Sunblocked? Keeping Kids Safer in the Sun

Summertime. Time was when a child could run around for days on end in a bathing suit, carefree in pursuit of new adventures while being sunkissed dark by the sun. Well…maybe that isn’t such a hot idea, so to speak, after all.

 Those cute freckles splashed across your kids’ cheeks? Sign of mild sun damage, actually.  Doesn’t your child’s getting a “base tan” protect him from ultraviolet (UV) rays? Not nearly enough. Don’t sunblocks cause cancer, and mess up your toddler’s all important vitamin D intake? Heck, no (and more on that in a bit).  What to do for newborns, or babies? Sombreros or parasols? Not exactly. Turns out, all of us parents would do well to rethink how we go about our fun in the sun. Forecast: not so dismal.

The ultraviolet rays that hit the earth, to tan or burn our skins, and potentially damage our tissues arrive here in two types, UVA and UVB. Many sunscreen products greatly reduce UVB ray penetration to the skin, and are rated by the well known SPF (sun protection factor) by many sunscreens on the market. UVA rays are less familiar to most people, but are no less harmful. UVA rays are not stopped as effectively by many sunscreens in use, and unlike UVB, they can pass through glass.   Over a lifetime, there is a cumulative dose effect here: the more UV rays our skin absorbs over time, the more likely (and more quickly) that we’ll suffer long term problems, including wrinkles, age spots, and skin cancers like melanoma.

Consequently, the more we work to protect ourselves, and our children, from the effects of sunlight and both forms of UV radiation, the better. We can prolong or prevent our hitting our solar ‘limit’; cancer isn’t inevitable. Sun protection is a really good idea

Unfortunately, we Americans love our sun and don’t protect ourselves very well. In the US, most kids will have received up to 80% of their lifetime sun exposure (and thus, solar radiation) by the time they are 18.  (Evidently, the remaining 20% happens in adult life in hours outside our cubicles). In any year, about a third of US adults get sunburned, and about 2/3 of kids get sunburned each summer. 

Very clearly then, our biggest window of vulnerability occurs in our littlest and younger people who think about this least. Fashion and developmentally appropriate cluelessness create a troublesome irony here. It is the young’uns who often think its pretty cool to burn til they’re nut brown, to use tanning salons, and to crisp on the beach. If you cock your ear, just right, you can here dermatologists screaming at the very thought. So, what can you do for your kids? ?

Plenty.

(re)Apply yourself early and often.

Research in adult studies has shown that people consistently apply too little sunscreen.  Hey, the stuff is expensive, but people seem not to realize that it takes up to 2 oz of sunscreen to adequately cover an adult. For a school age child, figure at least half that much. While that still may seem like a bunch, it pays not to skimp. Putting on too little sunscreen effectively lowers the blocking or absorptive power of the product.

Following a backlash from the consumer protection authorities a couple of years ago, sunscreens are now labeled more accurately as ‘water resistant,’ than as waterproof (they ain’t).  Swimming, or even sweating during exercise or in hot weather can decrease the amount of sunscreen on a child’s skin.  Dermatologists recommend a generous application of screen at least 30 minutes before kids enter then sun to allow their absorption, and then reapplications at least every 2 hours. That is quite a lot. You may need to buy more tubes than you had intended for your next weekend at the beach.

Choose well.

I encourage parents choose sunscreens for their kids that protect against for UVA and UVB rays. Read labels. And, when picking by SPF, I recommend that parents use products rated at 30 or higher. In the words of Dr Stephen White, pediatrician-turned-dermatologist practicing in Besthesda, Maryland: “the higher the SPF, the better the protection. And, the more room you have to make mistakes.”

What about the health effects of sunscreen itself?

In weighing the risks of avoiding sunscreens versus taking your chances with no protection, the answer is straightforward. Lube up!  The use of sunscreen in older kids and adults, per the FDA, is safe.  However, for parents who may be concerned about absorption of chemical sun quenchers in some products, those with metal sunscreens—like zinc or titanitum oxide–are likely safest.  These sunscreens often temporarily color the skin (think of the clownwhite color of a lifeguard’s nose), but newer preparations tend to minimize that chalky appearance, and their tendency to stain clothing. 

As for the risk of cancer with sunscreen use, concerns arose several years ago for a potential cancer link for products containing PABA.  Update: PABA is no longer used. Problem solved. Dr White puts the sunscreen-causes-cancer myth to rest in a refreshingly plainspoken way: “all (these) urban rumors are just crap.”

In other quarters, there have been some who’ve become anxious that sunscreen use will hamper their children’s absorption of vitamin D.  Fortunately, research puts those fears to rest. The routine intake of vitamin D in kids’ diets, the use of dietary supplements when necessary, and even incidental exposure to sunlight more than offset the decrease of vitamin D metabolism in sunscreened skin.

For some children and adults, however, there are real issues of allergy or hypersenstivity to some of the ingredients in certain sunscreen preparations. As with trying any new food, medicine, or skin product, parents and caregivers should take note if reactions occur, say, if rashes erupt where sunscreen product is applied.  Kids over 12 months with bumpy or itchy rashes can take some Benadryl (consult your kids’ doc if you have questions on this); rare, and more serious cases or kids with an ill appearance should merit a trip to the clinic or ER.  

Sun protection for the youngest

It is in the littlest children for whom we may need to most radically rethink sun time.  I can recall full well myself waiting to head to the beach for the “P.T.H”, aka the peak tanning hours, as a teenager. In actual fact, this midday time was more likely to sear my skin with sun damage than to achieve that desired savage tan. (um, not that I ever got that savagely tan anyway…)  And, since then, pediatric and dermatologic societies have become ever stricter on what is recommended for the littlest children under the sun.

 Dr White bumperstickers the issue thusly: “I think children under 2 shouldn’t be out from 10 am to 3 pm  (or 9-4) unless completely protected from the sun.” Parents have to remember UV rays pierce clouds on sunny days, and can be reflected off water, pavement, or snow, making even shady areas less protected.  How bright is too bright? “So, if you can take a photo without a flash,” Dr White advises, “that’s too much sun.”

As a dad of three kids, I recognize that many families will find these guidelines a challenge. Folks will inevitably find themselves at a beach, barbecue or sunsplashed location with an infant in tow. In these cases, common sense and some basic approaches will help fend off sunburn and sun damage. First choice, is choosing a shady spot, and wearing comfortable, natural fiber clothing with a wide brim hat for the babes. Routine sunscreen use (again, spf 30 or higher!) is ok in kids over 6 months. For babies under six months, experts  considered sunscreen a less preferred, but useable option if it looks like other measures won’t cover it, so to speak.

Cooling off cases of sunburn

For the afflicted, sunburns hurt . For children and adults, the treatments are “supportive” (read that as meds plus TLC), using some tried and true first aid techniques. Peak redness usually occurs 6-12 hours after sun exposure. Discomfort can get pretty wicked, with the first wave of pain arriving usually the night of the exposure. It can last for up to a few days, so take care in picking up or hugging littluns with burnt shoulders. Ever had a whack on the sunburned back yourself?  Be kind, be gentle.

For pain, my first recommendation is to use non steroidal anti-inflammatory medications, such as ibuprofen, in children over 12 months.  Motrin is appropriate and effective. Cool moistened towels, or applications of aloe gel may also provide relief.  Topical anesthetic sprays may provide a few minutes of relief, but I encourage families to put their dollars and effort elsewhere.

If a child appears inconsolable with these comfort measures, or if a sun exposed area shows more significant injury, such as blistering, I advise worried parents to check in with their doctor’s office. Fortunately, these miserable times are rarely life threatening. They sure are a bummer, however, and are best avoided.

So then, all this skin saving behavior may have its benefits. Short term? By picking your time to hit the beach at the ends of the day—earlier in the morning or later in the day—there’ll be untold advantage in getting a sweet parking spot, or just the right perch along the sands. And, in the long run, we’ll help our kids keep that skin they’re in, possibly getting another 120 years out of it or so in the bargain.

Happy summer. Oh, and probably time to re-apply the 30. Get to it!

 [surf here for a really nice link on the American Academy of Dermatology]

 photo above by addiesmom; cartoon below by me