Sunscreen smarts

While I can’t trace their origins precisely, I’m pretty sure this patch of freckles on my chest is a result of the oozing burn I got on a family trip to Jamaica when I was in grade seven. And I suspect the lines around my eyes might be a little softer if I hadn’t spent countless childhood days at the cottage sans sunglasses or sunscreen.

So, I decided the same fate wouldn’t befall my daughter. I resolved to douse her in sunscreen, knowing I was not only protecting her from spots and wrinkles, but skin cancer too. Well, not so fast. First of all, you almost have to be a chemist to figure out the lingo on a bottle of sunscreen. Plus, there’s the worry of applying chemicals to delicate baby-soft skin. And then to top it all off, new studies report that perhaps sun exposure may actually prevent skin cancer.

So how do you best protect your family and still have fun in the sun? Today’s Parent posed that heated question to the experts.

Why should kids wear sunscreen?
“Skin has a memory,” says Ronald Vender, dermatologist and associate clinical professor of medicine at McMaster Health Sciences in Hamilton. “Sun damage at an early age remains throughout adult life.”

Damage caused by tanning and burning is linked to melanoma and non-melanoma skin cancers, and photoaging (wrinkling, discoloration, moles). So it follows that if you protect your kids’ skin from the sun, you’re lowering their chance of developing these conditions later in life.

However, Vancouver dermatologist Jason Rivers points out that sunscreen is just part of sun safety. “We know that skin cancer is primarily preventable. But what we don’t know is how effective sunscreens are in preventing all skin cancers,” says Rivers, who has served as the head of the Canadian Dermatology Association Sun Awareness Program. A proper study would take at least 20 years to conduct, he says. “So the data just aren’t there. If you use [sunscreen] as your only method of sun protection, then you are somewhat misguided.”

Two studies published in the Journal of the National Cancer Institute in the US earlier this year made a splash in the media; headlines blared that sun may actually prevent cancer. Here’s the deal: One study found that for patients with early-stage melanoma, sun exposure may actually increase survival rates. The other study found that increased sun exposure was linked to a decrease in the risk of non-Hodgkin lymphoma. However, Rivers points out that in both studies, there was an association with sun exposure, not a cause-and-effect relationship. Neither study “changes our public health message,” he says. “We know that sun exposure does play a role in causing skin cancer and we know that people die from skin cancer.”

What’s the best way to apply sunscreen?
Only 50 percent of Canadians actually use sunscreen regularly and, when we do, we often don’t use it properly. We tend to be stingy, says Elena Pope, head of dermatology at The Hospital for Sick Children in Toronto. “SPF [sun] is tested using a generous amount.” It should be white on the skin and then rubbed in, rather than applied in a thin layer. Use about two tablespoons — the size of a 35 millimetre film canister — to cover your child’s face, ears, neck, arms, back and legs.

Sunscreen needs time to absorb into the skin before it’s exposed to sunlight, so apply it about 15 to 30 minutes before heading outside.

And don’t forget commonly missed areas like the ears, backs of knees, nose, hands and feet.

I coated my daughter with sunscreen and she still burned in some areas. What happened?
In theory, the amount of time you are protected is the amount of SPF multiplied by the amount of time it would take the skin to burn without protection. So if you are using SPF 30 and the skin would normally burn in 10 minutes, you’re protected for 300 minutes, or five hours.

But that’s in carefully controlled laboratory studies that don’t take into account kids wriggling around while having sunscreen applied, rubbing it off while playing tag or sweating it away on the soccer field. Unfortunately, the only surefire way to know sunscreen has lost its efficacy is when it’s already too late and the skin has started to burn. Instead, reapply every two hours, say, or at every snack time, and always after swimming or sweaty play.

Is there a difference between sunscreens made for kids and those for adults?
“That’s mainly a marketing thing,” says Rivers. “You can use the adult ones for kids.”

“Children’s formulations may be slightly milder,” says Pope. But if your child isn’t prone to reactions, it’s not worth the expense to buy different sunscreens for adults and kids. She recommends parents test sunscreen on their child’s forearm before using it on the entire body.

If you’re looking for a sunscreen the whole family can use, choose one that’s unscented and has a creamy consistency that rubs easily into the skin.
How can I encourage my children to use sunscreen?
Make sunscreen application part of the everyday routine, like brushing teeth, says Pope. Sunscreen use should be a year-round habit — rays from the sun can cause skin damage no matter the season.

While the experts suggest making it a rule that no one in the family heads outdoors without slathering on the sunscreen, that’s easier said than done. However, if sunscreen is readily available — in the glove compartment, by the front door — you up the chance that it will get applied.

Products made for kids with cool packaging and scents may have greater appeal, although the actual ingredients aren’t that much different from other sunscreens. And, as with bike helmets, kids are more likely to use it if you do.

Older kids, smitten by the bronzed look (thank you, Paris Hilton), are a tougher sell. Teens are unlikely to be motivated by talk of skin cancer, says Pope, but they might be swayed by the prospect of moles and wrinkles.

Also, speak to your child’s daycare and camp to ensure that they use sunscreen and practise sun safety throughout the day.

My son got sunscreen in his eye. What should I do?
Sunscreen can cause irritation if it gets in the eyes. This is why it’s important to avoid the eye area during application (if he’ll tolerate them, use sunglasses with UVA and UVB protection instead). If sunscreen does get in the eyes, flush with water for 10 to 15 minutes, and see your doctor if the irritation continues.

Can sunscreens ever be harmful to children?
Sunscreens undergo intense safety studies before showing up on store shelves, says Pope. “I’m confident that children are not exposed to anything that may have long-term effects,” she says. Both the Canadian Dermatology Association and the Canadian Paediatric Society (CPS) advocate the use of sunscreen on children for the prevention of sun damage. (A quick terminology note: When we’re speaking generally, sunscreen refers to both blocks and screens.)

Some kids may have an allergic reaction — rash, redness or itchiness — to certain sunscreen agents. PABA tends to cause more reactions than other ingredients, which is why it is rarely included in sun creams anymore. However, it is difficult to guide parents on which ingredient is likely to cause a reaction in an individual child, since everyone’s sensitivities are different, says Pope. (See Label Watching, for the pros and cons of different types of sun protection products.)

Which do I apply first, sunscreen or insect repellent?
Sunscreen should go on first. If you choose a spray repellent, you won’t risk rubbing away either product. Sunscreen needs to be applied generously throughout the day; repellent should be used sparingly and when there are insects around (which is often at dusk, when sun protection isn’t really a factor anyway).

When can I start putting sunscreen on my baby?
The CPS says that infants can start wearing sunscreen at six months. But they should be kept out of direct sunlight, with sunscreen used only as extra insurance in case the sun can’t be avoided.

Last year, the American Academy of Pediatrics went slightly against this wisdom by stating: “when adequate clothing and shade are not available, parents can apply a minimal amount of sunscreen to small areas, such as the infant’s (under six months) face and the back of the hands.” The risk here, points out the CPS, is your baby may rub the sunscreen into her eyes or lick it.

Do kids get enough vitamin D if they use sunscreen?
None of the experts we spoke to cited this as a concern for the typical Canadian child. “There are so many other ways to get vitamin D if you have a balanced diet,” says Pope.

“As far as I know, there are no studies to show that you get a significantly lower vitamin D level in the face of significant sun avoidance,” says Rivers. Nor is there any research to suggest that applying sunscreen inhibits the body’s ability to manufacture vitamin D.

And while the new studies mentioned above hypothesized that vitamin D may play a role in cancer prevention and survival, Rivers is doubtful. “The amount of time you need to get your vitamin D is five to 10 minutes twice a week in the summertime. And exposure is needed only on the arms and the face.”

He adds that those with darker skin synthesize vitamin D less in the skin than those with lighter skin. If you’re concerned about vitamin D, rather than going without sunscreen, speak to your doctor about your child taking a supplement.

My son has black skin and he never seems to burn. Do I need to worry about sun protection?
Yes. Skin of all types and colours can get sun damage — including premature aging and skin cancer. Skin does not have to burn to be susceptible, so make sure you practise sun safety.

Label Watching
Broad spectrum sunscreens protect the skin against both UVA and UVB rays.

UVA rays cause photoaging (wrinkles, blotches, sagging) and may cause skin cancer. Parsol 1789 is the only UVA screen that filters the entire range of UVA rays.

UVB rays are the primary cause of most skin cancers. There are a vast number of anti-UVB ray ingredients. Warning: Padimate O, a popular UVB filter, can stain light-coloured clothing.

Sunscreens chemically absorb UV rays. Sunblocks (zinc oxide, titanium oxide) deflect rays. Sunblocks are a good choice for children who have sensitive skin or are allergic to sunscreen. However, they leave a white cast on the skin (they are not effective if they are rubbed in to the point of being invisible, says Pope). Note: The terms screen and block are sometimes used loosely — check the ingredients list.

SPF (sun protection factor) indicates how effectively product absorbs or reflects UVB rays (there is no standard for UVA rays). While the Canadian Dermatology Association (CDA) recommends SPF 15, our experts recommend at least SPF 30.

Water-resistant sunscreens hold up for 40 minutes in water, and waterproof ones for 80 minutes. These products also stand up well to perspiration.

Expiration date indicates how long the product will keep its optimum efficacy. This refers to unopened bottles; open bottles can lose their potency before the expiration date. If a sunscreen has passed its expiration date, throw it out — it may have deteriorated to the point that it’s useless.

You can also look for the CDA logo, which indicates the product meets the organization’s criteria for sun protection: It has an SPF of at least 15 and is not likely to cause skin reactions.

Beyond the Bottle
Sunscreen should be just one aspect of healthy sun protection, says Vancouver dermatologist Jason Rivers. Here are other ways to keep kids sun-safe:

• Wear hats with wide brims; baseball caps don’t offer enough protection.
• Encourage children to wear lightweight long sleeves and pants, when possible. And consider clothing that has SPF built in — many kids’ clothing companies offer brightly coloured full-coverage sunsuits.
• Seek shade. Choose play areas with lots of shady trees or bring along a sun umbrella.
• Try to limit time in direct sunlight to before 11 a.m. and after 4 p.m.
• Teach this rule of thumb: Be extra cautious when your shadow is shorter than you are (when the sun is at its strongest).