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Choosing the Right Sunscreen for Children

Guest blog post by Robin P. Gehris, MD, FAAD, FAAP, Chief of Pediatric Dermatology, Medical Director of Pediatric Teledermatology and Clinical Associate Professor of Dermatology at UPMC Children’s Hospital of Pittsburgh. Dr. Gehris serves on the MRF Pediatric Melanoma Scientific Steering Committee.

With all the conflicting advice and new warnings in the current media, it can be hard to know what the best sunscreens are to use on our children. The good news is that it is not as complicated as it seems.

The best general advice for all patients, children or adults, is to use a product that is “broad spectrum,” meaning it blocks both main types of ultraviolet radiation: UVA, which are considered the skin-aging rays, and UVB, the skin-burning rays. UVA rays can penetrate glass, including car windows, which is why dermatologists recommend applying a sunscreen to the face and other areas that are not covered by clothing (such as the backs of the hands) EVERY day. This advice holds even for cloudy days. Clouds have been found to block only about 20% of the sun’s rays, which means that 80% are still present to cause damage! Be extra careful about sun protection when you or your kids are around water, sand or snow (or when carrying a backpack with a shiny metal frame) since all of these can reflect sunlight and cause severe burns if you are not protecting your skin with sunscreen.

 

Reapply sunscreen at least every 2 hours or more often if you are sweating or swimming.

Find shade and avoid direct sunlight between 10 AM and 2 PM (and even later in the height of summer or in very hot climates). Remember, when your shadow is shorter than you are, this is when UV rays are striking your skin most directly and most intensely.

What should parents know about the specific types of sunscreens and the way they are applied? Until the FDA concludes whether they are safe in children, we do not recommend spray-on products, as they can be inhaled. Depending on wind patterns at the time they are applied, spray-on products also tend not to provide even coverage of all skin surfaces, thus potentially leaving your kids vulnerable to an unpredictable sunburn. Don’t worry, though. If the only product you have available is a spray, then simply stand downwind from your child, spray the product thickly on your own hands, then use your hands to coat all exposed areas of your child. This avoids spotty coverage as well as the risk of inhalation.

As far as the ingredients in sunscreen, there are two main categories: physical blockers (also called inorganic blockers) and chemical blockers.

Physical blockers:

Products that contain zinc oxide or titanium dioxide as the primary ingredients are called physical or inorganic blockers. These physically sit on the outside layer of the skin and block the sun’s rays from penetrating, thus preventing damage. They do not get absorbed into the body and are the least likely to cause irritation or rashes in children who have sensitive skin. There are no current concerns about physical blocker sunscreens damaging coral reefs. Their only negative quality is that they can be slightly less elegant in terms of how the product feels going on the skin since they tend to feel thicker, but they certainly make up for it in their safety.

Another type of physical blocker is clothing. As a pediatric dermatologist and a mother, I am fully aware of the struggle that ensues when it’s time to apply or reapply sunscreen to younger children. I have become a huge fan of sun protective clothing and swimwear that physically reflects the sun. While all clothing provides some protection from the sun, it can be minimal – a brand-new plain white t-shirt provides about the same sun protection as SPF 6 sunscreen, not nearly enough for kids playing outside, let alone swimming! You can tell how sun protective the clothing and swimwear you buy for your child is by checking the UPF rating – which is the clothing equivalent of SPF for sunscreen. When your child is wearing a high UPF-rated swim shirt you only need to apply sunscreen to the remaining exposed areas of skin, which cuts down on time and your child’s frustration!

Chemical blockers:

Chemical sunscreens contain ingredients such as avobenzone or oxybenzone, which chemically react with the sun’s rays to deflect them. They are also considered very safe and highly effective, as well as more cosmetically elegant, in both children and adults. There is discussion of restricting use of these sunscreens in places like Hawaii, however, due to concerns about whether the chemicals in them may cause harm to coral reefs. Some patients who have very sensitive skin may be more likely to get a reaction to sunscreens with chemical ingredients, such as local irritation or a rash. The chemical sunscreens are also the most common cause of a localized allergic rash called “photo contact dermatitis,” which looks like eczema, and results from sunlight activating an allergy to the chemical sunscreen. This presents with an itchy rash only where the chemical sunscreen has been applied and only after going out into the sun. It is easily treated with topical steroids and future avoidance of the chemicals avobenzone and oxybenzone.

The Bottom Line:

My personal rule of thumb is to use the sunscreen with an SPF rating of 30 or more that your child likes. If you have a product that works and hasn’t caused past problems, there’s no need to change what you are doing. Just remember to reapply at least every 2 hours so a sunburn doesn’t ruin your family vacation on the first day, or cause problems in the future!

September is Pediatric Cancer Awareness Month. The MRF is committed to educating children and families about the important steps they can take to reduce their risk of melanoma and make a foundation for a lifetime of skin health. To support this important work, please consider a tax-deductible donation today.

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