Hand washing: how the skill grows from 15 to 36 months
Hand washing means washing hands with water and soap, rubbing, rinsing and drying. It is a short daily routine that toddlers can take over one step at a time, starting with holding their hands out.
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Hand washing: the ladder, step by step
Pick the step that looks most like your child today. The next step and activities that practise it appear below.
No step picked yet. There is no wrong answer: pick the closest one.
Next step: Rubs with you. Rubs palms together while you hold their hands under the tap.
Activities that fit this step
- Step-Stool Hand-Wash Song · 16–28 months · 2–5 min
- Pour-and-Rub Garden Hand-Wash · 20–32 months · 5–10 min
- Brush and Hands Wash-Up · 20–36 months · 3–8 min
Next step: Does part of it. Wets, rubs and rinses, with you helping with soap and drying.
Activities that fit this step
- Step-Stool Hand-Wash Song · 16–28 months · 2–5 min
- Pour-and-Rub Garden Hand-Wash · 20–32 months · 5–10 min
- Brush and Hands Wash-Up · 20–36 months · 3–8 min
Next step: Does it with reminders. Goes through wet, soap, rub, rinse and dry when you name each step.
Activities that fit this step
- Pour-and-Rub Garden Hand-Wash · 20–32 months · 5–10 min
- Brush and Hands Wash-Up · 20–36 months · 3–8 min
- Flush, Wash, Pants Up · 20–36 months · 3–6 min
Next step: Starts it alone. Heads to the sink before a meal or after the garden without being asked.
Activities that fit this step
- Brush and Hands Wash-Up · 20–36 months · 3–8 min
- Flush, Wash, Pants Up · 20–36 months · 3–6 min
- Hand-Wash Picture Steps · 24–36 months · 2–5 min
Top of the ladder (starts it alone). Keep it flexible: offer it in a new place, with a different person or with new materials.
Activities that fit this step
- Brush and Hands Wash-Up · 20–36 months · 3–8 min
- Flush, Wash, Pants Up · 20–36 months · 3–6 min
- Hand-Wash Picture Steps · 24–36 months · 2–5 min
The hand washing ladder
5 steps from the first sign to a flexible skill, covered here from 15 to 36 months. Children move at their own pace: use the steps to see what comes next, not as deadlines.
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Holds hands out
Stretches both hands toward the water when you say "wash hands".
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Rubs with you
Rubs palms together while you hold their hands under the tap.
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Does part of it
Wets, rubs and rinses, with you helping with soap and drying.
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Does it with reminders
Goes through wet, soap, rub, rinse and dry when you name each step.
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Starts it alone
Heads to the sink before a meal or after the garden without being asked.
When hand washing usually shows up
Holding hands out for you to wash them is a CDC 18-month milestone. Doing more of the routine, with help for the soap pump, the tap and the backs of the hands, usually builds over the third year.
This page follows hand washing from 15 to 36 months, a window that spans the 15-month, 18-month, 24-month, 30-month and 36-month CDC checklists.
In the library, 5 activities practise hand washing (4 as their main skill), for ages 16 to 36 months. One of them needs no prep and takes 10 minutes or less. By age, they sit closest to steps 2, 3 and 4 of the 5-step ladder, most (3) on “Does part of it”.
Related items appear on the CDC checklists for 18 months.
Related milestones
CDC checklist items (paraphrased) that involve hand washing. Checklists are for monitoring, not a test.
| Checklist | Milestone |
|---|---|
| 18 months | Holds out their hands so you can wash them. |
Activities that practise hand washing
Placed on the closest ladder step by age. By primary domain: 5 practical life. Quickest to start: Hand-Wash Picture Steps (2–5 minutes).
Step 2: Rubs with you
Step 3: Does part of it
Step 4: Does it with reminders
Skills practised alongside
The activities for hand washing most often also work on following two-step directions (1), helping with dressing (1), imitating actions (1), pointing to pictures (1) and potty awareness (1). Pairing them keeps practice playful: one activity, several skills.
Practise it inside everyday routines
- Wash hands at the same moments every day: before meals, after diaper changes or the toilet, after outdoor play.
- Sing one short rubbing song so your child knows how long to keep going.
- Set up a stable step stool and a towel hung at child height.
What to avoid
- Hot water from the tap; test the temperature on your wrist and keep the hot tap out of reach.
When to mention it to the pediatrician
Hand washing is a learned routine rather than a skill to test. If by 18 months your child will not hold their hands out to be washed, or reacts with strong distress to water and touch every time, mention it to the pediatrician.
Worried about hand washing between visits? Call the pediatrician; CDC's free resources also explain how to contact your local Early Intervention program directly. Milestones are for monitoring, not diagnosis.
Frequently asked questions
When do toddlers start hand washing?
Holding hands out for you to wash them is a CDC 18-month milestone. Doing more of the routine, with help for the soap pump, the tap and the backs of the hands, usually builds over the third year. The first step to look for: stretches both hands toward the water when you say "wash hands".
How can I help my toddler with hand washing?
Wash hands at the same moments every day: before meals, after diaper changes or the toilet, after outdoor play. Sing one short rubbing song so your child knows how long to keep going. A good first activity is Step-Stool Hand-Wash Song (16–28 months).
What should I avoid when practising hand washing?
Hot water from the tap; test the temperature on your wrist and keep the hot tap out of reach.
When should I mention hand washing to the pediatrician?
Hand washing is a learned routine rather than a skill to test. If by 18 months your child will not hold their hands out to be washed, or reacts with strong distress to water and touch every time, mention it to the pediatrician. You can also contact Early Intervention yourself.
Related
Monitoring, not medical advice. Talk to your pediatrician about any concern. Our sources and method.