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Healthy Children

with Steven Parker, MD

This blog is now retired. Dr. P passed away on Monday, April 13, 2009. The WebMD Community will dearly miss his kind, caring, and often humorous manner.

Monday, June 26, 2006

Summer safety (part 2): Practice safe sun!

I know, I know. For many of you, this mundane topic belongs in the DUH! category of pediatric advice. But consider this:

  • 50-80% of our lifetime sun-exposure occurs before age 18.
  • Many parents use only 50% of the optimal amount of sunscreen and often neglect to reapply it as the day goes on.
  • Early sun exposure is related to aging skin, wrinkles, and the later development of skin cancers. The most deadly, melanoma, has continued to increase over the past decades, perhaps because:
  • NEWSFLASH! It is now felt that exposure to UVA ultraviolet rays may be more important in causing later skin cancer. Many sunscreens do not provide adequate protection against UVA!

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First, a brief primer on sun-exposure

  • The sun contains three kinds of ultraviolet (UV – light with very short wavelengths) rays: UVA, UVB, UVC. (UVC rays are apparently the most dangerous but, at least for now, are blocked by the ozone layer and don’t penetrate the earth’s surface.)
  • UV rays interact with and are absorbed by your skin’s pigment cells (melanocytes) . More UV –> more melanin to protect the surrounding skin from burns –> suntan.
  • However, there is no such thing as complete protection from UV rays.
  • The sun’s rays are strongest in the summer, especially between 10am and 4pm. (Use the “shadow rule”: when your shadow is shorter than you are, the UV rays are most intense.)
  • UV rays reflect off water and snow, increasing exposure.
  • 2/3 of UV rays penetrate clouds and can cause unexpected sunburns.
  • The “SPF” (sun protection factor) on sunscreens estimates how well the UV rays are blocked from reaching the skin. A factor of “15″ means that sun exposure of 15 minutes is equivalent to about 1 minute exposure without sunscreen. An SPF of 10 blocks about 90% of UVB, a SPF of 15 blocks 93%, and an SPF of 30 blocks 97%.
  • However, SPF refers to the ability to block UVB, not UVA!

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I hope I’ve convinced you that this is a big deal and one of the important preventive measures to obsessively follow with your kids. Here are Dr. P’s Tips on protecting your child’s skin from harmful rays.

  • Wear sun-protective clothing. Look for summer clothing with Ultraviolet Protection Factor (UPF – similar to SPF in sunscreen) of 15 or greater on the label. (These can lose effectiveness if wet, stretched, or too tight.)
  • Wear caps/hats with broad bills that shade the face, head, neck and ears.
  • Use sunglasses with both UVA and UVB protection (Cataracts as an adult may, in part, be related to early unprotected eye exposure to UV rays + kids look so cute with shades!).
  • Play in the shade. Bring an umbrella or pop-up tent along to avoid direct sun.
  • No sunbathing! Remember: tan skin is damaged skin.
  • Use sunscreen liberally. There is no evidence at all that sunscreen is harmful to children. (Despite the absence of data, the American Academy of Pediatrics doesn’t advocate its use until 6 months of age. Recently they’ve said that if direct exposure to sunlight can’t be avoided, it’s probably fine to use it on the small parts of the body that will be exposed).
  • Pick a PABA-free “hypoallergenic” sunscreen that offers both UVA and UVB protection.
  • All sunscreens block UVB , but not all do a good job with UVA. Read the label: the best UVA protectors contain a chemical-free sun “blocker” (like zinc oxide, titanium dioxide) and/or the sunscreen avobenzone.
  • Use a sunscreen with an SPF of 15 or more whenever your child is exposed to the sun.
  • An SPF of more than 30 is not necessarily better, as the increased concentration of suncreen is more likely to cause skin irritation while offering very little extra protection (e.g., increasing SPF from 30 to 40 requires 25% more sunscreen with only 0.8% more protection).
  • Apply sunscreen liberally and let dry about 30 minutes before exposure.
  • Don’t forget the nooks, crannies, and high-exposure areas (ears, feet, lips, noses).
  • Remember: “water resistant” means it lasts about 40 minutes in the water; “water proof” means it wears off after about 80 minutes in the water. So, reapply, reapply, reapply (every 2-3 hours, or right after swimming or sweating a lot), as the day wears on.
  • If you read the labels, you’ll see there isn’t much difference (except cost) in sunscreens marketed for kids. Don’t feel obliged to use them, unless one especially appeals to your child.

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OK, you (or your independent child) blew it. What to do in case of sunburn?

Sunburn is caused by the high energy of the UV rays directly burning the exposed skin. It usually shows up 2-6 hours after exposure and peaks in severity at about 24 hours. Alas, no treatment (except avoiding further sun exposure) has been shown to reduce the extent of the damage or the time of healing.

For comfort, here are some tips:

  • Take a cool bath (some find adding baking soda or oatmeal to be soothing).
  • Gently apply cool, wet compresses.
  • Rub on soothing aloe vera gel.
  • Use a fragrance-free moisturizing cream (not petroleum-based) to rehydrate the skin.
  • If severe, 1% hydrocortisone cream may offer some relief (although, alas, it usually doesn’t in my experience).
  • Give a pain reliever which also reduces inflammation (such as ibuprofen).
  • Drink plenty of fluids.
  • While rare, if the sunburn is especially severe and/or accompanied by other symptoms (like severe pain, horrible blisters, nausea, confusion, headache, looking infected over time), seek medical attention!

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I’ve spent a long time on this because one of the real gifts you can give your kids is healthy, non sun-damaged skin. It’s worth the effort!

Related Topics: Summer Skin Care, WebMD Video: Safe Summer Tan?

Other Summer Safety Tips from Dr. P: Mosquitoes

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Posted by: Steven Parker MD at 6:06 pm

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