I wish I owned a sunscreen company. As a red-haired pale face, I slather myself in sunscreen every time I go out, especially in the summer. I wear sunscreen on my face year-round, even on cloudy days. It still doesn’t stop me from turning increasingly more freckled with each year. Both my little boys have inherited mommy’s light skin and even though I coat them head to toe in sunblock, my two year old son already has one tiny freckle on his hand.

When both of them were infants, I was really confused about what to do to protect their skin from the sun. I’ve heard everything from no sunscreen under six months to physical barrier sunscreen only to dress them in long pants and shirts (highly impractical for lots of stroller time in the hot city.) I still get confused about what to do and what to use on them. I hear conflicting reports about overly-protected children having Vitamin D deficiencies and looking at the Environmental Working Group’s annual sunscreen Hall Of Shame (http://www.ewg.org/2010sunscreen/) has me afraid of the ingredients in nearly every brand out there.

I decided to ask dermatologist and skin-care expert Dr. Channing Barnett for some answers. To see what Dr. Barnett has to say about sunscreen and children read below..

 - Robin Saks Frankel

1. Why is sunscreen so important, especially on young children?

Sun protection for children is extremely important. Protecting children from the sun not only prevents painful sunburns, it also significantly reduces the risk of premature aging and of developing skin cancer later in life. Did you know that just one blistering sunburn in childhood more than doubles your chances of developing melanoma later in life? About 23 percent of lifetime sun exposure occurs by age 18.[1] 

Given young children's generally fair and sensitive skin, sun exposure should be limited on children less than six months of age. For many years, pediatric authorities recommended that you not use sunscreen on babies less than six months old. However, the American Academy of Pediatrics now states that sunscreen is probably safe to use on babies and younger children, especially if you just use it on small areas of the skin that are exposed to the sun and not protected by clothing, such as the hands and face. Still, younger children should be kept out of direct sunlight because they can burn easily and may not be able to handle getting overheated as well as older children.

After six months, sensible (moderate) sun exposure with use of a well formulated sunscreen which provides complete UVB/ UVA (including long-wave UVA) is considered acceptable by the vast majority of pediatricians.  Keep in mind, breezes or water can cool the skin of children playing in the sun, so excessive sun exposure to sunlight is often not noticed until they are burned. Children who are increasingly sensitive to sun may also develop a rash. These two points both highlight the importance of using a sunscreen in children.

2. What about conflicting reports I've read that sunscreen is preventing my kids from getting enough Vitamin D?

One important health benefit that sunlight has on human skin is the production of vitamin D.  During summer months, particularly in the southern latitudes, some individuals acquire enough sun exposure to achieve an adequate vitamin D level.  However, the ultraviolet rays that stimulate vitamin D production (UVB rays) are also the ones that cause premature aging and skin cancer.  When sunscreen is applied to the skin, it not only reduces sun damage, but it also blocks vitamin D production. 

Vitamin D can also be obtained from one’s diet and it occurs naturally in a small range of foods.  Some is present in milk, oily fish (e.g., salmon, mackerel, sardines), and fortified cereal or orange juice. Unfortunately, dietary sources alone are usually not adequate for a healthy blood level without the addition of sun exposure or a vitamin supplement.  Vitamin D deficiency can cause rickets in children, and osteoporosis in adults.  An increased risk of other medical illnesses, such as type 1 diabetes and multiple sclerosis, as well as cancer of the breast, colon, or prostate, might be linked to vitamin D deficiency.  More research is needed to validate these associations, but in the meantime it seems reasonable to take measures to maintain an adequate level of vitamin D.

Some authorities recommend "sensible" or routine limited sun exposure for vitamin D. However, many variables affect the amount of exposure time needed (ie. skin color, age, season, weather conditions, time of day), making it difficult to give a simple recommendation that would be assured to provide sufficient vitamin D for all age groups.

Therefore, regarding children, I tend to align myself with the recommendation of the American Academy of Dermatology which is to “Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't seek the sun.[2]”

3. Is the type of sunscreen I use important and why?

The type of sunscreen that you select for you children is important. Sunscreens are chemical or physical agents that help prevent the sun's ultraviolet (UV) radiation from reaching the skin. Two types of ultraviolet radiation, UVA and UVB, damage the skin and increase your risk of skin cancer.  UVB is the main culprit behind sunburns, while UVA rays, which penetrate the skin more deeply, are associated with wrinkling and other effects of photoaging. They also exacerbate the carcinogenic effects of UVB rays, and increasingly are being seen as a cause of skin cancer on their own. Sunscreens differ in their ability to protect against UVA and UVB.

SPF — or Sun Protection Factor — is a measure of a sunscreen's ability to prevent UVB from damaging the skin. Most sunscreens with an SPF of 15 or higher are good for protecting against UVB.  SPF 15 blocks approximately 93 percent of all incoming UVB rays; SPF 30 blocks 97 percent; and SPF 50 blocks 98 percent. As you can see, no sunscreen can block all UV rays and once you get above an SPF of 30, the difference in blockage is 1% or less. 

I recommend a broad-spectrum sunscreen offering protection against both UVA and UVB rays. The "water resistant" and "very water resistant" types provide the longest lasting protection (less reapplications required) and are especially good for hot, summer days or while playing sports, as they are less likely to drip into your children’s eyes.

Many of the sunscreens available in the US today combine several different active chemical ingredients that provide broad-spectrum protection. UVB protection is achieved with PABA derivatives, salicylates, and/or cinnamates (octylmethoxycinnamate and cinoxate).  Shorter-wavelength UVA protection is achieved with benzophenones (such as oxybenzone and sulisobenzone) and the remaining UVA spectrum is blocked with ecamsule (MexorylTM), avobenzone (Parsol 1789), titanium dioxide, or zinc oxide. Zinc oxide or titanium oxide are the least likely to irritate the skin, while benzophenone-3 or oxybenzone can be irritating to children's skin. Of note, higher SPF sunscreens contain higher concentrations of active ingredients which can lead to greater skin irritation at the higher concentrations.

4. How else can I protect my children from sun damage besides regular applications of sunscreen?

Of course, using a well formulated sunscreen is only one part of your child's skin protection needs. I recommend the use of sun protective clothing and hats and to keep children in the shade when possible.  Long-sleeved, unbleached cotton clothing is cool and comfortable, while also highly protective. Clothing with an Ultraviolet Protection Factor (UPF) listing on the label offers extra protection. Choose a wide-brimmed hat that protects face, neck, and ears.  It is best to avoid or limit peak sun exposure hours which are typically from 11 a.m. to 2 p.m. And don’t forget that eyes and lips are very sensitive to sun exposure and therefore need adequate protection. Given that small children rarely allow parents to keep sunglasses on them, this is another good reason to avoid any prolonged, direct sun exposure.

--A co-founder of Barnett Dermatology located on the Upper East Side of Manhattan, Dr. Channing R. Barnett is a board certified dermatologist with particular expertise in dermatologic and cosmetic surgery.  The cornerstone of Dr. Barnett’s successful Manhattan practice is her philosophy of using minimally invasive procedures for maximum skin care results and long-term benefit. In addition to her private practice, Dr. Barnett holds the academic appointment of Assistant Clinical Professor in the Department of Dermatology at Columbia Presbyterian Medical Center. She is also an Attending Physician in the Department of Dermatology at the James J. Peters VA Medical Center in Bronx, NY where she has her own clinical practice and where she teaches dermatologic surgery to the dermatology residents.

Visit Barnett Dermatology on the Web: barnettdermatology.com

Facebook: http://www.facebook.com/BarnettDermatology

Twitter: http://twitter.com/SkinCareDr

[2] http://www.aad.org/public/sun/smart.html

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