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Children Are Consuming Hand Sanitizer. Here’s How to Keep Them Safe.

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Alcohol-based hand sanitizer became a must-have item during the pandemic. But as sales jumped and families stocked up, poison control centers started getting more calls about little children who had accidentally ingested it.

Even now, about a year after the frenzy to stock up on sanitizer first began, hand sanitizer remains within easy reach in many homes, and calls to the nation’s poison control centers are on pace to continue trending higher than before the pandemic.

Last year, there were more than 20,000 exposures to hand sanitizer among children under 6, an increase of 40 percent from 2019, according to data from the American Association of Poison Control Centers that was obtained by The New York Times.

Most of these exposures involved children 2 and younger who had ingested the sanitizer. In many cases, no symptoms were recorded, which means that the child might have only taken a brief taste or lick, something that will not typically cause significant health effects, said Dr. Justin Arnold, the medical director of Florida Poison Information Center Tampa. But in other instances, children experienced vomiting, cough and mouth irritation.

Even though most cases are mild, by storing sanitizer properly and supervising young kids while they use it, parents can avoid the stress of having to call poison control or taking an unnecessary trip to the emergency room.

The uptick in exposures has continued in recent months. In January, for example, there were nearly 34 percent more hand sanitizer exposures reported among children under 6 than there were the year before.

Exposure to household cleaners like liquid laundry detergent packets, bleach, all-purpose cleaners, drain cleaners and oven cleaners also increased, rising by 10 percent among children under 6 during the first few months of the pandemic, according to a report released in August by the American Association of Poison Control Centers.

But when it comes to hand sanitizer, something we regularly reach for when we’re outside and slather all over our hands, it’s easy to let your guard down, experts said. Especially because hand sanitizer does not come with a child-resistant closure.

“People don’t recognize how toxic it is if ingested, what the effects are and what they need to do for safe storage,” said William Eggleston, a clinical toxicologist at the Upstate New York Poison Center in Syracuse, N.Y., and an assistant professor at the Binghamton University School of Pharmacy.

It depends how much is swallowed.

If children ingest enough alcohol-based hand sanitizer, they can get “dangerously drunk,” said Dr. Diane Calello, a pediatric toxicologist and the executive and medical director of the New Jersey Poison Center.

Last spring, Dr. Calello co-authored a Centers for Disease Control and Prevention report about the rise in calls to poison centers that warned parents to keep hand sanitizers, cleaners and disinfectants away from kids. The report highlighted the case of a preschooler who was found unresponsive at her home near a 64-ounce bottle of ethanol-based hand sanitizer. Her blood alcohol level was at .27 percent, more than three times the federal legal limit over which an adult is not permitted to drive.

Hand sanitizer is 60 to 95 percent alcohol, a much stronger concentration than you would find in beer, wine or most hard liquors. A child weighing 20 pounds who drank a tablespoon or two could become intoxicated, Dr. Calello said, and appear “a little drunk.”

“As a dose gets higher they can get very sleepy and have trouble breathing, just as we see with severe adult alcohol intoxication,” she added.

After drinking even a modest amount of alcohol, children are more likely than adults to experience a dangerous drop in blood sugar, which can make them lethargic starting about six to 10 hours after consumption, Dr. Calello said.

Ingesting sanitizer can also irritate the throat or stomach, especially if they are formulated with isopropyl alcohol, which is an ingredient often found in rubbing alcohol, the experts said.

Keep all hand sanitizers out of children’s reach — and also out of sight, even if all you have is a small bottle that you keep tucked away in a handbag or a backpack.

“It’s important for parents to treat it like medications in the household,” Dr. Eggleston said.

You may be wondering if your family ought to avoid hand sanitizer entirely. While washing your hands is the most effective way to get rid of germs, the C.D.C. still recommends using hand sanitizer with at least 60 percent alcohol to help prevent the spread of the coronavirus if soap and water aren’t readily available.

If you have children under 6 at home, supervise them while they’re using it, Dr. Arnold said.

“You don’t want the child to pump their own and start to taste it,” he added.

There was a spike in calls to U.S. poison control centers in July and August after the Food and Drug Administration warned of hand sanitizers that may contain methanol, which can be toxic if ingested. Hand sanitizers should never contain methanol.

“You can die from drinking methanol — and people do,” Dr. Calello said.

The absorption of methanol in the skin, however, is “pretty minimal,” she added.

You can visit the F.D.A.’s website to search for the list of sanitizer products that should not be used (including several brands imported from Mexico that contain methanol). If you discover that you have one of these products in your home, the F.D.A. advises putting the hand sanitizer bottle in a hazardous waste container, if available, and seeking guidance from your local waste management center about the safest way to dispose of it. Do not flush or pour it down the drain or mix it with other liquids.

If your child swallowed hand sanitizer, don’t try to induce vomiting, the experts said. Call poison control at 1-800-222-1222 so that you can get quick guidance on the best course of action.

If your child is unconscious, acting abnormal, is difficult to wake up or has trouble breathing, call 911.

“Fortunately, the milder cases are much more common,” Dr. Calello said. “More likely we’re going to say, ‘Stay home, watch him, I’m going to call you back in an hour or half-hour.’ We keep a lot of people out of hospital that way, by providing them with real-time phone guidance.”

You should also call poison control if your child gets hand sanitizer in their eyes. In the United States, there were about 900 reports of ocular exposure in children under 6 in 2020, an increase of 54 percent from 2019. A recent JAMA Ophthalmology study out of France that reviewed data from poison control centers there found that eye-related hand sanitizer exposures in children increased sevenfold in 2020 compared to 2019, and an increase in surgeries required to manage the resulting chemical injuries.

“In an emergency, any clean liquid can be used to irrigate the eye following chemical exposure,” Dr. Kathryn Colby, an ophthalmologist at the New York University Grossman School of Medicine, wrote in a commentary published in JAMA Ophthalmology last month. “Finally,” she added, “parents need to understand the importance of an eye examination if any exposure occurs in children,” because early diagnosis and treatment is crucial.

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