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Care for Infants

Dr. Mary Ann Advises Parents About Sun Protection for Infants and Small Children

Dr. Mary Ann LoFrumento is a pediatrician, parent advocate, and educator with more than 20 years of experience. An attending physician at the Goryeb Children’s Hospital in Morristown, New Jersey, she was formerly a clinical assistant professor at Columbia University’s College of Physicians and Surgeons. It was while serving as managing partner for a large pediatric group in New Jersey that ” Dr. Mary Ann” recognized the need to help parents cope with “information overload.” She began developing straightforward child care materials for parents, went on to produce pediatric medical education videos through Halo Productions, and founded Simply Parenting in 2002. Simply Parenting’s books and multimedia resources on childcare embody Dr. Mary Ann’s “back to basics” approach. We talked with her recently about sun protection for infants and small children.

Q. Is sun exposure really more dangerous for infants and young children than it is for an adult?

A. The risk of sun exposure begins early in life, and children need extra protection from the sun. Eighty percent of lifetime sun exposure occurs before age 18, because children tend to spend so much time outdoors. Every sunburn adds to the risk of developing melanoma, the deadliest form of skin cancer. Research suggests that two or more blistering sunburns as a child or teen increases the risk of developing skin cancer later in life.

Q. What are the basics about protecting the youngest children from the sun?

A. Keep kids out of the midday sun ( 10 a.m. to 4 p.m.), when the rays are strongest. Use a sunscreen labeled “broad spectrum,” which protects against both UVA and UVB rays. Both types of rays from the sun are known as “ultraviolet,” and both can cause skin damage. UVA rays cause long-term damage like wrinkling, while UVB rays are responsible for most sunburn and blistering. UVB protection is especially important. Although these types of rays are only .5 percent of the sunlight that reaches earth, they cause most major skin damage. (Be aware that SPF refers only to protection against UVB rays.) Select a waterproof sunscreen with an SPF (sun protection factor) of at least 30. The higher the SPF, the better. Apply sunscreen 30 minutes before going outside, and reapply every two hours or after the child has been in the water. Kids should wear broad brim hats — make sure that baseball cap is not on backwards. Dark colored clothing can provide some sun protection, but light colored clothes (especially if they get wet) do not. The ideal protective clothing will not only be dark in color, but will be made of a tight-weave fabric. A good test is to hold the clothing up to the light. If you can see through the fabric it means light can get through. To protect a child’s eyes, use sunglasses that give both UVA and UVB protection. Remember that sun reflects off surfaces like water, sand, snow, and concrete, which means more risk of sunburn when you are near those surfaces. Also, don’t reserve sunscreen for sunny summer days. Even on a cloudy day, 80 percent of the sun’s rays pass through the clouds.

Q. There are so many different types of sunscreen on the market. How does a parent choose the right one, and do those made specifically for kids offer additional protection?

A. The most complete protection comes from broad spectrum sunscreens that contain zinc oxide, titanium dioxide, or avobenzone. These block UVA and UVB rays, and any of these types of sunscreens are good for children. The advantage of buying a sunscreen marketed specifically for kids is that it’s likely to be waterproof and have a more pleasing smell.

Q. I’ve heard that sunscreen can clog children’s pores. Can it cause skin problems?

A. Sometimes the use of an oil-based sunscreen can cause acne. You can avoid this problem by using a non-comedogenic (oil-free) sunscreen, which is less likely to cause breakouts. A few very sensitive children will develop a rash with certain sunscreens. If this occurs, parents should check with their pediatrician or dermatologist for advice about special sunscreens.

Q. How young is too young to apply sunscreen?

A. There is controversy on this point, but a common sense approach is to keep babies under six months out of direct sun as much as possible. We don’t yet know the full risks and benefits of using sunscreen on babies this young. According to the American Academy of Pediatrics (AAP), babies can sunburn more easily because their skin is thinner and is more likely to be sensitive. This is true even for babies with naturally darker skin. Therefore, dress infants in hats and protective clothing when outdoors. If exposure to direct sun is unavoidable for a baby younger than six months, the AAP suggests that parents consult their pediatrician about the decision to apply sunscreen. If a baby under 12 months ever gets a sunburn, the pediatrician should be contacted immediately because this could become a medical emergency. A sunburned infant could have serious skin blistering or pain that needs professional attention. They could suffer from heat exhaustion and should be checked for related symptoms like dehydration. If a young infant becomes sunburned and you can’t immediately reach your pediatrician, it’s wise to go to the emergency room of your local hospital.

Q. Is water-proof really waterproof? When does sunscreen need to be re-applied?

A. A sunscreen labeled “waterproof” is intended to stay on the skin for 80 minutes in the water. One labeled “water resistant” is intended to last about 40 minutes. Regardless, you must reapply sunscreen after your child comes out of the water, every time. Also, remember that towel-drying can also remove sunscreen.

Q. Do the expiration dates on sunscreen really matter, or is it okay to use last summer’s bottle?

A. Expiration dates do matter, and experts don’t recommend using last year’s lotions. The products lose their effectiveness over time when chemical ingredients begin to break down or separate. If the sunscreen develops a gritty feel or changes color or consistency, you should throw it out. Always check the expiration date on a bottle of sunscreen. The Food and Drug Administration says you should store sunscreen in a dim, cool place, because high temperatures can affect the product.

Q. Is there a “right way” to apply sunscreen to maximize effectiveness?

A. Apply sunscreen to dry skin 30 minutes before leaving the house. Don’t forget to apply to the face, hands, ears, and even the scalp, but steer clear of the eyelids and areas immediately around the eyes to avoid irritation. Babies and toddlers tend to suck their thumbs and put their hands in their mouths frequently, so limit the amount of sunscreen you put on that area. One tip is to apply the sunscreen to the backs of the hands but not the palms or between the fingers. Regardless of your child’s age, apply sunscreen before clothing or the bathing suit goes on, so you don’t miss any spots. One ounce of sunscreen should cover all parts of a small child’s body.

Q. What if a child needs both bug repellant and sunscreen? Will the products still work if they are applied together?

A. The Centers for Disease Control (CDC) says you can apply both sunscreen and bug repellant without any problem, and both products will work. They discourage the use of new products that combine both sunscreen and bug repellant in one lotion, because the re-application times are so different. For example, sunscreen needs to be reapplied more often than bug repellant, and the makers of bug repellants warn that they can be dangerous to kids if over-applied. CDC recommends putting on sunscreen first. Wait 30 minutes for the skin to absorb it before applying bug repellant.

Q. What about children’s swimwear and clothing products that claim to provide SPF protection?

A. Some manufacturers have come out with special clothing that claims to give extra protection from ultraviolet rays. However, these products are very new on the market and we don’t have a lot of information about them yet. They should be viewed as “extra protection,” and should not be relied upon to prevent sunburn.

Q. Do children with naturally dark skin, such as African-American children, need less protection than children with fair skin?

A. Regardless of ethnicity or skin type, we all need extra protection from the sun. This may be even more necessary as pollution depletes the ozone protecting the earth’s atmosphere and reduces our environment’s natural, built-in sunscreen. The American Academy of Dermatology suggests a broad-spectrum sunscreen that protects against UVB and UVA rays for any person of any skin type who is exposed to the sun. The minimum SPF you should use on a child is 30, regardless of ethnicity or darkness of skin.


For more information about sun protection for infants and young children, visit the American Academy of Pediatrics at www.aap.org and the American Academy of Dermatology at www.aad.org.

For more from Dr. Mary Ann, visit www.simplyparenting.com.