Q&A: Summer tips for keeping kids safe from sun, heat and air pollution
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Key takeaways:
- It is important to keep children protected from the sun, heat and air pollution in the summer.
- The AAP recommends mineral-based sunblocks, wide-brim hats and monitoring the air quality index.
Protection from the sun, heat and air pollution is important to keeping children healthy while they spend more time outside this summer, the AAP said this week as it announced tips for preventing illnesses related to outdoor activities.
The AAP recommended that families check the daily air quality index to identify when it might be unsafe for children with asthma or other health concerns because of pollution, wildfires or heat, and had other recommendations for keeping them safe from the sun and heat.
We spoke with Teresa S. Wright, MD, FAAD, FAAP, division chief of pediatric dermatology at Le Bonheur Children’s Hospital in Memphis, Tennessee, and associate professor of dermatology and pediatrics at the University of Tennessee Health Science Center, about best ways to protect children from sun damage and what to look for in a sunscreen.
Healio: What are the AAP’s major recommendations for sun protection that are unique to babies and children?
Wright: The main thing is to think of sun protection as something that has multiple factors. It’s not just the use of a good sunscreen. You want to try to limit exposure to the sun during the peak hours, which will usually be listed as 10 a.m. to 4 p.m., so avoid midday sun as much as possible. If you are going to be outside during those hours, try to seek shade as much as possible, try not to be out in the direct sun, use some protective clothing — preferably lightweight clothing with a tight weave that covers the body — wear a hat that preferably has a 3-inch brim that goes all the way around so it protects the ears, the neck and the scalp, as well as the face, and wear sunglasses that fit properly and that offer broad spectrum protection.
In addition to that, you want to use sunscreen, and there are specific recommendations about sunscreen for babies. In general, a baby should really be kept out of direct sunlight, and you want to really avoid a baby getting a sunburn. In general, everybody says no to being out in the sun for babies aged younger than 6 months, and the AAP used to have a policy that that said not to use sunscreen on babies aged younger than 6 months. I think the reason they decided to say that was to really emphasize that the important thing was keeping babies out of the sun. [The AAP has since] adjusted its recommendation to say that if you're in a situation where it's impossible to be completely shielded from the sun, it is okay to use small amounts of sunscreen on small areas of exposed skin on babies aged youngers than 6 months, [such as] the face or the tops of the hands.
As a pediatric dermatologist, I always recommend choosing a product that is mineral based. That means a sunscreen that contains physical blockers. The old-fashioned ingredients include oxide and titanium dioxide — we have a long history with those, we know that they're safe, they're broad spectrum, they're very unlikely to cause irritation or a reaction on the delicate skin of an infant or even a young child.
Healio: Are there any common misconceptions about sunburn or sunblock use in children?
Wright: I would just say in general, obviously you're trying to avoid burns. If a child has a minor sunburn, like a little bit of redness or tenderness, usually it's OK just to do cold compresses, a pain reliever that’s safe for their age, and then make sure they’re drinking plenty of fluids.
If a child aged younger than 1 year has a significant sunburn, then that's something that should be seen by a pediatrician or physician. And if the child has a more severe sunburn, has a lot of pain, blisters, has fever, has headache, nausea or vomiting, then they should definitely be seen by a physician.
There’s [a misconception that] all sunscreen is created equal, that it doesn't matter what kind [you use], and you don't need to look for specific qualities. But we really do recommend you choose something with a high enough sun protection factor, or SPF. The AAP currently recommends an SPF of at least 15. The American Academy of Dermatology recommends an SPF of at least 30. As a pediatric dermatologist, I generally recommend at least 30 — most products marketed for children are going to have an SPF of at least 30.
SPF is just a measure of protection against ultraviolet B rays, which are the part of the spectrum that causes sunburn. When you go from an SPF of 15 to an SPF of 30, you actually do get a bit more protection. An SPF of 15 will protect against about 93% of UVB rays, whereas the 30 will go up to 97%. And you don't get a whole lot more protection above that. So, we don't really encourage people to look for SPF 100, because theoretically, there really isn't any such thing as SPF 100.
You also want to look for broad-spectrum sunblock. You want it to protect against UVA and UVB. UVA is the part of the ray that is responsible for aging of the skin, but together, UVA and UVB can contribute to cellular damage, which can increase your risk of skin cancers as you age, so those are important.
I think sometimes people think a higher SPF means that they don't need to reapply as often, but that's not true. You should be reapplying at least every 2 hours when you're out in the sun and more often if you're sweating a lot or swimming or rubbing the product off.
With sunscreen, it's really important not only that you choose a good product but that you use it correctly. One thing that parents often don't do is they may choose a sunscreen spray product, and then they just spray the kid with it when they're running by and they don't take the time to make sure they're covering all the areas and then rubbing it in. I've recently told some parents they need to rub in the sunscreen, and they were really surprised by that.
The other thing is that sunscreen is not just for sunny days. A lot of times people may only be putting it on (themselves) or putting it on their children when they are going to be outside and it's sunny. [Even though] the clouds reduce some of the harmful UV rays, they don't block all of them. You can still get burned or get sun damage on a cloudy day.
Additionally, there's no such thing as completely waterproof sunscreen. They can say “sweat resistant” or “water resistant,” but they will eventually wash off, so you have to be mindful of that. I usually tell parents who have kids and are going to the beach, or are going to the pool — they're going to be outside — just really get a good layer of sunscreen on them, even before you put their swimsuit on, that way, you're less likely to miss spots around the edges of their clothing.
Healio: What about safety when it comes to sunscreen itself?
Wright: Every few years, there are things in the news about safety concerns with sunscreens. Ideally, you don't want to inhale any kind of aerosolized chemical products. That was more of an issue for people who might have lung disease or asthma, but we certainly recommend not spraying sunscreen on kids who are not old enough to hold their breath. It's generally better to spray sunscreen into the hand and then apply it to the child, especially around the face and neck.
Then there were concerns about some of the chemical ingredients. I did mention using mineral-based products for babies and younger kids, but the other category of ingredients in sunscreens is chemical ingredients, which absorb the UV radiation, and some of those have had safety concerns as well. People have been concerned about things like oxybenzone because they might have some mild hormonal properties. There were concerns about that with kids.
Reference:
Summer sun, heat & air quality: Tips to keep kids safe. https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Sun-Safety-and-Protection-Tips.aspx. Published June 28, 2023. Accessed June 29, 2023.
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