By Jennifer Linder, MD
In adults, sunburns are painful, and cause tissue damage that can lead to skin cancer. But in babies, sunburns can be a medical emergency, causing dehydration, high fever, blisters, infections, chills, and heatstroke, not to mention vastly increasing their lifetime skin cancer risk.1
Babies are not only likelier to become seriously ill from sun overexposure, but also more apt to develop sunburns: their sensitive skin contains less melanin, the pigment that gives our hair and eyes their color and offers some sun protection. In short, parents must do everything they can to keep babies safe from sunburn.
Shade and ShelterFirst, infants should be kept out of direct sunlight. Seeking shade between 10 AM and 4 PM, when the sun’s ultraviolet (UV) radiation is most intense, should be a top priority. Trees, awnings, gazebos, covered pavilions, and a long hood or sun umbrella on the baby carriage or stroller all provide varying degrees of shade.
Sun-Safe TogsDressing babies in sun-protective clothing is another must: lightweight, breathable long-sleeved gowns, one-pieces (coveralls or “onesies,” which go from shoulder to foot), or long-sleeved shirts and long pants in bright colors (soft whites and pastels let more light reach the skin) offer excellent protection. Parents should cover the often-exposed, delicate eye, scalp, and neck areas with UV-blocking sunglasses and broad-brimmed hats or sun bonnets, ideally with brims 4” around or greater.
Road SafetyIf you are traveling by car, keep your baby centered in the back seat, furthest from both side windows. Even better, have UV-blocking film applied to all the windows—the sun’s ultraviolet A (UVA) radiation can penetrate glass, but window film will block almost 100 percent of both UVA and ultraviolet B (UVB) rays without reducing visibility. Finally, keep babies hydrated and cool on the road, as they are susceptible to heat exhaustion due to their limited ability to regulate body temperature.
To Sunscreen or Not to SunscreenWhile these practices are universally recommended, one sun protection method for babies is subject to mixed messages: sunscreen. The US Food and Drug Administration and The Skin Cancer Foundation recommend using sunscreen only on children older than six months; the Foundation further recommends keeping babies out of direct sun for the first six months. The American Academy of Pediatrics, on the other hand, suggests applying sunscreen to small areas of exposed skin in infants younger than six months old if appropriate clothing and shade are not available.2
Why is using sunscreen on newborns controversial? There are key differences between infant and adult skin. First, infants’ skin is thinner, with a thinner stratum corneum, the dead outermost skin layer. It thus protects the body less effectively against outside agents; the chemicals in sunscreen might penetrate deeper, making newborns more vulnerable to contact dermatitis (skin reactions, like rashes), allergies, or inflammation. Newborn skin is also missing a functioning acid mantle, the film on the skin’s surface that protects the skin from bacteria, viruses, and transepidermal water loss (TEWL), a condition that can lead to dehydration.3,4,5 Lack of the acid mantle could leave babies more vulnerable to the chemicals in sunscreen.
In addition, babies also have a higher surface area-to-body weight ratio than older children and adults. A baby’s body surface area is about four times the body surface area-to-weight ratio in adults, which again leaves them exposed to greater penetration by chemicals. In adults, most sunscreen ingredients don’t get absorbed systemically (by the bloodstream) — and those that do are absorbed in insignificant amounts — but a baby’s skin may be considerably more vulnerable to this absorption; thus, it is wise to avoid any ingredients that could cause babies problems.
Whether or not the ingredients in sunscreen can penetrate babies’ skin significantly, they are not meant to be ingested, and infants could very well lick them off their fingers or any other reachable body area. That’s the main reason The Skin Cancer Foundation recommends holding off on sunscreen until baby is at least six months old.
Whenever you begin using sunscreen on your infant, perform a patch test first (trying sunscreen on a small area of skin) to make sure your baby can tolerate the product. Sunscreens that consist primarily of physical or mineral sunscreen agents, like zinc oxide and titanium dioxide, are less likely to irritate babies’ skin than chemical sunscreens. Most sunscreens made for young children are mineral/physical formulations. While some question whether the new micronized/nanoparticle-sized physical sunscreens (which don’t leave the classic white smears on the skin) penetrate the skin too invasively, no study has ever shown these ingredients to penetrate deeper than the stratum corneum in humans. If you would prefer to use chemical sunscreens and skip the micronized products, avoid sunscreens containing PABA or oxybenzone, which have been associated with skin reactions.6,7
While the effects of sunburn in babies can be serious, luckily, numerous sun protection methods give parents multiple options for keeping their young ones sun-safe. With 3.5 million skin cancers in more than 2 million people diagnosed in the US each year,8 the earlier we can begin using sun safety with our children and instilling this behavior in them, the better.
Jennifer Linder, MD, is a dermatologist and fellowship-trained Mohs surgeon in Scottsdale, AZ, and Chief Scientific Officer at PCA SKIN®. She holds a clinical faculty position in the Department of Dermatology at the University of California, San Francisco. Dr. Linder is a member of numerous societies, including the American Academy of Dermatology, the American Society of Dermatologic Surgery, and the American College of Mohs Surgery. She is a member of The Skin Cancer Foundation’s Amonette Circle.
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