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Encouraging sun avoidance, adequate sunscreen for infants
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In the Pharmacology Consult column from the July issue of Infectious Diseases in Children, Edward A. Bell, PharmD, BCPS, addressed many questions surrounding sunscreen use, including whether sunscreen products with higher SPF (sun protection factor) values were better to use, were there differences in the numerous sunscreen products, and should pediatricians routinely recommend sunscreen use to their patients.
In response to a recent inquiry from a reader, Bell elaborated on pediatrician recommendations for appropriate sunscreen use for infants and toddlers, as well as frequently cited parental concerns regarding para-aminobenzoic acid (PABA) as an active ingredient in sunscreen.
Dr. Bell,
Thank you for your enlightening review about the use of sunscreens. The recommendation for reapplication every 2 hours was new information for me. I had been recommending reapplication every 3 hours, or more often, if the patient has been swimming or perspiring significantly.
I would like your opinion and/or thoughts about what sunscreens are safe for use on infants and toddlers, as it is a question I am often asked. My usual advice to parents about general sun protection for infants and toddlers includes:
Beyond that, I am not certain about which sunscreens, with which ingredients, can be safely used. I would consider zinc oxide an utterly safe physical sun block and titanium oxide is the best physical block. Aside from sunscreens that are PABA-free, what about sunscreens containing ingredients such as oxybenzone, octinoxate, retinyl palmitate, homosalate, otocrylene and parabens? Are there chemical ingredients that should be avoided based on the child’s age and surface area/weight? What other precautionary advice would you give to parents of children aged younger than 9 to 12 months?
Johnye Ballenger, MD, FAAP, West Cambridge Pediatrics and Adolescent Medicine, P. C., Cambridge, Massachusetts
Dr. Ballenger,
Thank you for your question. Reapplying sunscreen every 2 or 3 hours is likely sufficient, and I have seen both recommended. However, you raise a good question about young infants. The AAP recommends, due to their thinner and developing skin, that infants aged younger than 6 months avoid direct sunlight as much as possible. When in direct sunlight, use of shading, such as a canopy from a stroller, should be used, in addition to the other measures as you listed.
Sunscreen can be applied to exposed skin on infants aged younger than 6 months, and I am not aware of any specific data indicating increased adverse effects or toxicities from sunscreen use in infants, or from specific active ingredients in sunscreen.
I believe the main concern with sunscreens that include PABA is a higher rate of contact dermatitis/allergic reactions from its use, and PABA is probably not contained in many products.
The focus with infants should be on avoidance of direct sunlight during the peak hours as you mentioned, although sunscreens can be applied to additionally protect infants. The best strategy for pediatricians may be emphasizing sun avoidance for young infants – with some sunscreen use when necessary – to parents and caregivers rather than advocating sunscreen use for infants.
Edward A. Bell, PharmD, BCPS, Infectious Diseases in Children Editorial Board member, professor of pharmacy practice, Drake University College of Pharmacy and Health Sciences, Blank Children’s Hospital and Clinics