Fun in the Sun this Summer
Robert P. Lindeman, MD, PhD
Natick Pediatrics, PC

See that bright, hot yellow ball up there in the sky? That’s the sun. You may remember it from last summer. This is not an optical illusion: Summer really is coming again! And though you deserve to enjoy the sun as much as you can this summer, it’s important to remember how to avoid the dangers of too much sun.

The biggest danger posed by sun is skin cancer, particularly melanoma. The more sun you are exposed to during your life, the greater the chances of your developing skin cancer. There is a certain amount of accumulated sun exposure that is considered “safe”, and but this amount varies from person to person, depending on the amount of natural pigment (melanin) in your skin. Unfortunately, some people absorb their entire quota of sun exposure during childhood! Skin cancer even strikes people in their 20’s. Factors that raise your lifetime risk of skin cancer include family history of skin cancer, presence of moles on the skin, and light colored hair or eyes.

Of course, too much time in the sun is never safe, as everyone knows who’s ever had bad sunburn. There are even also more serious complications of too much sun, including heat exhaustion and heat stroke. These conditions are caused by the dehydration that comes from excessive sun exposure. It is important for your child to drink plenty of fluids on a hot day. As for the amount of fluid required, I recommend that a child should drink a little more than you think he or she needs to.

Its important to remember that a person can get sunburn even on overcast days. This is because sunburn is caused by ultraviolet rays, which can penetrate cloud cover. Air temperature doesn’t matter either: you can get sunburn on sunny cool days as well.

Sun Protection
The best way to avoid excess sun exposure is to stay out of the sun! For most people, this is neither practical, nor even possible. A fair compromise would be to try and stay indoors during “peak sunburn hours”, between 10AM and 2PM during summer. Sunscreen should be applied to exposed skin during these hours even if your child is playing in the backyard, fully clothed.

Clothing provides better sun protection than any sunscreen. Children with fair skin should probably cover up as much skin as is possible or reasonable, even while swimming or playing in the water.

Covering up is especially important for infants less than 6 months old. Because I don’t recommend sunscreen for these babies, you should make sure your baby wears a hat and stays in the shade, out of the direct rays of the sun.

The general rule of sunscreen is “more is better”. I recommend using sunscreen with a sun protection factor (SPF) of at least 15. I prefer SPF 45 for my sun-sensitive patients. I also recommend avoiding preparations that contain PABA, which can cause skin rashes.

For sunscreens to be effective, you need to apply them at least 30 minutes before your child goes outside. Its no good to apply the first coat at the beach! Besides, applying sunscreen before dressing helps to prevent any “missed spots”. You’ll need to re-apply the sunscreen after your child emerges from the water, or when he/she has been running around and sweating. There is no such thing as a truly “water-resistant” sunscreen: these products need to be reapplied after swimming or sweating. But no matter what the activity, sunscreen should be reapplied every 2-3 hours during sun exposure.

Any part of the body that is exposed to sun needs to be protected with sunscreen. It is a good idea to cover a few inches beneath the edge of a bathing suit. Do not neglect ears (especially the area behind the lobes on children with short hair), eyebrows, and lips. For the latter, there are many good lip balms that provide sun protection. Look for a lip balm with a stated SPF. Hats are almost essential for children with thin hair, and of course for infants.

A fair amount of sun enters the body through the eyes. Ultraviolet light can cause damage to the delicate tissues of the eyes. Its worth the investment to buy sunglasses that provide protection against ultraviolet radiation. It is can be difficult to convince most children to wear sunglasses because they feel awkward and they make the world look different. But, with time, many children will get used to them, and some even think they’re cool!

A Word about Prescription Medications
There are some medicines which that can increase your child’s susceptibility to sunburn. Most of these are antibiotics and acne preparations. I usually recommend that children taking these drugs avoid sun altogether, as sunscreen may not help prevent a burn. Tanning booths are just as dangerous in these cases. If your child is taking any medication, you should ask your child’s care provider if it is okay to go out in the sun.

How to Care for Sunburn
Ibuprofen (Motrin/Advil) given early in the day, as the sunburn is emerging, can prevent a bad burn from becoming worse. It should be given at a dose appropriate for your child’s weight, every 8 hours for the first 24 hours after the sun exposure. Ask your child’s care provider about your child’s correct ibuprofen dose. Never give aspirin to a child or adolescent.

Moisturizers should be applied early and often. I recommend Aloe Vera gel, which is available over the counter at most pharmacies. For the most swollen and painful areas of the burn, 1% hydrocortisone may be applied. Avoid pain-killing sprays and ointments containing Benzocaine: these may cause skin irritation or allergy.

When to Call the Doctor

• If sunburn blisters and then becomes infected.
• If your child has an unexplained fever in the evening after getting a sunburn
• If your child cannot look at a light (this may indicate sun damage to the child’s eyes)
• If your child faints, develops nausea and vomiting, or becomes disoriented. These are signs of heat stroke.

For more information about Natick Pediatrics, or to talk to the doctor, please call the office at (508) 655-9699.

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Medical Office Building
MetroWest Medical Center
Leonard Morse Campus
67 Union Street, Suite 305
South Natick, MA 01760

(508) 655-9699
(508) 655-2984 fax

Posted: November 15, 2002