Hand Washing for Health
By Dr. Bettye M. Caldwell
The work involved in keeping our children healthy is divided between the parents and the children themselves. During the first year or so of life, the responsibility falls mainly on the parents. They have to arrange for their children to have regular medical check-ups, get all the necessary immunizations and receive prompt attention when they are sick. Young children simply can't avail themselves of such services without parental action. Furthermore, they don't have to learn a pattern of behavior in order for those things to happen; they just have to go along and receive the services.

Of course, in addition to seeing to it that necessary health services are provided, parents have to maintain constant vigil to make certain their children remain safe. They have to keep small objects that can be swallowed out of reach, watch very carefully whenever children are in or near water, keep little hands out of fecal matter, etc.

Very quickly, however, parents and children begin to share responsibility for maintaining health. The parental role changes from providing services and monitoring safety to instilling behavior traits that allow their children to take increasing responsibility for staying safe and healthy. It isn't an easy part of parenting, and it doesn't happen all at once. In fact, you'll still be working at it when your kids are grown (or think they are) and want to climb mountains or ride motorcycles.

The Most Essential Habit: Hand washing
Once they are toddlers and become mobile, children have to assume more responsibility for keeping themselves healthy. This requires them to develop and strengthen habits that are essential to personal health. As soon as they can manage we start teaching them to brush their teeth, to chew food thoroughly before swallowing, to refrain from running into the street and not to put small objects in their mouths, all of which are absolutely essential health and safety habits.

We know that if they don't develop those habits during early childhood, they will acquire them only with great difficulty in later years. But I don't think we put enough emphasis on the habit that just may be the most crucial one for staying healthy—washing hands.

Hand washing is such a humble, everyday act it may not seem to merit designation as a major technique for preventing illness and keeping children healthy. Yet there is hardly anything more important for children to learn than to wash their hands frequently and thoroughly. Parents can't just tell them to do it once and expect them to remember; it has to become a second-nature routine.

I became aware of the importance of this habit during the years when I was either directing a childcare center or training personnel to assume that role. Minimizing illness in childcare is a big challenge. The two biggest challenges are not rare or unusual diseases; they are colds and diarrhea. Although it doesn't happen often in high-quality programs, sometimes every child in the place will have a runny nose or a productive cough. And when mucous runs down the upper lip of a toddler, pre-tissue children will usually swipe at it and leave a residual on their hands. Similarly, if a runny stool escapes a diaper, a young child will often put his or her hands in it. Those hands have to be washed, and washed thoroughly.

Not only do the children's hands have to be washed. So do those of the adults who care for them. Rigid guidelines are now in place in most states that require childcare staff to wear plastic gloves while changing and disposing of soiled diapers, then to wash their hands in hot soapy water for 10 seconds, and to turn off the faucet with either a foot pedal or with a paper towel in their hands. Such meticulous attention to hand washing has helped cut down the spread of viruses and infections in childcare settings.

Hand-washing at Home
It is equally important for parents to follow a similar routine at home, and to begin training their children to do this with decreasing amounts of help as they get older.

Let's say your baby has two or three siblings who are already in school. They are going to be exposed to all sorts of viruses and bacteria and will be bringing residuals home—if they don't already have the hand-washing habit. So start early, and stay with each of your children until they become dedicated hand-washers.

A wonderful pediatrician in Philadelphia, Dr. Susan Aronson, has written and spoken extensively on this topic. She recommends letting children stand at the basin (use a stool if necessary) and running the water on their hands a few seconds. Then apply enough liquid soap to work up a good lather and let them (or help them) rub their hands together for a full 10 seconds. Then, with the fingers pointing down so that loosened germs will come off the skin, run the water over the hands to rinse them thoroughly. Dry them on a reasonably germ-free towel before the child is allowed to handle toys or furniture. And don't worry about a protest from your child. The child never lived who didn't love playing in water! Then make sure you go through the same routine yourself.

Finally, a personal note from me. I am so convinced of the importance of hand washing that I now routinely carry a small bottle of hand sanitizer in my purse and always use it when I go out to lunch or dinner. (Just think about how many car door handles, elevator buttons, stair rails and shared menus you have touched before the waiter brings the dinner rolls.) Friends might consider me a compulsive hand-washer, but I almost never have a cold!