during the COVID-19 pandemic, the National Poison Data System has received numerous other reports of worrying exposures in children. Many are aimed at children 5 and under.
Health experts recommend using a hand sanitizer containing 60% to 95% alcohol to kill the virus that causes COVID-19. Alcohol consumption generally contains 5 to 40% alcohol. The FDA has started letting companies that don’t normally produce hand sanitizer make and sell it during the pandemic. Before buying or using any hand sanitizer, make sure it has a label listing the ingredients, warnings, and precautions. Also, it’s a good idea to check the list of what not to use at www.fda.gov/handsanitizerlist.
To reduce the risk of injury from children who drink hand sanitizers, manufacturers should add ingredients to make them taste bitter. This important step helps prevent children from eating the product. However, the FDA has been alerted that some young people have tried drinking hand sanitizers from distilleries that failed to make them taste bad.
You can look for bitter ingredients such as denatonium benzoate (Bitrex); sucrose octaacetate; or butanol (also called tert-butyl alcohol). Today’s denatured hand sanitizers taste bitter, but you should get rid of all the old bottles of “denatured alcohol,” which may contain toxic methanol.
Be especially careful with isopropyl alcohol (isopropanol) hand sanitizers around children. These can be more toxic than those made with ethanol or ethyl alcohol.
Do-it-yourself hand sanitizer recipes, which are widely available on the internet, may not be the best option for families. The FDA warns that if it is manufactured incorrectly, hand sanitizer may not work. Skin burns from homemade hand sanitizer have also been reported. Call 911 immediately if your child has collapsed, has a seizure, has difficulty breathing, or cannot wake up after using or swallowing hand sanitizers. Alternatively, you can reach your regional poison control center by dialing 1-800-222-1222.
If you are concerned about the risk of poisoning in your child, talk to your pediatrician. Your regional pediatric environmental health specialty unit also has staff who can discuss their concerns about the safety of hand sanitizers with parents.
Dr. Kevin C. Osterhoudt is the Medical Director of the Poison Control Center at the Children’s Hospital of Philadelphia.