To keep your family safe this summer, follow these tips from a pediatrician who's also a skin-cancer survivor.

By Wendy Sue Swanson, M.D.
May 01, 2014
Sun protection
Credit: Thayer Allyson Gowdy

When I dream about an ideal day with my children, I picture us outside, enjoying the warmth under a big blue sky. We'd play, run, picnic, swim, and cuddle. We'd read and tell each other stories and explore. Everything about my imaginary day works perfectly except for one problem: The entire day takes place in the sun.

I'm a pediatrician, so I've always been adamant about sun protection with my two boys, but it wasn't until I was diagnosed with malignant melanoma that I really learned how to be smart about the sun and change our future health risk. Everything feels different on this side of a skin-cancer diagnosis. The one solace for me is knowing how much I can do to avoid it happening to my boys.

The fact remains that over the past 30-plus years, malignant melanoma, the deadliest form of skin cancer, has risen in children and teens an average of 2 percent every year. But you can preserve your children's future health by being smarter now. One way we may be able to turn this around is by showing our children strong examples of how to play safely under the sun. Unfortunately, a 2013 study in The Journal of Pediatrics concluded that what pediatricians say in the exam room during checkups doesn't change families' behavior in the sun. It's also distressing to know that nearly a quarter of a person's lifetime sun damage occurs during the first 18 years -- although these are the years when our kids are still under our control! Following the guidelines below will help our children grow up to have fewer wrinkles, fewer moles, and perhaps less skin cancer from sun exposure. That's a huge win for our little sunshines.

Understanding the Sun

It's as simple as this: The sun gives off UV radiation that damages cells in our body. UVA rays play a major role in skin aging; UVB rays lead to burns. (An easy way to remember: A=age, B=burn.) But both contribute to cancer. The amount of UVA radiation is unwavering every day of the year, while UVB varies with the season and is most intense during summer. All skin-color changes -- freckles, suntans, and sunburns -- are a reflection of UVB damage, but you may not see the effects of UVA damage until you get wrinkles.

Remember that burns don't discriminate (neither does skin cancer), so even dark skin can burn and be damaged, though research has found that the risk of melanoma is more than ten times higher for people with white skin than it is for African Americans. More sun exposure during childhood may contribute to more moles developing later. And the more moles you have, the more likely it is that one could become cancerous. A mole can be congenital (meaning that a child is born with it or it develops during childhood without any sun exposure), but sun damage can also contribute to development of moles. One Canadian study found that children whose parents were educated on the use of sunscreen and given a hearty supply of it went on to develop fewer moles than those whose parents weren't given the educational materials or sunscreen.

You're used to hearing that it's ideal to have your kids outside every day for at least one hour of moderate to vigorous activity. At the same time, recent research from The Journal of Pediatrics found that children who play outdoor sports are twice as likely to use inadequate sun protection and get burned than those who don't. Since we know that one blistering sunburn in childhood more than doubles the risk of melanoma later, it's crucial to help our little athletes be cautious. "We want healthy, active children and this, of course, includes having them play outside. But part of keeping them healthy involves thinking about minimizing the damaging effects of the sun," says Parents advisor Lawrence Eichenfield, M.D., chief of pediatric and adolescent dermatology at Rady Children's Hospital-San Diego. Parents sitting in the stands and lining the sides of the field need to be careful too! So keep these strategies in mind.

Steer clear of midday sun. Do your best to avoid outdoor activities between 10 A.M. and 2 P.M. Select the 9 A.M. swim lesson over the one at 1 P.M. whenever you can. Plan an early-morning hike or a late-afternoon trip to the park. I see it this way: The sun is always more beautiful when it's near the horizon anyway.

Wear sun-protective clothing. Using rash guards, hats, and sunglasses is a very effective way to reduce sun exposure. (Lines such as Coolibar have UPF50+ hats and clothing for the whole family, including lightweight swim tights, tunics, golf shirts, and more.) Encourage your young athlete to wear a long-sleeved uniform whenever possible.

Don't confuse temperature with sun intensity. The sun is not necessarily stronger when it's hotter outside. In fact, you can get far more sun damage on a cool, clear day than on a warm, muggy one. Sun intensity is determined by a combination of where you are, what the weather is like, and the time of year. Even cloudy days in Seattle, where I live, can cause significant sunburn!

Know the UV Index every day. The risk from the sun's rays is reported by the Environmental Protection Agency (EPA) as a daily UV Index for most U.S. zip codes. This is calculated based on the amount of ozone, the elevation, cloud coverage, latitude, and time of year. Follow the UV Index score -- which ranges from "low" to "extreme" -- every day. By tracking it daily I've learned a ton about being outdoors safely, including the fact that it can be worrisome even on cloudy days. After I gave a presentation at my son's preschool, the teachers started posting the UV Index every day and using sunscreen during peak hours, even when the Index was moderate. Download the free SunWise app or search "EPA UV Index" online. Enter your zip code and voilà! Up comes your UV forecast.

Use sunscreen every day, all year. Keep it stashed in the car too, and know that it doesn't last forever. Sunscreens all have an expiration date, and after that point ingredients can be less effective.

Protect skin when skiing or even near the water. Snow, water, and ice can all act as a reflector and increase intensity of the UV radiation, making the risk for burn even greater.

Decoding Sunscreen

Labels can be confusing. Fortunately the FDA has created new rules for sunscreen labels. Manufacturers can no longer describe their products as "waterproof," "sweatproof," or "sunblock." Sunscreens labeled "water resistant" must state how long you'll be protected while swimming or sweating, and there will be only two options: 40 minutes or 80 minutes. Remember that you need to reapply every hour or two, especially if your child is perspiring a lot or playing on floats, slides, or other equipment where sunscreen could rub off easily.

The numbers

Choose "broad-spectrum" sunscreen with a sun protection factor (SPF) of at least 30. Broad spectrum protects your family from both UVA and UVB rays; 30+ SPF means you'll avoid more than 97 percent of UVB rays. Many sunscreens are labeled SPF 50+, but the FDA has not found that they're any more effective than SPF 50 products.

The ingredients

Some experts question the safety of oxybenzone, parabens, and vitamin A in sunscreen. But there is no definitive study that guides doctors in telling families what to avoid. Many doctors advise using the fewest chemicals possible, especially for babies and toddlers under 2, who have thinner and more absorbent skin. Opt for mineral-based ingredients such as zinc oxide and titanium dioxide, because they sit on top of the skin and therefore aren't absorbed.

The formulation

In general, buy the sunscreen you like best, whether it's spray, lotion, wipes, or stick. Avoid using a spray in the wind (none of it will make it onto your child); don't spray near the face. Be sure to use a lip product with SPF as well, since the skin on our lips is very thin and burns easily, and don't forget to reapply often.

The most important factor when choosing which form of sunscreen to use: Pick the one that provokes the least resistance from your kid! If your child squirms, kicks, and refuses to let you apply (or reapply) sunscreen, let her help decide which kind she likes. Once it's on, know that you've taken the absolute best step toward keeping your child's skin healthy.

All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. 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.

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