Opinions

Sun Safety in Children
by Emily Pingrey (Cinderella)

As much as 80% of a total lifetime sun exposure occurs during childhood(Johnson et al, p. 891). Yet childhood is a time when it is "cool" to be tan. Childhood is also a time when parents still have control over their children's behaviors. There are many behaviors that parents make certain that children adopt. For example: wearing seatbelts, looking both ways before crossing the street, and brushing teeth daily. But somehow sun safety is not always number one on parent's list of behaviors to teach their children. According to Johnson et al, social cognitive theory, which claims that a person's surrounding social and physical environment influences his or her behavior. This theory can be extended to support the claims that parents are responsible for their children because their beliefs on the subject and their subsequent norms and practices(Johnson et al, pg. 892).

Parents need to be taught how dangerous the sun can be to their children. Parents need to be educated on safe sun behaviors so that their children can adopt appropriate behavior. A consumer based search on the popular based research site, Google, led to a link on children's sun safety at www.keepkidshealthy.com/welcome/spring/sun_saftey.html. This consumer web site states that 80% of a person’s lifetime sun exposure occurs before age 21 and that regular use of sunscreen in children can lower their risk of skin cancer by almost 78%(cite). The website suggests parents pick a sunscreen that offers UVA and UVB protection and that has a SPF of 15 or higher.

They also list a number of tips to protect children from damaging effects of the sun. The list of tips to protect children from the damaging effects of the sun includes: children should wear protective clothing including a hat, long sleeve shirt, and long pants. The www.keepkidshealthy.com website states that most clothing only has an SPF of 5-9. According to the article, "Issues in Summer Safety..." by Barbara Sheer, the proper clothing can act as an SPF of up to 60. However, Sheer says that the special clothing that can provide this level of protection is expensive which generally inhibits parents from buying them. Sheer also cautions that wet clothing can transmit up to 30% of the sun's rays. Despite the fact that special clothing may be the best guard against the sun, Sheer still suggests that long sleeve shirts and long pants made of closely woven knits. Similarly the Committee on Environmental Health for the American Academy of Pediatrics suggest that clothes offer the simplest and often most practical means of sun protection. They suggest that "parents should consider dressing their children in lightweight long pants and long-sleeved shirts, even in the summer(p.330)." The clothes should have a tight weave, one that lets in little light when held up to a lamp or window"(p. 336).

As for wearing a hat as the www.keepkidshealthy.com suggests. This recommendation is confirmed by the American Academy of Pediatrics. They recommend that "hats with bills can be cooler and more comfortable than a bare head in the summer"(p.331). They also say "a hat with a brim can reduce UVB exposure to the eyes by 50%"(p.331). According to the American Academy of Pediatrics, "UVR can contribute to the development of age-related cataract, pterygium, photodermatitis, and cancer of the skin around the eye"(p.329). "Infants and children < 10 years may be at increased risk for retinal injury because the transmissibility of the lens to damaging visible blue and UV light is greatest during this period"(p.330). The www.keepkidshealthy.com suggests parent's should protect their child's eyes with sunglasses that protect against UVA and UVB radiation.  The American Academy of Pediatrics agrees with this statement. The AAP suggests "sunglasses should be worn whenever the child may be in the sun long enough to get a sunburn or tan. Sunglasses should be chosen to block 99% to 100% of the full UV spectrum"(p.331). "Even infants should wear sunglasses. Larger lenses, well fitted, and close to the surface of the eye, provide the best protection"(p.331). Similarly Barbara Sheer states that the American Academy of Opthalmology "recommends eye protection with sun exposure great enough to tan or burn."

The consumer based website states that "exposure to sun puts people at risk for skin cancer and premature aging and that most of that exposure comes during childhood(80% of a person's lifetime sun exposure occurs before they are 21). Regular use of sunscreen in children can lower their risk of skin cancer by almost 78%.However, they also recommend not using sunscreen more than one year old. After this time, the chemicals that protect your children are broken down and can no longer be considered effective. Johnson et al confirm both of these statistics nearly word for word as do Sheer and the American Academy of Pediatrics. Johnson et al adds that, "The U.S. Preventive Services Task Force concurred, concluding that avoiding sun exposure or using protective clothing is likely to decrease the risk of malignant melanoma and nonmelanoma skin cancers"(p. 891). As well one of the objectives of Healthy People 2010 is to decrease the incidence of skin cancer by the following methods, "Increase the proportion of adolescents in grades 9 through 12 who follow protective measures that may reduce the risk of sun cancer: avoid the sun between 10:00 AM and 4:00 PM, wear sun protective clothing when exposed to sunlight, use sunscreen with a sun protective factor(SPF) of 15 or higher, and avoid artificial sources of ultraviolet light"(p.891). As for the consumer website's advice for sunscreen use. They suggest picking a sunscreen that offers UVA and UVB protection and that has a SPF of 15 or higher. They also suggest applying the sunscreen in a thick coat at least 30-45 minutes before going outside and reapply every two hours(or more often if child swimming or perspiring heavily). As for the type, the consumer web site suggests if the child has sensitive skin, use zinc oxide or titanium dioxide that physically block the sun's radiation. The American Academy of Pediatrics backs up the consumer websites information.

The AAP states "sunscreens reduce the intensity of UVR affecting the epidermis"(p. 331). Opaque sunscreens, including zinc oxide and titanium dioxide reflect and scatter the light, but the AAP cautions they are not always cosmetically acceptable. Instead the AAP recommends "chemical UV absorbent agents because they are usually colorless and more cosmetically acceptable"(p,331). The American Academy of Pediatrics describes the sun protection factor(SPF) as "a grading system used to quantify the degree in the reduction of erythema provided by using a given sunscreen"(p.331). The AAP further explains the SPF with an example, summarized as follows. An SPF of 15 or more theoretically filter >92% of the UVR responsible for erythema; sunscreen with an SPF of 30 filters about 97% of UVR. However the AAP cautions that the SPF is often much lower because the amount used is usually less than half the recommended amount(331). Sheer identifies the lack of the proper of sunscreen. Sheer quotes the University Health Services recommended amounts of sunscreen. "1/2 teaspoon of sunscreen applied each to the face and neck, the arms and shoulders, and the torso, and that 1 teaspoon be applied to the legs and top of the feet on each side"(p.323). Sheer says the most frequently missed areas were "on the face: periorbital, ears, perioral, nasolabial, hairline, nose, forehead, and cheeks"(p323). As for sunscreen claims to be water proof or sweat proof, Sheer gives these guidelines. "Waterproof products last up to 80 minutes of continuous water exposure. Water resistant products protect up to 40 minutes and sweat resistant products protect up to 30 minutes"(323).

As for the SPF to use. Sheer agrees with the consumer website. Sheer says, "children over 6 months should use a sunscreen with an SPF between 15 and 30"(p.323). Sheer quotes the FDA in saying, "An SPF above 30 offers little additional benefit and may expose children to potentially harmful levels of chemicals"(p.323). The consumer website states that sunscreen use is only safe in infants over six months old. Sheer backs up the website's recommendations. Sheer says, "Children under 6 months of age should not have sunscreens applied. They need to be protected from the sun and kept in the shade"(p.320).

The consumer based website as well suggests that parents limit children's exposure to the sun when it is at its strongest(10 am-4pm). The website also recommends parent's apply sunscreen even on a cloudy day. The AAP confirms this statement stating, "children's activities can be selected to avoid or minimize sun exposure between 10 am and 4 pm"(p.330). Sheer says "in the summer, between 10 am and 3pm the sun is strongest at all latitudes. Cloudy days offer no protection since 80% of the UV rays can penetrate the clouds"(p.319). Likewise the AAP confirms that "clouds are not sufficiently protective against UVR. UVR on cloudy days may be reduced by only 20%. As for the consumer websites claim that DEET lowers the effectiveness of sunscreens, so a higher SPF should be used if combining sunscreen and insect repellent, neither the American Academy of Pediatrics, Barbara Sheer, DNSc, FNPC, PNP, nor Johnson et al mentioned this problem. A research search for the combination of DEET and sunscreen turned up no such journal articles. Therefore no recommendation can be made in that regard.