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Angela Oswalt Morelli , MSW, edited by Mark Dombeck, Ph.D.

After dental hygiene, thorough and careful hand-washing is perhaps the second most important personal hygiene habits children need to practice in middle childhood. By this age, children will almost certainly have learned that they are supposed to wash their hands regularly. However, they will often forget to do this because they are distracted, or because they don't really understand the connections between washing, soap germs and disease.

girl washing handsAccordingly, many kids will still need to be reminded to wash their hands before meals, after playing outside or with pets, after using the bathroom and after they have sneezed or blown their noses or coughed. As well, their hand-washing efforts should be monitored, as they may otherwise rush the process (e.g, by skipping the soap or hot water, or barely wetting their hands before declaring them "clean"). Children should be washing their hands thoroughly with soap and warm water, being careful to clean under and around their fingernails. The washing procedure should last at least 15 seconds so as to thoroughly remove soil and germs.

Children should be taught to use waterless antibacterial hand sanitizer to kill germs when they are unable to get to a hand-washing station. Sanitizer products are useful for reducing risks associated with the spread of disease but they are not a substitute for soap and water when dirt or soil is visible on children's hands. When used, sanitizer should be rubbed into hands for at least 15 seconds.

Coughing and Sneezing

Children should be educated about the nature of germs, including bacteria and viruses that cause illness, and how these invisible but very real germs can contagiously spread through the air when people cough or sneeze. This information helps children understand why it is so important that they cover their mouths or noses before coughing or sneezing.

Children should be taught to blow their noses into disposable tissues, and to sneeze or cough into tissues or napkins whenever possible so as to minimize infection risk. If they cannot locate a tissue in time, they should at the very least try to cough or sneeze in a direction away from where other people are located.

People cover their mouths and noses while coughing and sneezing for reasons of social attractiveness as well as hygiene. Younger children may not appreciate the importance of not offending others in this manner as they are less socially aware than older children. However, at some point during middle childhood, children will likely start to care deeply about how they are perceived by others and will become more influenced by socially driven emotions like shame. Parents will need to use their judgment in deciding when appealing to their children's developing sense of shame will be useful as a means of suppressing their habit of open coughing and sneezing.