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Tips for a Healthy Day at the Beach

I always thought that skin docs stayed out of the sun as much as possible to reduce their risk of getting skin cancer. So I was a little nervous asking Elizabeth Alvarez Connelly, M.D., to go to the beach with me to talk about sun safety. "I take my children there practically every weekend," she told me. A pediatric dermatologist in Miami, Dr. Alvarez Connelly thinks you can let kids enjoy the outdoors -- and never have to deal with sunburn -- if you plan ahead. So sun and sand, here we come!

Her family arrives looking pretty much as I expected: The three kids (Abigail, 5, Lucas, 4, and Matthew, 2) are wearing wide-brimmed SPF 50 hats, ultraviolet protective sunglasses, and sunshirts (aka rash guards) while Dr. Alvarez Connelly is in shorts, a lightweight sweater, and an attractive sun hat. "The water's still a little cold for me to go swimming, but if it were warmer I'd have on my rash guard and sarong," she says. Her mom, who's come along to help watch the kids, is covered up too. The purpose of all this clothing: "The less skin you have exposed, the less sunscreen you have to put on," she tells me, rubbing SPF 50 sunscreen on the legs of Matthew, who's anxious to start playing with his sand bucket.

I thought you were supposed to apply sunscreen 30 minutes before you plan to be outside, so I ask why she's doing it now. "That's true for many sunscreens because they need to be absorbed into the skin," she says. "But, the one I use for the kids and myself contains zinc oxide and gives immediate protection."

"What about Matthew's cheeks?" I ask. She says the kids used sunscreen sticks on their faces in the car. "They like applying it themselves, and I just smooth out any clumps and make sure there's enough right under the eyes, which is an area parents tend to forget about." For her own face, Dr. Alvarez Connelly puts on SPF 30 moisturizing sunscreen and moisturizer daily.

"Mommy, Mommy, look at the naked man!" Lucas shouts. For a second, I'm thinking someone is in the buff. But thankfully it's a false alarm; Lucas is pointing at a dad in the water who just removed his drenched shirt. "Lucas is so accustomed to my rules of 'no shirt, no hat, no play' that when he sees a guy without a shirt, he thinks he's naked," explains Dr. Alvarez Connelly. "Actually, I'm surprised he hasn't said it sooner, because a lot of guys around here aren't wearing a shirt." She tells me that a regular shirt is usually the equivalent of SPF 5 or 10.

Moms aren't setting a better example, she says pointing to a bikini-clad woman in the water. "Her kids are in rash guards, so clearly she knows about sun protection, but she looks like she's out for a tan herself. Geez, I wish she'd put on a cover-up, if for no other reason than to send the right message to her children." A lot of women, Dr. Alvarez Connelly explains, have heard that two blistering sunburns in childhood can raise the chance of melanoma (the most serious skin cancer) later in life. But they think they can't do any more damage to their skin in adulthood so they don't bother. "That's completely off the mark because the two other kinds of skin cancer, basal and squamous cell carcinomas, are linked to how much sun you get over a lifetime, not just during childhood," she explains. Then, there's the matter of wrinkles, of course."

"But what if that mom has on SPF 70?" I say, playing devil's advocate. Her response took me off guard: "If you relied only on sunscreen, there's still a good chance you could get a burn." Even though higher SPFs give you added protection, most people, she explains, under-apply sunscreen. Women typically need an ounce to cover their whole body -- about as much as you'd get in a little cup of salad dressing when you order it on the side. "Since this woman is tall and in a bikini, she probably needs more than that," she says. "And she's at the beach only with her young kids, so who will put it on her back for her?"

A half hour into the trip, Dr. Alvarez Connelly calls the kids over for sandwiches, raisins, and trail mix. Lunch has a dual purpose. "It gets them under the umbrella and lets me dry them off and reapply sunscreen while they're distracted with something else," she says. "Abigail is at the hardest age now that she's swimming because she doesn't like to go in the water with a hat anymore."

She tells me about a study that was done at the University of Colorado. It showed that for every waterside vacation a family took when their kids were 1 to 7 years old, the kids had 5 percent more moles (a risk factor for skin cancer) despite using sun protection. "The parents likely didn't use enough sunscreen or reapply it often," says Dr. Alvarez Connelly.

I admit to her that last year my fair-skinned 6-year-old daughter had a discernible tan line by July despite the fact that I slathered on lotion. "How much damage did I do?" I asked.

"If she tanned gradually and didn't burn, it's not ideal but probably okay," reassures Dr. Alvarez Connelly. Her prescription: Get her a cute rash guard (to make it more comfortable, buy it a size bigger than usual because they're generally tight-fitting) and a swim skirt to cover some of her legs. We should also reapply sunscreen every 30 minutes when she's in and out of the water, and use sunscreen every single day, not just when we're going to the pool or park. "A lot of parents blow it off when it's not especially hot out yet," she says. "But you can get a sunburn when it's 60 degrees F just as you can when it's 90 degrees F."

If school-age girls are at the most difficult stage, what's easy? "Babies," says Dr. Alvarez Connelly, without hesitation. "The lowest rates of sunburn are in infants under 1 because you protect them with clothing, strollers, and other forms of shade."

After Matthew picks the M&M's out of his trail mix, he's ready to go back in the water. But he threw his hat into the ocean before lunch; now it's soaked. So Dr. Alvarez Connelly gives him Lucas's hat. A few minutes later, Lucas is done and says, "Mommy, I need my hat to play." Dr. Alvarez Connelly removes hers, adjusts it, and puts it on him. "Oh well," she says. "Everything can't be perfect. Next time, I'll remember to pack extra hats."

Originally published in the June 2010 issue of Parents magazine.