The Great Coverup

Four families put their sun-safety routines to the test -- and it turns out there's plenty of room for improvement. What could you be doing differently this summer?

Everyone knows how harmful ultraviolet rays can be to a child's skin. But it's worth repeating. "Most skin cancers and precancers, which are likely to develop into tumors, are due to a lack of sun protection in childhood," says dermatologist Anna Paré, M.D., of Dermatology Consultants in Atlanta. "Nearly all of the damage we get, including wrinkles, dark spots and fine lines, is from exposure before age 18." So we asked families to share their sun-protection practices. This is what they're doing right, and what they -- and all of us -- can do to keep our kids safe.

The family

Kristen Williams and her daughter, Lilian

Kristen Duncan Williams, Eliot Shepherd, and Lilian, 5, of Brooklyn, New York

Sun strategy

They use spray sunscreen on their body and stick sunscreen on their face. "Spray was life-changing for me," says Kristen. "I think of my poor parents chasing us around the beach with palms full of greasy lotion and I'm so grateful." They also bring a large umbrella to the beach and place an inflatable pool beneath it; Lilian uses it to house her collection of crabs, shells, and other beach finds.

The challenges

Kristen spends so much time making sure her child is well-slathered that she often forgets to cover herself. She also can't stand the feeling of sunscreen and sand on her hands, making it even less appealing to apply SPF after she's put it on Lilian. While vigilant about sunscreen at the beach, Kristen and her husband did once forget to put it on Lilian before camp. The result was only a minor sunburn -- but it was enough to generate guilt.

What the dermatologist says

"Kristen and Eliot are doing an excellent job keeping their daughter well covered, and having her play under an umbrella with the little pool is a great idea," says Dr. Paré. "But they should use a lotion with an SPF of 30 or higher before they leave the house year-round, to create a first layer on their skin. It's easy to miss spots when you use a spray sunscreen, so I recommend it for reapplication only. As for Kristen's aversion to having sandy, sticky hands, baby wipes should easily take care of the problem."

The Mann family

The family

Edie Mann and her family

Edie and Patrick Mann, and Chloe, 5, and Tyson, 4, of Broomfield, Colorado

Sun strategy

The family often spends full days at the pool. Edie, who is fair-skinned, covers her body and scalp with sunscreen spray and puts tear-free sunscreen on her face. She had blistering sunburns as a teenager, and both her father and grandmother developed basal cell carcinoma, the most common form of skin cancer. But she rarely applies any sunscreen to her children, whose father is African American. "Their skin just gets beautifully mocha," she explains. "They do not burn. I'm sure in extreme conditions they could, but they never have. I'm equal parts lazy and coveting their beautiful skin as it tans." Everyone wears hats and shades, but not diligently, Edie admits.

The challenge

Both children have asked if they can take sunscreen to school because the teachers put it on the other kids. Edie says she intends to send it so they don't feel left out, but always forgets.

What the dermatologist says

"It's a big myth that African-American skin doesn't burn. Ultraviolet exposure results in sun damage for people of every race, so a child who is African American and Caucasian and doesn't wear sunscreen is getting plenty of damage, which puts them at risk for cancer too. Although the children's skin may be beautiful now, it certainly won't stay that way if their parents don't start using sunscreen on them. At the very least, they'll get brown spots and textural changes that will come significantly sooner than if they'd been protected as children. To remember the sunscreen, the Manns can try packing it in their kids' lunch boxes or backpacks and leaving it there until the bottle needs to be replaced."

The Sylvester family

The family

Sylvester family at the beach

Aly and C.J. Sylvester, and Nina, 10, David, 8, Mary, 6, and Mark, 4, of Wilton, Connecticut

Sun strategy

Summer for the Sylvester kids means splashing around in their backyard swimming pool. Aly and C.J. use stick sunscreen on the kids' face and cream on their body; they each use spray for their own body and cream on their face. "Our children are better about using sunscreen than we were as kids," says Aly, who adds that they line up patiently for sunscreen before school and camp, and remind her if she forgets. Neither the adults nor the kids wear hats or protective clothing at the pool, but Mom and Dad do wear sunglasses. And when they head to the beach in Maine for two weeks, Aly tries -- not always successfully -- to get the kids to wear a sun-protective shirt when swimming and playing.

The challenges

"We have to be careful with David's ears, because he has a crew cut and spends most of his time playing sports or swimming," says Aly. Also, it's tough to get the kids to come out of the pool, dry off, and reapply sunscreen. "We do it every few hours," she says, though they're more vigilant at the beach.

What the dermatologist says

"Playing in the pool all day long equals a lot of sun exposure. At the very least, the kids should be reapplying water-resistant sunscreen every two hours when they're in the pool, just as they do at the beach. The kids should wear their sun shirts in the pool as well as at the beach. The sun's UV rays are strongest between noon and 4 p.m., so ideally the kids can come inside for lunch, or at least eat in the shade. As for David and his crew cut, many men develop precancers and skin cancers on the tips of the ears and on the scalp from sun exposure. So make sure those areas are always covered. It'd be good for the Sylvesters, and every family with a pool, to have a basket of waterproof sunscreens nearby. But keep the basket in the shade; sunscreen can become less effective if it's heating up all day. Set your phone timer as a reminder to reapply."

The Asturias family

The family

Asturias family

Kathryn and Tom Asturias, and daughters, Maya, 5, and Ava, 3, of Irving, Texas

Sun strategy

Protecting young children from the blazing Texas summer sun means sending them to day care with plenty of sunscreen whenever the weather is nice enough to go outside. Kathryn chooses sprays and lotions with the highest SPF she can find, and keeps some at day care -- which has two swimming pools -- so the teachers can reapply before recess. The girls also wear sun-protective swimsuits, hats, sunglasses, and rash-guard shirts. At home on weekends, they try to limit time in the sun, but when they are out for long periods, they reapply sunscreen every half hour.

The challenges

Maya and Ava have sensitive skin and occasional eczema outbreaks, triggered by heat and chlorine. Prescription medications ease the eczema at night, but Kathryn forgoes it during the day for sunscreen. "Our pediatrician told me that the girls will probably outgrow the eczema," says Kathryn.

What the dermatologist says

"The children are being well protected from sun damage, but Kathryn and Tom may be able to avoid aggravating the eczema flare-ups by choosing sunscreens with titanium dioxide and zinc oxide, which physically block the sun. They might also consider Vanicream, an over-the-counter moisturizer for kids with eczema. It can help for a child who has a chronic skin disorder to consult with a dermatologist, who can test for potential skin allergies that might be making the eczema worse. Kathryn shouldn't worry about choosing an SPF above 30, because the higher amounts don't provide significantly better protection."

Should your child see a derm?

Most of the sun-related concerns you have about your child's skin can be addressed during regular checkups with a pediatrician. See a dermatologist if your child sunburns or freckles easily -- this is associated with a higher risk of moles and skin cancer, says Parents advisor Lawrence Eichenfield, M.D., chief of pediatric and adolescent dermatology at the University of California, San Diego, and Rady Children's Hospital. Kids who have more than 30 moles or a strong family history of skin cancer should also visit a derm. What constitutes a strong family history of skin cancer? If either parent has had melanoma (the most deadly form of skin cancer), unusually shaped moles, or moles that have required a biopsy, a derm should do a baseline evaluation of the child's skin -- and should also check out any mole that's changing and looks different from the other moles, adds Dr. Eichenfield.

Don't Forget the Eyes

"The sun can damage the eyes just as it can damage the skin," says Dr. Lawrence Eichenfield. "Children need good sunglasses to reduce the cumulative risk of cataracts, and also to give added protection to the sensitive skin around the eyes." Look for shades that absorb 100 percent of ultraviolet rays and that, ideally, wrap around your child's eyes so that sunlight can't come in through the side of the frames. Try them on your child before you buy, and make sure you can't see her eyes when she's wearing them -- this is how you'll know they block out enough light.

Originally published in the June 2013 issue of Parents magazine.

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