Infants sun exposure

Sun-Safe Babies - The Skin Cancer Foundation

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Parents’ instinct is to protect their infants and toddlers from harm. Yet our experts report that too many babies are getting tans and sunburns. Here, we offer their simple tips to prevent damage to your child’s skin that could lead to skin cancer.

By FLETA N. BRAY, MD, KEYVAN NOURI, MD, and COLLEAGUES

Melissa Flesher, a mother of two young boys in Topeka, Kansas, knows firsthand how dangerous the sun can be. She remembers being sunburned as a child from daily summertime trips to the pool with friends. She also used tanning beds in high school and college. In 2010, when she was 36 years old and seven months pregnant, she was diagnosed with a stage I melanoma on the back of her thigh. Luckily her doctor caught it early, but it was a scary wakeup call. Now that Melissa and her husband, Ryan, have two boys who inherited the same fair skin she and Ryan have, she worries about keeping them protected.

Infants at Risk

She’s right to be concerned. Research shows that some babies are being exposed to the sun’s damaging ultraviolet (UV) rays in the first six months of life, when their skin is most vulnerable. When our research team at the University of Miami surveyed local parents about how well they were protecting their young children from the sun, the results were alarming. Many parents’ efforts were inconsistent. Worse, we found that as many as one-third of parents actively increased their infants’ sun exposure each day, believing mistakenly that it would build their babies’ tolerance to the sun’s rays. As a result, 12 percent of the parents reported that their babies’ skin had tanned before they were 6 months old, and 3 percent said their infants had been sunburned.

There is strong evidence that sun exposure and sunburns during childhood multiply the risk of one day developing skin cancer, including melanoma. While melanoma still rarely develops before age 20, incidence in children and teens is rising rapidly. The skin of all infants (not just those who have fair skin) is particularly vulnerable to sun damage. This is partly because they haven’t yet developed all the melanin — the natural skin pigment that provides some sun protection — that they will have when they get older.

How to Protect Your Baby

Because infants’ skin is so sensitive, it’s better in the first six months to shield them from the sun rather than use sunscreen. It’s especially important to avoid direct sun exposure and seek the shade during the sun’s hours of greatest intensity, between 10 AM and 4 PM. Keep to the shady side of the street on walks, and use the sun shield on your stroller.

It’s also best to dress your baby regularly in a brimmed hat and lightweight clothing that fully covers the arms and legs. Our research at the University of Miami found that while most parents (83 percent) try to keep infants under 6 months old in the shade, they are less likely to cover their baby consistently with hats (only 43 percent did), long-sleeved shirts and long pants (only 40 percent did). Sunglasses that filter out UV are also extremely important, since the melanin in babies’ eyes is still forming. (Many stores sell baby-sized versions with soft elastic straps to keep the glasses on.)

Car rides can lead to unintended sun exposure, too. While glass screens out most UVB rays, the chief cause of sunburn, UVA rays can penetrate windows. Like UVB rays, UVA rays damage DNA and can lead to skin cancer. By law, front windshields are treated to filter out most UVA, but side and rear windows generally aren’t. Consider buying a UV shield, which you can hang over any window that allows sunlight to reach the child’s car seat. Or, consider professional protective window film (but check local regulations for these). Otherwise, it’s best for your baby to wear sun-protective clothing in the car.

Start Sunscreen at 6 Months

Once your baby reaches 6 months of age, it’s time to introduce sunscreens. Choose a broad-spectrum, water-resistant sunscreen that offers a minimum sun protection factor (SPF) of 15. Look at the active ingredients; zinc oxide and titanium dioxide are good choices, because these physical filters don’t rely on absorption of chemicals and are less apt to cause a skin reaction. You may want to test sunscreen on the inside of your baby’s wrist. If the child has a little irritation, try another sunscreen. Continue to cover your baby with a hat and protective clothing. Use sunscreen on all exposed areas, such as the back of the hands, face, ears and neck. Apply sunscreen 30 minutes before going out and reapply it every two hours or more frequently if you take your baby into the pool or if he or she is sweating.

How to Protect Your Toddler

Toddlers are difficult to catch and hold still, so you may need to be creative with your sunscreen routine. Sunscreen in stick form works well for the face and hands, as toddlers are less likely to rub the product into their eyes. Spray sunscreens are popular, but take care to apply the sunscreen evenly and liberally over all exposed skin, and rather than spraying a baby’s face directly, spray the sunscreen into your hands and apply it by hand.

Also continue to seek shade, schedule outdoor playtime before 10 AM or after 4 PM and keep covering young children with hats, sunglasses and lightweight clothing that covers as much skin as possible. For added protection, look for special clothing marked with an ultraviolet protection factor (UPF) of 30 or more, which will allow only 1/30^th of the sun’s rays to reach the skin.

Melissa Flesher’s boys, Tyler and Dylan, took their hats off for the brief photo shoot.

Flesher is vigilant about protecting her boys Tyler, 5, and Dylan, 18 months. “I make it a point to try to keep us all out of the sun and in the shade, if at all possible,” she says. But it isn’t always easy. “Our first year of T-ball last year had 4-year-olds playing games at high noon in the full sun and heat. That was awful! I can’t bear the thought of them facing skin cancer as adults, like I did.” In those situations, sunscreen is your main option for protection beyond whatever uniform the team wears: Be sure to apply it half an hour before the game. Also, even if game schedules are unchangeable, it’s worth asking coaches if they can try to schedule practice times when the sun is not at its greatest intensity.

Flesher worries about when the boys aren’t in her care. They both attend the same day care, she says, “and the teachers have been pretty good about applying sunscreen to all of the children once or twice a day during the spring and summer. Both boys also have their own hats in their cubbies, and their teachers insist that they keep them on outside, sometimes to their dismay since not all the kids wear hats.” Both boys also store sunglasses in their classroom. “Tyler is usually pretty good about asking for and keeping on his ‘cool shades,’ but keeping sunglasses on a toddler is challenging,” she says.

Good Habits for Life

Flesher says she’s well aware how important it is to instill good sun protection habits from a young age. She’s concerned, though, about when Tyler goes to kindergarten next year. “I’ve heard stories about how difficult it is to get teachers in a public school with large class sizes to agree to put sunscreen on one ‘special’ child,” she says. However, you should liberally apply an SPF 30 or higher sunscreen before school, and you can check in with the teacher at reasonable intervals, providing gentle reminders about reapplication.

Flesher also worries that when the boys are old enough to decide for themselves when and if to put on sunscreen and protective clothing, they may choose not to do so. “I can only hope that what I’m teaching them now will be life lessons that they carry on, practice and teach to their own little ones.”

CHILDREN OF COLOR NEED PROTECTION, TOO

Babies and children of all skin colors need sun protection. While people who have dark skin tones develop far fewer skin cancers than those who have light skin tones, when they do develop skin cancers, they’re more likely to be diagnosed at a later stage and have worse outcomes. It’s also important to remember that infant and toddler skin has less of the melanin pigment that provides some sun protection for darker skin later.

Fleta N. Bray, MD, received her medical degree from the University of Miami Miller School of Medicine in May 2016 and plans to specialize in dermatology.

Keyvan Nouri, MD, is chief of dermatology services at Sylvester Comprehensive Cancer Center/University of Miami Hospital and Clinics and director of Mohs, dermatologic and laser surgery at the University of Miami Miller School of Medicine.

Additional contributors (medical students at the University of Miami): Sebastian Verne, Jessica Cervantes, Alexandra Balaban, Eric R. Bray and Brian J. Simmons

*This article was featured in The Skin Cancer Foundation Journal 2016

Sun Safety for Children and Babies | Patient Education

Melanoma is among the most common forms of cancer for young adults 15-29. Some experts blame the inappropriate use of sunscreen, saying that people do not apply enough lotion (a golf ball-size dollop) or do not reapply it as frequently as required. Products can no longer claim to be waterproof, only water-resistant, and labels must note a time limit of either 40 or 80 minutes before the sunscreen is ineffective.

Sunscreen is just one of the defenses against the harmful effect of UV radiation. Strategies such as seeking shade and dressing children in sun-protective clothing are just as important. A bad sunburn in childhood or adolescence doubles the risk of melanoma later in life, according to the Skin Cancer Foundation.

Rates of skin cancer—including melanoma, the most serious form of skin cancer—continue to rise, even in young people. Parents need to be extra vigilant about sun protection all the time. Just one blistering sunburn in childhood more than doubles a person's chances of developing melanoma later in life. Young skin is delicate, thinner, and produces less melanin, a skin protecting pigment. Ultra violet (UV) rays reach the skin’s pigment producing melanin cells, called melanocytes, and cause DNA damage to the skin.

Infants

0-6 months:

Infants under 6 months of age should be kept out of direct sunlight.
Avoid using sunscreen. Baby’s young skin doesn’t have the ability to metabolize and excrete chemicals often found in sunscreens.
Dress baby in lightweight sun—protective clothing that breathes and covers the arms and legs.
Always protect your baby’s head, face, ears, and neck with a wide-brimmed hat. A baby who wears a hat during the first few months will get used to having it on.
Use stroller shades and umbrellas.
Use removable mesh window shields to keep direct sunlight from coming in through the windows of your car or invest in UV window film, which can screen almost 100 % of ultraviolet radiation without reducing visibility.
Use sunglasses with UVA/UVB protection. Eyes are affected by exposure to the rays of UV radiation. Overexposure to UV light contributes to the development of cataracts, retinal damage and other eye problems. Experts report that as much as 80% of UV damage to our eyes is done before the age of 18, making it even more important all of us to start protecting our eyes at an early age.
Take walks early in the morning before 10 AM or after 4 PM and use a stroller with a sun—protective cover.

Babies

6-12 months:

It's now safe to use sunscreen on babies. Choose sunscreen designated for infant skin, and one that won't sting baby's eye.
All the protection methods explained above still apply, however now sunscreen use should be incorporated.
Apply broad-spectrum sunscreen with a minimum SPF of 30, with UVA/UVB protection particularly to areas left uncovered such as baby's hands. Some children experience allergic reactions to various sunscreen ingredients. Test a product first by applying a small amount to a limited area of skin. Choose a product that is hypoallergenic and fragrance-free.
Most importantly, sunscreen must be applied 30 minutes before going outside and reapplied every two hours or after swimming or excessive sweating. Products can no longer claim to be waterproof, only water-resistant, and labels must note a time limit of either 40 or 80 minutes before the sunscreen is ineffective.

Toddlers/Pre-School Age

Protecting toddlers from the sun requires a little more thought and effort. It is important to educate your child and caregivers.
All the protection methods explained above still apply, including how sunscreen use should be incorporated
Make sure your child seeks the shade between 10 AM and 4 PM. Check the outdoor area where your child plays to make sure there is adequate shade.
Make sure toddlers are covered. Long-sleeved, unbleached cotton clothing is cool and comfortable, while also highly protective. Clothing with an Ultraviolet Protection Factor (UPF) listing on the label offers extra security. The Skin Cancer Foundation recommends clothing with a UPF of 30 or higher.
Don't forget hats and sunglasses. Choose a wide—brimmed hat that protects face, neck, and ears.

Pigmentation

Whatever our skin color, we're all potentially susceptible to sunburn and other harmful effects of exposure to UV radiation. Although we all need to take precautions to protect our skin, people who need to be especially careful in the sun are those who have.

pale skin
blond, red, or light brown hair
been treated for skin cancer
a family member who's had skin cancer

Sunglasses

Children under age 10 are at a high risk for skin and eye damage from UVR. The skin on their eyelids and around their eyes is more delicate and vulnerable than adult skin. And until about age 10, the lens of a child's eye is clear, allowing greater solar penetration and thus greater UVR—induced ocular changes.

Retinal exposure to UVR is associated with cataracts and macular degeneration, both causes of vision impairment. UVR damage builds over time, so the sooner you start protecting your children's eyes from the sun, the lower their risk will be of ever developing future eye problems.

Fortunately, good sunglasses protect both the skin around the eye and the eye itself. While children under 6 months old should never be exposed to the sun, once they reach 6 months, they should wear sunglasses outside. If they require prescription glasses, they should also wear prescription sunglasses.

Keep these rules in mind when buying sunglasses for children:

Find glasses that block 99-100 percent of both UVA and UVB rays. Buy ones that indicate the percentage of UVR protection they provide. The more skin covered, the better, so look for large, wraparound styles.
Use playground-proof lenses. Kids run, trip, fall, and bounce off objects at alarming speed. Their sunglasses should match this active lifestyle. Find impact-resistant, scratch-proof lenses that don't pop out of the frames. Avoid glass lenses, unless recommended by a doctor; plastic is safer. Frames should be bendable but unbreakable. Make sure the glasses fit snugly, close to the face.

"Sun Protective” Clothing

Clothing is the single most effective form of sun protection. It is our first line of defense against the sun’s harmful ultraviolet rays.

Clothing made with sun-protective fabrics differs from typical summer fabrics in several ways. They typically have a tighter weave or knit and are usually darker in color. Sun-protective clothes have a label listing the garment's Ultraviolet Protection Factor (UPF) value. The UPF label will help you identify sun-protective garments. The number on the label indicates what fraction of the sun’s rays can penetrate the fabric. The higher the UPF, the higher the protection.

A fabric with the minimum recommended UPF rating of 20 allows 1/20th of the sun's UV radiation to pass through it. This means that this fabric will reduce your skin's UV radiation exposure by 20 times where it's protected by the fabric. The more intense the hue, the better the UV defense—dark or bright colors, like red or black, absorb more UVR than white.

What is SPF?

SPF, or Sun Protection Factor, is the amount of UV radiation required to cause sunburn on skin with the sunscreen on, relative to the amount required without the sunscreen. SPF protection doesn't increase proportionally. For example, SPF 2 absorbs 50% of UV radiation, SPF 15 absorbs 93%, and SPF 34 absorbs 97%.

What is UVA & UVB?

UVA and UVB refer to different kinds of ultraviolet radiation. Exposure to UVA and UVB can be harmful and cause cancer. Sunscreens protect from UVB rays, but not all sunscreen product screens out all UVA rays. Some may advertise UVA protection, but no criteria exist in the U.S. for measuring and labeling the amount of UVA defense a sunscreen provides yet.

What is Broad-spectrum protection?

“Broad-spectrum” indicates that a product shields against UVA and UVB. It does not guarantee protection against all UVA wavelengths, however. Most broad-spectrum sunscreens and sunblocks with an SPF of 30 or higher do a good job against UVB and short UVA rays. If they also contain avobenzone, zinc oxide, or titanium dioxide, they should be more effective against the entire UVA spectrum.

Tips on Applying Sunscreen

Water and perspiration reduce the SPF value of many sunscreens—even those that are water-resistant—so be sure to reapply the product often.
Sunscreen sprays may not work as well to prevent sunburn. The concern is twofold: that not enough sunscreen makes it onto the skin, and that the spray may be inhaled into the lungs.
If your baby is taking medication, ask your doctor or pharmacist if the medications increase your baby’s skin sensitivity to the sun or aggravate sunburns or rashes. Certain antibiotics, diuretics, antihistamines, and antidepressants are among the commonly used drugs that can increase sensitivity to the sun's rays.
Experts estimate that about half of the recommended amount of sunscreen is applied on their children. Read the product’s usage instructions to make sure you are using the proper amount.
Apply sunscreen at least 30 minutes before your child will be exposed to the sun.
Reapply sunscreen regularly and at least every 2 hours. Repeat application more often if your child is swimming or sweating.
Use sunscreen even if it is cloudy outside. Clouds don't absorb or block UV radiation.

Sun Exposure & Vitamin D

Some sunlight is good for you and is needed for bone health. It has been suggested by some vitamin D researchers that approximately 5 to 30 minutes of sun exposure at least twice a week to the face, arms, legs, or back without sunscreen usually lead to sufficient vitamin D. Individuals with limited sun exposure need to include good sources of vitamin D in their diet or take a supplement to achieve recommended levels of intake.

How much Sun is enough for your child? - Magazine

Bone health is essential for upright posture and stable walking. Only sunlight, more precisely, ultraviolet radiation, allows the children's skeleton to develop. Most of the bones of a newborn are made up of cartilage, which undergoes gradual ossification. Bone mineralization itself begins when children receive calcium and phosphorus from their diet: both trace elements are then incorporated into bone development under the influence of vitamin D.

Most foods contain only small amounts of vitamin D, although fish oils and oily fish contain quite a lot. But thanks to UV radiation, we can produce the necessary amount of vitamin D ourselves: this happens when enough sunlight hits the skin.

If there is a lack of vitamin D, the bones cannot develop properly. In infants, acute vitamin D deficiency can lead to rickets, so taking this vitamin, for example, is recommended for babies in Germany. While breast milk, the best food for infants, contains relatively little vitamin D, commercial infant formula should be fortified with vitamin D (up to 15 micrograms or 600 IU/litre). nine0003

To ensure sufficient vitamin D in the skin, infants and older toddlers should be exposed to the sun for 30-60 minutes a day: enough if only the face is exposed and facing a clear sky. Babies don't need direct sunlight, and they certainly shouldn't be out in the open without clothes, losing body heat.

But too much sunlight can be harmful, especially for babies and young children. At a tender age, a baby's skin is thin and has few melanocytes (skin cells that produce the protective pigment melanin). This means that even a relatively short period of sun exposure can cause sunburn. Like any other burn, it is manifested by reddening of the skin, and in severe cases leads to the formation of blisters. Sun exposure during childhood can greatly increase the risk of developing skin cancer. This is partly because the child's immune system is not yet fully developed, so it cannot repair the cell damage caused by the sun's rays. nine0003

Use a sunscreen with a high SPF of at least 20 and up to 50 for your child. avoidable sun exposure.

The younger the child, the more important it is not to stay under the scorching rays of the sun (especially during the daytime from 11:00 to 16:00). nine0023
The child's skin should always be covered with light cotton clothing and the head covering should shade the skin of the neck.
Sunscreen factor 20 or higher without fragrance or preservatives should be used.
Sun lotion or cream should be applied with extreme caution on the ears, nose and tops of the feet.

Even if sunscreen is applied, this does not mean that children can be exposed to direct sunlight for a longer period of time. If exposure to the sun, despite the precautions mentioned above, has led to sunburn, this condition requires immediate effective treatment. nine0003

Sun protection Interview Skin care Children Edelweiss

Children's skin and the sun: what you need to know

Why avoid direct sunlight and what to do about overheating and sunburn

The sun gives a good mood and promotes health. However, in addition to benefits, its rays can be harmful, and first of all, this applies to delicate children's skin. Pediatric dermatologist, doctor of the highest category Natalia Zhovtan tells what rules parents should follow on sunny days and on a beach holiday.

The solar regime depends on age

Russia is a northern country, and there are not so many sunny days a year in most of its territory. At the same time, natural light is one of the conditions for the formation of vitamin D in our body. It is also called the "growth vitamin" because of its role in the absorption of calcium and phosphorus, which are important for the proper development of bones and teeth. In addition, the benefits of the vitamin for the immune system and cell division have been proven. At the same time, 60% of Russian young children are deficient in vitamin D.

Most of it is produced naturally in our skin by exposure to sunlight. At the same time, dietary supplements and vitamin complexes are a half-way solution, because vitamin D is poorly absorbed from food. However, there is one nuance here.

In order for the body to produce vitamin D, direct contact with the sun's rays is not at all necessary - neither for children nor for adults. Enough partial shade and diffused light - for example, under a canopy or trees. Ultraviolet rays also get there in sufficient quantities, reflected from the ground, foliage and other surfaces. Therefore, by the way, there is no reason to sunbathe under the scorching sun: a tan is formed even in the shade, while it turns out to be more even and beautiful. nine0003

Special category - children under 3 years of age. Their skin is very thin, very susceptible to the sun, and its protective functions have not yet been formed, so direct contact with direct sunlight is contraindicated for babies. Aggressive ultraviolet easily penetrates deep into the skin and can cause sunburn even in a few minutes. So with babies and young children, it is better to walk in the morning or in the evening along the shady side of the street and use an umbrella from the sun.

Danger time and additional protection

On a hot summer day, it is generally undesirable for children (and adults too) to be in the sun between 11 am and 4 pm. If you still need to go outside or the child asks to go for a walk or to the beach, sunscreens, sprays and lotions should be used for additional protection. They reflect some of the ultraviolet radiation, preventing sunburn and skin cancer.

For children, it is better to choose hypoallergenic products without dyes and fragrances with a high level of protection (SPF) - 50 and above. The younger the child, the higher the level of protection should be. And you need to keep in mind that even products with SPF 100 (their manufacturers claim complete reflection of harmful radiation) lose their protective properties quite quickly, especially when the skin comes into contact with sand and water, so after 2 hours they must be applied again. Although there are special waterproof beach products, they also need to be updated every 2-3 hours. nine0003

It is better to choose a children's sunscreen together with a dermatologist or pediatrician, while focusing on the assortment presented in a pharmacy, and not in a supermarket. Although such funds are a little more expensive, they are certified and provide reliable protection.

If a child has sunstroke

Prolonged exposure to the sun can cause sunstroke, especially in children, because their thin skin quickly dehydrates. Unlike adults, they cannot yet monitor their condition and feelings themselves, so parents have to constantly monitor the child: how long he was in the sun, whether his head and shoulders were covered, when sunscreen was last applied, whether the baby feels well. The basic rules are known to everyone, but not everyone follows them, so let us remind you once again: light-colored clothes with long sleeves, a hat, drinking plenty of water. nine0003

Sunstroke or heatstroke, in fact - overheating of the body and primarily the brain. Moreover, it can be obtained even in the shade, just two factors are enough - hot weather and lack of fluid in the body.

Its main symptoms are lethargy and dizziness, sometimes nausea. Young children may become anxious and cry. To alleviate the condition of the child, it is necessary to isolate him from the sun and lay him down, give him a cool (but not too cold) drink. Plain still water is best, sweet soda is worst. You can dampen clothes with cool water or apply a cold compress to your forehead, arms, legs, or underarms. This will quickly cool the body and bring the child to his senses. nine0003

If the child is sunburned

Sunburn occurs when exposed to direct sunlight, when the protective mechanisms of the skin cannot cope with the received dose of ultraviolet radiation and the deep layers of the skin are damaged. Moreover, in summer you can get it not only on the beach, but also in the sandbox in the yard of your house, and in winter, for example, in the mountains. Ears, the tip of the nose, face, shoulders and chest are especially easily burned.

People with fair skin and hair are most susceptible to sunburn. Another risk factor is long games in the water. After all, water reflects the sun's rays, enhancing their effect on the skin. nine0003

The main problem with sunburn is delayed symptoms. They do not occur immediately, but by the evening or even the next day (usually 4-6 hours after exposure). This is redness of the skin, a burning or tingling sensation in the affected areas, in extreme cases, blisters and vomiting. The child feels weak or, conversely, anxious, his body temperature may rise slightly. In this case, children's ibuprofen, paracetamol or other antipyretics will help.

To help with sunburn, first you need to provide shade, cool the skin and stop the loss of moisture: give a drink (recommendations are the same as for sunstroke) and apply a cold compress to the affected areas of the body. Then apply a healing agent with corticosteroids (cream, gel or lotion, but not ointment - fatty agents create a film on the skin and lead to an increase in temperature). For example, the Fenistil gel (can be used from the age of two months) and the Advantan emulsion (from six months) have proven themselves well.