Disease burden due to unsafe water, lack of sanitation, and poor hygiene behavior requires attention. In developing countries, poor school hygiene behavior remains high-risk and causes infectious disease among students. Safe hygiene behavior such as hand washing with soap can protect children from infectious disease. However, a cross-sectional study found the correct rate of hand washing of Chinese people was only 4%. Our research evaluated the knowledge, attitudes, and practices (KAP) of sanitation and hygiene among school children in the rural area of Northeast China. Participants were 333 groups of students and their parents. A questionnaire was used in the participants who reported the score of KAP level of sanitation and hygiene. Hand washing skill was checked following a checklist. Observation of sanitation facilities at school was also conducted. The questionnaires included participant characteristic, household socioeconomic status, and KAP questionnaire. The results of the questionnaires survey showed more than 80% of students had adequate knowledge of proper hygiene. Although students have sufficient knowledge about hygiene, lack of facilities may negatively affect their practice. There was no soap available in 2 schools, 53% of students reported it affects their hand washing performance at school. The results indicated the impact of gender, facilities and knowledge level on behavior. Our findings underscore the need for more hygiene education and the improvement of sanitation and hygiene facilities in the area.