Fact sheet - Sun protection and babies (0-12 months)

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Fact sheet - Sun protection and babies (0-12 months)


This fact sheet is endorsed by the Australasian College of Dermatologists

Summary statement

Too much ultraviolet (UV) radiation can cause sunburn, skin and eye damage, and skin cancer. Overexposure to UV during childhood and adolescence is a major factor in determining future skin cancer risk[1][2][3][4].

A baby’s skin is sensitive and can burn easily[5]. The mechanisms are unclear, but the skin is particularly susceptible to the harmful effects of solar UV during childhood. The possibility that sun exposure during childhood stimulates the initial mutational step in the development of melanoma is supported by epidemiological research[6]. The cumulative nature of sun damage indicates that infants should be protected from exposure to UV from the day they are born[7]. It is recommended that infants under 12 months are always well-protected from direct sun when UV levels reach 3 or above.

When UV levels are below 3, sun protection is generally not required and a few minutes of direct UV exposure is considered safe and healthy for babies. However, if spending longer periods of time outdoors during low UV periods, it is recommended that your baby is wrapped or dressed in clothing that covers as much skin as possible, wears a hat and is kept in the shade.

Parents and care providers are encouraged to access UV levels and the daily sun protection times for their location which are available in the weather section of the newspaper, at Cancer Council's website www.myuv.com.au, on the free SunSmart app, and at the Bureau of Meteorology website.

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Recommendations

To protect babies from solar UV, Cancer Council Australia recommends using a combination of sun protection measures whenever UV Index levels reach 3 or above as shown by the daily sun protection times.

Plan daily activities to ensure the baby is well protected from the sun. Aim to minimise time (or take particular care) outside during the middle hours of the day during the summer period when UV levels are at their strongest. These vary depending on your location in Australia, so checking the UV index is recommended.

Children often copy those around them and learn by imitation. Research shows that if adults adopt sun protection behaviours, the children in their care are more likely to do the same[8].

  • Use a combination of sun protection measures and never rely on just one:
    • Seek shade. Make use of any available shade for the baby's pram, stroller or play area. The material used should cast a dark shadow. UV can be scattered or reflected so even in the shade, other sun protection methods should be used. Consider using a cover for the car windows. Untinted clear auto glass (side windows) blocks almost all UVB radiation, but only 21% of UVA radiation[9].
    • Slip on clothing that covers as much of the baby’s skin as possible. Choose cool, loose fitting clothes and wraps made from densely woven fabrics. Some fabrics have an ultraviolet protection factor (UPF) rating. The higher the UPF, the greater the protection provided by the fabric. If possible, choose fabrics that are at least UPF15 (good protection), but preferably UPF50 (excellent protection).
    • Slap on a broad-brimmed, bucket or legionnaire style hat so the baby’s face, neck and ears are protected. For young babies, choose a fabric that will crumple easily when they put their head down. Consider the hat’s size and comfort, the amount of shade it provides to the face, if it will obstruct vision, hearing or safety. Hats that can be adjusted at the crown are best. If the hat is secured with a long strap and toggle, ensure it has a safety snap, place the strap at the back of the head or trim the length so it doesn’t become a choking hazard.
    • Slop on sunscreen. Sunscreen should be used as the last line of defence after clothing, a hat and shade. Because very young babies (less than six months of age) absorb more of any chemical applied to the skin than adults, the widespread regular use of chemical sunscreens is not recommended[10]. Instead, avoiding direct sunlight and using a reflectant sunscreen on the areas of skin left exposed, is preferred. (Please see below for more information about chemical and reflectant sunscreens). Sunscreen should be applied 15–20 minutes before going outside. To help ensure it is effective sunscreen should be reapplied every two hours, or more often if it has been wiped or washed off. Always test the sunscreen on a small patch of the baby’s skin to ensure there are no reactions.
    • Slide on some sunglasses, if practical, to protect the eyes. Look for sunglasses that are labelled AS/NZS 1067:2016 and are a close fitting, wrap-around style that covers as much of the eye area as possible. Some babies’ sunglasses have soft elastic to keep them in place. Toy or fashion-labelled sunglasses do not meet the requirements for sunglasses under the Australian Standard and should not be used for sun protection.
  • Check the baby’s clothing, hat and shade positioning regularly to ensure s/he continues to be well protected from UV.

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Sunscreen use and babies

Physical protection such as shade, clothing and broad brimmed hats are the best sun protection measures. If babies are kept out of the sun or well protected from UV radiation by clothing, hats and shade, then sunscreen need only be used occasionally on very small areas of a baby’s skin.

Sunscreens work in two ways:

  • Blocking or reflecting the UV radiation away from the skin. These are known as reflectant or physical sunscreens, such as zinc oxide and titanium dioxide. Reflectant sunscreens may take on a milky-white appearance when applied to the skin.
  • Absorbing UV radiation, preventing it from getting into skin cells. These are called absorbent or chemical sunscreens and usually containing a mixture of synthetic chemicals, such as cinnamates, dibenzoylmethanes (salicylates) and benzophenones. Absorbent sunscreens are usually invisible when applied to the skin.

The Australasian College of Dermatologists does not recommend the widespread regular use of chemical sunscreens in very young babies (less than six months of age), as they absorb more of any chemical applied to the skin than adults[10]. However, physical sunscreen can be used on the areas of skin not covered by clothing and a hat.

Some babies may develop minor skin irritation in response to sunscreen use. True allergic contact dermatitis to the active chemicals in sunscreen is very rare, but may result from reactions to preservatives or perfumes in the product.

Sunscreen milks or creams formulated for sensitive skin usually contain titanium dioxide or zinc oxide and are less likely to contain alcohol or fragrances that might irritate the skin. It is recommended to first test the sunscreen on a small area of the baby’s skin to check for any skin reactions, which can take up to 48 hours to develop. As with all products, use of any sunscreen should cease immediately and medical attention should be sought if any unusual reaction is observed.

Vitamin D

A lack of UV exposure can lead to low vitamin D levels. Vitamin D is produced when the skin is exposed to UV radiation and is necessary for the development and maintenance of healthy bones and muscles.

There is no evidence to indicate Australian children are low in vitamin D and most babies and children will get enough vitamin D from their daily exposure. Babies with darker skin types may produce less vitamin D[11]. Vitamin D deficiency can also be a problem in chronically ill, or institutionalised children[12] and in babies of vitamin D deficient mothers[13]. However, because Vitamin D is only produced for the first few minutes of sun exposure each day[14], extended and deliberate sun exposure without any form of sun protection is not recommended, even for those diagnosed with vitamin D deficiency.

If you are concerned about a baby’s vitamin D levels, it is best to speak with a doctor.

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Nappy rash

Nappy rash includes a number of inflammatory skin conditions of the groin and buttock area that are direct or indirect result of wearing nappies. Nappy rash is extremely common and generally results from a combination of factors that begin with prolonged exposure to moisture from urine and faeces. Appropriate recommendations include frequent nappy changing, applying barrier creams to the affected areas and exposing the inflamed area to the open air as much as possible[15]. The practice of exposing a naked baby to direct or indirect sun puts them at high risk of sunburn and skin damage and therefore is not recommended.

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Jaundice

Neonatal jaundice generally only causes concerns in about 10% of babies[7]. Treatment for jaundice should be under medical supervision in a controlled environment. Exposing babies to direct sun is inappropriate to treat neonatal jaundice.

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Fact sheet details

This fact sheet was developed by Cancer Council Australia's National Skin Cancer Committee. The fact sheet was externally reviewed by Dr. Vanessa Morgan, Dermatologist. It was endorsed by Cancer Council Australia's principal Public Health Committee and published in April 2017.

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References

  1. Armstrong B. How sun exposure causes skin cancer: An epidemiological perspective. In: Hill D, Elwood JM, English DR. Prevention of Skin Cancer. Dordrecht, Netherlands: Kluwer Academic Publishers; 2004. p. 89-116.
  2. Whiteman DC, Whiteman CA, Green AC. Childhood sun exposure as a risk factor for melanoma: a systematic review of epidemiologic studies. Cancer Causes Control 2001 Jan;12(1):69-82 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11227927.
  3. Khlat M, Vail A, Parkin M, Green A. Mortality from melanoma in migrants to Australia: variation by age at arrival and duration of stay. Am J Epidemiol 1992 May 15;135(10):1103-13 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1632422.
  4. Autier P, Boyle P. Artificial ultraviolet sources and skin cancers: rationale for restricting access to sunbed use before 18 years of age. Nat Clin Pract Oncol 2008 Apr;5(4):178-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18268545.
  5. Seidenari S, Giusti G, Bertoni L, Magnoni C, Pellacani G. Thickness and echogenicity of the skin in children as assessed by 20-MHz ultrasound. Dermatology 2000;201(3):218-22 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11096192.
  6. Armstrong BK. Epidemiology, causes and prevention of skin diseases. In: Grob JJ, Stern RS, MacKie RM, Weinstock WA. Melanoma: childhood or lifelong sun exposure. Carlton: Blackwell Science; 1997 Available from: http://ebookscentral.com/book/67645/epidemiology-causes-prevention-skin-diseases#.
  7. 7.0 7.1 Hurwitz S. The sun and sunscreen protection: recommendations for children. J Dermatol Surg Oncol 1988 Jun;14(6):657-60 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3372848.
  8. Dobbinson S, Fairthorne A, Bowles K-A, Sambell N, Spittal M, Wakefield M. Sun protection and sunburn incidence of Australian children: summer 2003–04. Melbourne: Centre for Behavioural Research in Cancer, Cancer Council Victoria; 2005 Jul.
  9. Bernstein EF, Schwartz M, Viehmeyer R, Arocena MS, Sambuco CP, Ksenzenko SM. Measurement of protection afforded by ultraviolet-absorbing window film using an in vitro model of photodamage. Lasers Surg Med 2006 Apr;38(4):337-42 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16596658.
  10. 10.0 10.1 Australasian College of Dermatologists. A-Z of skin: Sun Protection & Sunscreens. [homepage on the internet] ACD; 2016 [cited 2017 Jan 10]. Available from: https://www.dermcoll.edu.au/atoz/sun-protection-sunscreens/.
  11. Dawson-Hughes B. Racial/ethnic considerations in making recommendations for vitamin D for adult and elderly men and women. Am J Clin Nutr 2004 Dec;80(6 Suppl):1763S-6S Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15585802.
  12. Riggs BL. Role of the vitamin D-endocrine system in the pathophysiology of postmenopausal osteoporosis. J Cell Biochem 2003 Feb 1;88(2):209-15 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12520516.
  13. Wagner CL, Greer FR, American Academy of Pediatrics Section on Breastfeeding., American Academy of Pediatrics Committee on Nutrition.. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008 Nov;122(5):1142-52 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18977996.
  14. Nowson CA, McGrath JJ, Ebeling PR, Haikerwal A, Daly RM, Sanders KM, et al. Vitamin D and health in adults in Australia and New Zealand: a position statement. Med J Aust 2012 Jun 18;196(11):686-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22708765.
  15. Harrison SL, Buettner PG, MacLennan R. Why do mothers still sun their infants? J Paediatr Child Health 1999 Jun;35(3):296-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10404454.

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