Columnists :: Kids Health With Dr Jack
Cooling off cases of sunburn by Jack Maypole, MD
MySouthEnd.com ContributorThursday May 31, 2012 Summertime. Time was when a child could run around for days on end in a bathing suit, carefree in pursuit of new adventures while being sunkissed dark by the sun. Well...maybe that isn’t such a hot idea, so to speak, after all.
Those cute freckles splashed across your kids’ cheeks? Sign of mild sun damage, actually. Doesn’t your child’s getting a "base tan" protect him from ultraviolet (UV) rays? Not nearly enough. Turns out, all of us parents would do well to rethink how we go about our fun in the sun. Forecast: not so dismal.
The ultraviolet rays that hit the earth, to tan or burn our skins, and potentially damage our tissues arrive here in two types, UVA and UVB. Many sunscreen products greatly reduce UVB ray penetration to the skin, and are rated by the well known SPF (sun protection factor) by many sunscreens on the market. UVA rays are less familiar to most people, but are no less harmful. UVA rays are not stopped as effectively by many sunscreens in use, and unlike UVB, they can pass through glass. Over a lifetime, there is a cumulative dose effect here: the more UV rays our skin absorbs over time, the more likely (and more quickly) that we’ll suffer long term problems, including wrinkles, age spots, and skin cancers like melanoma.
We can prolong or prevent our hitting our solar ’limit’; cancer isn’t inevitable.
Unfortunately, we Americans love our sun and don’t protect ourselves very well. In the US, most kids will have received up to 80% of their lifetime sun exposure (and thus, solar radiation) by the time they are 18. In any year, about a third of US adults get sunburned, and about 2/3 of kids get sunburned each summer.
What can you do? Plenty.
Research in adult studies has shown that people consistently apply too little sunscreen. Hey, the stuff is expensive, but people seem not to realize that it takes up to 2 oz of sunscreen to adequately cover an adult. For a school age child, figure at least half that much. While that still may seem like a bunch, it pays not to skimp. Putting on too little sunscreen effectively lowers the blocking or absorptive power of the product.
Swimming, or even sweating during exercise or in hot weather can decrease the amount of sunscreen on a child’s skin. Dermatologists recommend a generous application of screen at least 30 minutes before kids enter then sun to allow their absorption, and then reapplications at least every 2 hours. That is quite a lot. You may need to buy more tubes than you had intended for your next weekend at the beach.
I encourage parents choose sunscreens for their kids that protect against for UVA and UVB rays. Read labels. And, when picking by SPF, I recommend that parents use products rated at 30 or higher.
Dr Stephen White, a Maryland Dermatologist, bumperstickers the issue thusly: "I think children under 2 shouldn’t be out from 10 am to 3 pm (or 9-4) unless completely protected from the sun." Parents have to remember UV rays pierce clouds on sunny days, and can be reflected off water, pavement, or snow, making even shady areas less protected. How bright is too bright? "So, if you can take a photo without a flash," Dr White advises, "that’s too much sun."
First choice, is choosing a shady spot, and wearing comfortable, natural fiber clothing with a wide brim hat for the babes. Routine sunscreen use (again, spf 30 or higher!) is ok in kids over 6 months. For babies under six months, experts considered sunscreen a less preferred, but useable option if it looks like other measures won’t cover it, so to speak.
For the afflicted, sunburns hurt . For children and adults, the treatments are "supportive" (read that as meds plus TLC), using some tried and true first aid techniques. Peak redness usually occurs 6-12 hours after sun exposure. Discomfort can get pretty wicked, with the first wave of pain arriving usually the night of the exposure. It can last for up to a few days, so take care in picking up or hugging littluns with burnt shoulders. Ever had a whack on the sunburned back yourself? Be kind, be gentle.
Some children may experience a case of the unfortunately named "sun poisoning." This phenomena is real, and arises from a hypersensitivity reaction to sunlight, and may result in skin eruptions ranging from itchy bumps and patches of redness to unsightly and uncomfortable blistering on exposed areas. In many children, parents may observe that some areas of the body may be persistently more sensitive to recurrences with prolonged time under the sun. First line therapies: Antihistamines and avoidance of further exposure. Readily had Children’s Benadryl is a great start for the itchiness and inflammation.
For pain, my first recommendation is to use non steroidal anti-inflammatory medications, such as ibuprofen, in children over 12 months. Motrin is appropriate and effective. Cool moistened towels, comfortably chill baths (with a splash of lavender oil is nice), or applications of aloe gel may also provide relief. Topical anesthetic sprays may provide a few minutes of relief, but I encourage families to put their dollars and effort elsewhere.
If a child appears inconsolable with these comfort measures, or if a sun exposed area shows more significant injury, such as blistering, I advise worried parents to check in with their doctor’s office. For severe cases, when kids are not responding to a family’s best efforts, then an ER visit may be required for pain control. Fortunately, these miserable times are rare and are seldom life threatening. And yet: sunburn is a bummer. Bad cases are best avoided by the use of sunblock, and being judicious with clothing, hats, and being careful about being out at times of peak solar intensity.
Jack Maypole, MD is director of Pediatrics at the South End Community Health Center, and Director of the Comprehensive Care Program at Boston Medical Center, a clinic for children with complex and chronic illness. Portions of his articles are drawn from his blog found at thefastertimes.com/pediatrics.