Sunscreen Beyond the Basics Part III: Do Children Need Sunscreen?

16 March 2019

One of the questions I get asked very often from my patients and readers is this: Does my child need to wear sunscreen? I am going to address the topic of sun protection and sunscreen for children by reframing this question to you: imagine that you are out on a sunny day with your one year old kid (and in Singapore, we can never truly run away from the sun), say at the pool and you have your skin prepped with your sunscreen and vitamin C. What about your kid? Does your child need to be protected with sunscreen too?

 

We are all well aware of the harmful effects of UVA and UVB rays from the sun on our skin. I will not belabour the point, but skin cancer, burns, pigmentation and signs of aging can be attributed to excessive sun exposure. So what about the impact of the same UVA and UVB rays on a child’s skin? Is a child more vulnerable to the impact of sun exposure?

 

This blogpost will cover the differences between a child’s skin versus an adult’s skin when it comes to sun exposure; sun safety tips and updated guidelines and recommendations on sun safety and sunscreen for children.

 

For more about how to choose a sunscreen, please refer to my blogpost Sunscreen Beyond the Basics.

To learn more about safety issues surrounding sunscreen filters, please refer to my blogpost Sunscreen Safety and What You Should Avoid.

 

Do children need sun protection?

 

Without a doubt, yes.

 

If the adult skin is susceptible to the harmful effects of UV rays, then so are children’s’ skin. In fact, the skin of infants are more vulnerable to the effects of external agents such as UV rays from the sun and of course, sunscreen. Research has also shown that a sunburn at any point in life (including childhood) increases the risk of skin cancer1.

 

How are the skin and metabolism of babies different from adults?

 

Layers of the skin

 

Babies have thinner skin than adults. The top most layer of the skin called the stratum corneum2, that is the skin’s first line of defense against harmful external agents, is thinner in babies. Babies and children also have larger surface area to body weight ratio compared to adults; and this leads to higher absorption chemicals and drugs as compared to adults3.

 

The implication of babies having thinner skin and lesser skin defense than adults is that children are more vulnerable to the effects of UV rays as well as the chemicals in sunscreen that may cause skin irritation. Conversely, this also means that babies are more prone to the effects of the sun like sunburns and dehydration.

Differences between children and adults which affect the drug clearance and bioaccumulation of drugs.

 

The body’s metabolism of drugs and chemicals is also less developed in children which means that the clearance of drugs is slower than adults3,4. This leads to possible bioaccumulation of drugs in the circulation in children.

 

How do I protect my child from the sun?

 

These tips might sound like common sense to a lot of us but these tips are adapted from the American Academy of Paediatrics.

 

1. Keep your baby in the shade as much as possible- e.g.umbrellas on the strollers

2. Keep your baby covered- sun hats, clothings that cover exposed limbs… etc

3. Look out for signs of sunburn and dehydration- excessive crying, irritability and redness are some of these signs

4.If your child is sunburnt, apply a cold compress to the area of burn and get out of the sun ASAP!

 

Do children need sunscreen?

 

The subject of whether children need sunscreen will hinge on the risk benefit ratio of sun exposure and using sunscreen for children because of the inherent immaturity of babies’ skin.

 

The US Federal Drug Agency (FDA)’s sunscreen guidelines differ for children below and above 6 months of age.

 

 

For children below 6 months of age, the US FDA does not recommend sunscreen use and recommends keeping children out of direct sunlight. On the other hand, where shade and appropriate clothing are not available; the American Academy of Paediatrics suggests applying sunscreen to small amounts of exposed skin.

 

For children above 6 months of age, the US FDA recommends using sunscreen.

 

My tips on choosing a sunscreen for your precious little one

 
  1. Physical vs chemical sunscreens: physical (inorganic) sunscreen filters like zinc oxide and titanium dioxide are less likely to irritate babies’ skin compared to chemical sunscreen formulations.
  2. Guidelines for adults also apply to children- choose a broad spectrum sunscreen with SPF value above 30.
  3. Avoid sunscreen sprays- there is a risk of aerosol inhalation and the application may not be consistent.
  4. Consider testing for skin reactions or irritation before using the sunscreen on a large surface area. Apply a small amount of the sunscreen to the inner upper arm (where the sunscreen is less likely to be smeared away) and observe for any redness or rash after 24 hours.
      REFERENCES

1. Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis. Dennis et al. Ann Epidemiol. 2008;18(8):614–627.

2. The Infant Skin Barrier: Can We Preserve, Protect, and Enhance the Barrier? Lorena et al. Dermatol Res Pract. 2012; 2012: 198789.

3. Multi-organic risk assessment of estrogenic properties of octyl-methoxycinnamate in vivo: A 5-day sub-acute pharmacodynamic study with ovariectomized rats. Klammer. Toxicology. 2005 Nov 5;215(1-2):90-6.

4. Sunscreens in human plasma and urine after repeated whole‐body topical application. Janjua. J Eur Acad Dermatol Venereol. 2008 Apr;22(4):456-61.


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