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Get Serious About Sun Safety

Okay, this question sounds like a no-brainer: Is sunscreen the key to protecting your family from skin cancer?

The answer: Yes -- and no. Of course, it's crucial to make sure your kids wear sunscreen whenever they're outside, but high-SPF products have given us a false sense of security. Too many parents assume they can just give their children a little spritz or smear and they'll be magically protected for hours. As a result, kids today may actually be spending even more time in the sun -- and may be exposed to more UV radiation -- than they were a decade ago.

"Wearing sunscreen doesn't make it safe for you to stay out in the sun all day, just like wearing a seat belt doesn't make it safe for you to drive 100 miles per hour," says Andrea Cambio, MD, a pediatric and adult dermatologist in New York City. If your child gets just one bad sunburn, his chance of getting melanoma -- the most deadly form of skin cancer -- doubles. Even if your child normally tans, her golden skin is still a sign of sun damage. Don't let our culture's obsession with bronzed celebrities fool you: About every hour, another person in the U.S. dies from melanoma, and 20 percent of Americans will get skin cancer during their lifetime.

In fact, melanoma, which is seen primarily in adults over age 50, now strikes kids as young as age 10. "We're definitely seeing more melanoma in children than we used to," says Parents advisor Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Children's Hospital, San Diego. This is partly due to the fact that the UV-blocking ozone layer has thinned -- another vital reason you need to be vigilant about protecting your kids.

But many of us are much too lax: In a poll of more than 3,700 Parents readers, only 38 percent of those surveyed said that they put sunscreen on their children every day in the summer, and only 7 percent do so year-round, as experts recommend. And pediatricians aren't always focusing on the problem either; a recent study in Pediatric Dermatology found that doctors only raise the issue of sun safety during 1 percent of all well-child checkups.

Here's the crucial medical message: It's estimated that your child will get more than half of his lifetime sun exposure before age 18, and smart sun protection throughout childhood can decrease his skin-cancer risk by 80 percent. And while most people know that sun exposure can cause cancer, far fewer know that even a mild sunburn suppresses the entire body's immune system -- possibly making a child more vulnerable to infections.

Sunscreen is only one aspect of skin-cancer prevention. Equally essential: limiting time in the sun between 10 a.m. and 4 p.m., seeking shade, putting on a hat, and wearing protective clothing. Although 94 percent of readers knew sunscreen was important, only 56 percent believed the same about hats, and just a third said either shade or clothing was crucial. Because steps you take now can save your child's life, we teamed up with the American Academy of Dermatology to give you the very latest information.

The sun has three kinds of ultraviolet rays with different wavelengths.

UVA leads to skin aging and cancer
UVB causes burning and cancer
UVC can't pass through the ozone layer

In the past, experts believed that UVA -- which accounts for up to 95 percent of all UV radiation that reaches the earth -- caused fewer cancerous mutations than UVB. But new research shows that UVA, which penetrates deep into the lower levels of skin, may actually be equally dangerous.

1. A sunscreen's SPF (sun-protection factor) is a measurement of how well it protects against sunburn. If you slather on an SPF 30 product, you should be able to stay in the sun for 30 times longer without burning than if your skin were bare. However, SPF only measures how well a sunscreen blocks UVB. There are no numbers that measure protection against UVA.

2. Clothing's UPF (ultraviolet-protection factor) reflects how much total UV the fabric blocks. UPF 50 means that only one-fiftieth of all UV rays (2 percent) can shine through.

You need to think about sun safety year-round -- whether you're at the beach, at a soccer game, or in your backyard. In fact, your child gets lots of little doses of UV when you don't even realize it -- while sitting in his stroller or even in the back seat of the car -- and they all add up. Here are smart ways to stay safe.

  1. Nurture your children's lotion devotion. Put sunscreen on them every day after they brush their teeth or before they get dressed. "If you get kids in the habit of wearing sunscreen when they're young, they'll be more likely to make it part of their routine as they get older," says Dr. Cambio.
  2. Fill a basket by your front door with sunglasses, hats, and sunscreen. Grab a bottle on your way out so you can put more on later in the day.
  3. Keep sunscreen in all your bags -- from your purse to kids' sports duffels. At the beach, keep it in your cooler; it'll feel refreshing when you reapply.
  4. Put tubes of SPF 30 lip balm in the pockets of frequently worn coats, backpacks, and purses.
  5. Pack sunscreen with your child for preschool or daycare, and talk to his teacher about reapplying it.
  6. Explain to your kids that too much sun is bad for their skin. "Just like you tell them about the dangers of smoking and the importance of eating healthy foods, talk to them about risks from the sun," says Susan Boiko, MD, a pediatric dermatologist at Kaiser Permanente, in San Marcos, California.
  7. Let your kids see you putting sunscreen on yourself -- and don't even think about going to a tanning salon.
  8. Make it fun to play in the shade. Get a UV-protective tent to use in your backyard.

Q. Do I need to be careful even if my child's skin tans very easily? Absolutely. "A darker-skinned child has more natural protection because of the melanin in his skin, but it's only the equivalent of an SPF 8," says Dr. Boiko. His risk of skin cancer is lower than that of a fair-skinned child, but you probably allow him to spend more time in the sun. Even African-Americans can get skin cancer. In fact, reggae legend Bob Marley died of melanoma when the cancer spread to his brain.

Q. Those sun-protective shirts seem so hot. Any good alternatives? Take a look at some of the latest offerings in sun-protective clothing, and you'll be surprised how the fabrics have gotten lighter, softer, and more breathable. "They're the best protection when your child is swimming because even waterproof sunscreen can't stay on for long periods of time in the water," says skin-cancer surgeon Susan Weinkle, MD, assistant clinical professor of dermatology at the University of South Florida, in Tampa.

Another option: Rit SunGuard Laundry Treatment UV Protectant ($20), which increases the sun-protectiveness of clothing and bathing suits.

Q. Is a pricey department-store sunscreen better than one I get at the drugstore? No. "You can choose an expensive product or a generic brand as long as it's at least SPF 30 and broad spectrum," says Dr. Weinkle. "Of course, if you're more likely to use the $25 sunscreen because it feels and smells better, then it's worth it." But if you'll apply sunscreen more generously because it's cheap, then stock up on a bargain brand.

Q. My child always has a tan line by the end of August. Should I really be aiming for no color at all? "Kids should get as little color as possible, but many still get some despite using sun protection," says Robert Brodell, MD, professor of dermatology at Northeastern Ohio University College of Medicine. If your child's tan lines show a big contrast, you need to do more to block those rays.

Q. Does sunscreen expire? Yes, and many products carry expiration dates. If yours doesn't, it's probably good for up to three years after you buy it. But if you're applying adequate sunscreen -- about an ounce (two tablespoons) for one's entire body -- you should use several bottles in a season. In fact, a 6-ounce bottle should last a family of four only one day at the beach if everyone reapplies once. If your bottle lasts for months, you're not using enough.

Q. How can I protect my baby? Infants shouldn't be out in direct sunlight because their skin is too sensitive. Protect your little one with a hat and light clothing, and make sure he's shielded in his stroller or baby carrier. Pediatricians now say it's safe to use sunscreen on areas that you can't avoid exposing, such as arms and legs, but keep it away from the eyes and mouth. "Look for brands that contain titanium dioxide or zinc oxide," Dr. Cambio says. "These are called 'physical blockers' because they aren't absorbed by skin but stay on the surface and act like an umbrella to keep damaging rays out."

"You can buy the best sunscreen, but it won't protect you if you don't apply it properly," says pediatric dermatologist Virginia Sybert, MD, clinical professor of medical genetics at the University of Washington, in Seattle. Here's how.

  • Get an early start. Put sunscreen on all sun-exposed areas at least a half hour before going out so it has time to be absorbed into the skin. If you put it on your child before she gets dressed, you'll be less likely to miss spots.
  • Use more than you think you need. When manufacturers test a sunscreen's SPF, they're required to apply a thick layer to skin. "Most people don't use half that much," says Dr. Boiko. "Put enough sunscreen on your child's skin so that it's visibly white, like butter on a bagel, and then rub it in until it disappears."
  • Don't forget to reapply. Put on more every two hours and right after kids get out of the water -- even if your sunscreen says "waterproof" or "one application lasts all day." Surprisingly, the FDA has no approved regulations about these types of claims on labels, and most sunscreens wear off in the sun and water, especially after kids towel off. In fact, lawyers recently filed a class-action suit against several sunscreen manufacturers alleging that labels mislead consumers.
  • Remember these spots. People often overlook the ears, nape of the neck, chin, tops of the feet, backs of the hands, part in the hair, and any sparse spots on the scalp. "Little boys often wear baseball caps, but their ears stick out," says Dr. Weinkle. "I see lots of skin cancer on ears." Stick sunscreens are especially good for these areas because they don't drip.
  • Pucker up. A recent study found that 63 percent of sunscreen users don't protect their lips -- another common spot for skin cancer. Don't use petroleum jelly on your child's lips when she's going outside. It offers no protection and actually attracts more sun. Instead, use lip balm with an SPF 30, and reapply it often.
  • Don't save it for sunny summer days. The sun's reflective powers are great -- 17 percent on sand and 80 percent on snow. Even when it's cloudy, 80 percent of invisible UV rays still hit your child's skin, and they can cause surprisingly bad burns.

Fun in the Sun

Children need to get used to wearing sunscreen. It's as essential as bathing and brushing their teeth. Here's how to avoid a daily struggle.

  1. Get a kid-friendly brand. If she likes Barbie, get Barbie sunscreen or one in a pink bottle.
  2. Let him apply it himself first. Don't worry about the mess. Once he's done, you can give him a good once-over yourself.
  3. Use your imagination. Tell your child that sunscreen is special "makeup" or "paint," and write words or letters on her body (and let her do the same to you).
  4. Find the form he likes best. Experiment with foams, sport creams, gels, and no-rub sprays.

  • Sun Signals UV Sensors ($6) stickers change color when it's time to apply more sunscreen -- so your kids won't put up a fight.
  • Body Glove's Rashguard ($25-27) lets kids avoid burns too -- just like surfers do.
  • Lands' End Kids' Swimsuits are all now made with UPF 40 fabric.
  • Sun Smarties Infant Cabana ($50) is SPF 50 and pops up and folds down in less than 10 seconds. [Update: This item is currently unavailable as of 2012]
  • Baby Blanket Sun Protectors ($10) sunglasses have an adjustable elastic strap and 100 percent UV-protective lenses.
  • L.L.Bean's Toddler Sun Protector Hat ($12.50) is made of lightweight UPF 40 fabric and prevents red necks. [Update: This item is currently unavailable as of 2012]
  • Coolibar's Two-Piece Swim Set ($49) is made from a special UPF 50 fabric containing titanium dioxide.

Savvy Screens

  • Aveeno Baby Continuous Protection Sunblock Lotion SPF 45 ($14) is gentle, broad spectrum, and fragrance-free.
  • No-Ad Disney Sun Pals Sunblock with SPF 30 or 45 ($10) has Ariel, Winnie the Pooh, or Nemo on the bottle.
  • Hawaiian Tropic Baby Faces & Tender Places SPF 50+ Stick ($7) is great for the face and ears.
  • Blue Lizard Australian Sport Suncream SPF 30+ ($12) contains several broad-spectrum ingredients, and the bottle turns blue in the sun.
  • Coppertone Kids Continuous Spray SPF 50 ($10) uses air-spray technology so you can quickly cover a large area.

Sunscreen Essentials

If you're like 58 percent of the Parents readers we polled, evaluating sunscreen labels can seem like reading a chemistry textbook. Here are the most important things you need to know when you shop.

  1. Buy at least SPF 30. Many experts say that SPF 15 is plenty, but going higher gives you a crucial margin of error. "If you don't apply enough -- which most people don't -- then an SPF 15 will only be an SPF 6 or 7," says Dr. Boiko. "If you don't use enough of an SPF 30, it may be equivalent to an SPF 15."
  2. Choose one that says "broad spectrum," "multispectrum," or "UVA/UVB protection." This means it protects against both UVB and UVA rays (although not necessarily equally). Look on the ingredient list for avobenzone (aka Parsol 1789), titanium dioxide, zinc oxide, or oxybenzone. All of these ingredients shield against both types of rays.

Don't Forget Sunglasses!

Your child's future's so bright, she's gotta wear shades. Sun exposure can damage her eyes, so make sure they're protected.

  1. Read the fine print. Choose sunglasses labeled "100% UV protection."
  2. Let your child choose a style he likes. Look for frames in his favorite color or decorated with characters he loves. "Once older kids see that celebrities and rock stars wear sunglasses, they'll want a pair," says Dr. Brodell.
  3. Even babies need shades. Your baby may take them off at first, but keep trying until she gets used to them. Look for ones with an elastic strap.
  4. Set a good example. If you wear your sunglasses, your kids are more likely to wear them.

Lessons from the Land Down Under

With the highest skin-cancer rates in the world, Australians have made sun prevention a public-health priority. It's too early to tell the full impact of this campaign, but the country's skin-cancer rate has started to decline. Here's what we can learn from them.

  • Cover up. The Aussie mantra: Slip! Slop! Slap! That means slip on a shirt with long sleeves and a collar, slop on sunscreen, and slap on a hat with a 2- to 3-inch brim that shades the nose, ears, and back of the neck. Many Australian schools have uniforms made of sun-protective fabrics and don't let students play outdoors unless they Slip! Slop! Slap! Try talking to your child's school about a similar policy.
  • Focus on fabric. Australians were the first to realize that regular clothing doesn't offer as much protection as people think. They pioneered ways to manufacture UV-blocking fabrics (including using tighter weaves and treating material with special chemicals), launched sun-protective clothing lines, and created the UPF rating system.
  • Be shady. Australians have built many shaded playgrounds and public places, and we need to do the same. One way is with the American Academy of Dermatology's Shade Structure Program, which offers $8,000 grants to nonprofit or educational organizations that need shade in an outdoor spot like a playground, eating area, or baseball dugout. For an application, go to aad.org.

The Vitamin D Debate

There is one known health benefit of sunlight: It triggers the production of vitamin D. Some pediatricians are concerned that kids aren't getting enough of this bone-building nutrient because there's been a small increase in rickets cases in the U.S. Could sunscreen be to blame? Most kids can get all the vitamin D they need from their diets and incidental sun exposure while using sunscreen, according to a study in the Journal of the American Academy of Dermatology that reviewed all the scientific evidence. "Sunscreen doesn't completely block UVB, which causes the skin to produce vitamin D," says researcher Barbara Gilchrest, MD, professor of dermatology at Boston University School of Medicine. Most of the children with rickets have been African-American or had dark skin, in which abundant melanin absorbs UV and reduces vitamin D production. "If your child has dark skin, spends little time outdoors, or doesn't drink fortified milk or orange juice, talk to your doctor about a vitamin supplement," Dr. Gilchrest says.

Copyright ? 2006. Reprinted with permission from the June 2006 issue of Parents magazine. Reviewed and updated 2012.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.