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Elaine Siegfried, MD

With the warmer weather, many kids are heading outdoors, which can be a great way to get exercise and enjoy spring and summer. But medical specialists warn of the dangers of getting sun-burned.

A sunburn can be very painful, but the most serious long-term risk is skin cancer. Dr. Elaine Siegfried, a pediatric dermatologist at SSM Cardinal Glennon Children’s Medical Center and Saint Louis University School of Medicine, explains that a clear link exists between getting blistering sunburns and an increased risk of skin cancer later in life.

The risk exists not only for the most common forms of skin cancers – basal cell carcinoma and squamous cell carcinoma – but also for the potentially fatal malignant melanoma. Dr. Siegfried notes that basal and squamous cell cancers are localized on the skin and rarely spread to internal organs, making treatment less complicated. But melanoma can spread throughout the body – especially if not detected early.

People with all skin types can get sun-burned, but very fair skinned people are at highest risk for cancer. Dr. Siegfried notes that this includes children who burn easily and seldom tan – usually those with blond or red hair, blue eyes and freckles.

Freckles can be cute, but freckled kids also tend to burn easily.  Dr. Siegfried notes that freckles represent a defective attempt by  skin cells to distribute melanin – the brown-black pigment that gives skin color.

Dr. Siegfried adds that children in families with lots of moles and skin cancer also should be especially cautious because these traits are associated with an increased risk of skin cancer, particularly melanoma.

Kids of course don’t worry about skin cancer –but parents do.  Rather than worry, parents can take simple steps to reduce the risk—the most straightforward being to keep children out of the midday sun.

“The cardinal rule of protecting against sunburn is to avoid exposure at the peak hours of the day, so play outside before 11 and after 3,” Dr. Siegfried says. The mid-day rule also applies on cloudy days, Dr. Siegfried continues, because clouds may not block the sun’s burning rays.

 UVA rays cause tanning, but also aging of the skin and contribute to cancer risk. UVB rays cause burning, even on cloudy days.

If children are playing outside at midday, Dr. Siegfried suggests seeking shade. The next best protection is generous use of sunscreen products, but parents should read the labels and look for products that are waterproof, rub-poof and protect against a broad spectrum of rays – both the tanning and burning rays.

Dr. Siegfried notes that higher SPF (sun protection factor) numbers, such as 50, may not offer superior protection.  Products with SPF of 15-20 are adequate for most children who are not exposed to prolonged or intense sunlight when applied in sufficient quantity and reapplied according to package directions.  Children whose skin is sensitive to ingredients in sunscreens may get itching or a rash within one to two weeks after application.  If your child cannot tolerate sunscreen she recommends zinc oxide – the white ointment long favored by lifeguards to protect their noses.

Be sure to apply the sunscreen to all exposed surfaces. This includes the tops of the ears, back of the neck, the part in the hair and even the tops of little feet.

Clothing also can be used to protect the skin from sun. Dr. Siegfried suggests holding material up to the light to test it. Choose a tightly woven fabric, but keep in mind that some knit fabrics may stretch when they are wet. Try wide-brimmed hats: Little girls at least may love them and they offer great protection.

Very young infants have not developed melanin protection from gradual sun exposure, so infants are more susceptible to sunburns than older family members. Package labeling on most sunscreens cautions against application to babies younger than six months of age, because these products have not been specifically tested in this vulnerable age group.  So the safest approach for babies is to provide shade, such as an umbrella, a wide-brimmed hat or a stroller awning.  When shade is not available, generic 20-40 percent zinc oxide ointment is a safe and effective alternative that can do double duty to protect against diaper rash.

Excessive sun exposure also is widely known to be associated with premature aging of skin. Again – kids don’t worry about this and may not need to for decades – but the big risk is for cancer, Dr. Siegfried emphasizes.

“If a child gets a sunburn today, the worst thing that can happen is that they have pain and redness and maybe blistering,” Dr. Siegfried says. “The pre-cancerous damage that occurs also won’t show up for years, but it’s a good reason to protect kids.”

If cancer were not worry enough – a long history of sun exposure also is associated with increased risk for cataracts in adults. Dr. Siegfried says that the best protection is sunglasses, which, fortunately, many kids think are cool.

More information about helping kids to enjoy summer safely – without getting excessive sun – can be found in the KidsHealth Library.

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