Transcription:
Is Sunscreen Safe For Kids?

Bill Klaproth (Host): So, how safe is sunscreen? That seems to be a big question lately. A recent study about sunscreen’s absorption into our bloodstreams has many parents wondering if sunscreen is safe for our kids. so, we’re here with the Chief of Pediatric Dermatology at Le Bonheur Children’s Hospital, Dr. Teresa Wright to talk about these new findings and what is most important for parents to know.

This is the Peds Pod by Le Bonheur Children’s Hospital. I’m Bill Klaproth. Dr. Wright so, a new study released by the Food and Drug Administration found that the active ingredients in sunscreen may soak all the way into our bloodstreams. So, what is significant about this research?

Teresa Wright, MD (Guest): First of all, the important thing to understand is when we talk about active ingredients in sunscreen; there are two broad categories of ingredients. And one of those is physical blockers, those are ingredients primarily like zinc oxide and titanium dioxide. Those sit on the surface of the skin and reflect rays of the sun that can be harmful. And then the other class of ingredients is chemical sunscreen ingredients and those are to some degree, absorbed into the skin and they work by absorbing UV radiation and converting that to heat which is dispersed via the skin.

So, this study was only looking at chemical ingredients in sunscreens. It looked at four fairly common chemical ingredients and tried to answer the question of are these chemicals being absorbed through the skin into the bloodstream and are they present in the bloodstream and it did show some level of those ingredients within the bloodstream during the time of the study and those levels appeared to increase during the few days. I think it just looked at them over about a four day period with multiple blood samples.

So, basically, all they were able to conclude is that it is in there. It’s still not clear whether it’s really a safety issue and there needs to be further studies to determine whether there’s any safety concerns with that.

Host: So, some people may ask the question then, what’s worse sunscreen in our bloodstream or the effects of sun on our skin?

Dr. Wright: Well I think there’s a lot of evidence that the effects of sun on the skin can be dangerous. We know that excess sun exposure contributes to development of a variety of skin cancers, including the most deadly form which is melanoma. So, I think that in general, we should think of sunscreen as a good thing and we should all be using it but until these questions are answered, it’s really best and particularly when we are talking about children, it’s really best to just stick with products that contain physical blocking ingredients. So, your active ingredient should be zinc oxide and or titanium dioxide.

And if you are concerned about the possibility of adverse effects from chemical ingredients, just avoid them. It’s very easy to avoid them for now.

Host: Okay, well that’s really good to know. So, then let’s talk about this. What is the difference between UVA and UVB rays. I think there’s a lot of confusion surrounding those two.

Dr. Wright: Right. So, these are the two main wavelengths or forms of ultraviolet radiation that reach the earth from the sun. Basically, the UVA rays are longer, and they penetrate more deeply into the skin. For along time, we’ve known that they are very important in photoaging affects of the skin. So, that’s primarily the kind of sun exposure that over time leads to sun damage; the wrinkling and sun spots we all see as we get older. Over the last few years, it’s also become apparent that UVA rays actually do contribute to increased risk of skin cancer as well.

However, UVB rays on the other hand, are shorter rays. They tend to cause problems in the higher layers of the skin. They are ones responsible for sunburn. I always remember that because UVB, B for burn and they are the ones – those are the rays that are really playing the primary role in increasing your risk of skin cancers. UVB. But they both play a role and it’s important to use products that protect your skin from both those forms of UV radiation from the sun.

Host: So, that’s a good way to remember that. The B in UVB stands for burn. So, earlier, you were talking about chemical absorption and how potentially that may be bad. We don’t quite know at this point and how what you want to look for is a sunscreen that sits on top of the skin like zinc oxide or titanium dioxide. So, there are a lot of different sunscreens with long, long lists of ingredients. So, when we are standing in the store and we’re looking at the sunscreen; how do we know what is safe and what is unsafe?

Dr. Wright: Right. So, we’ve already talked about the ingredients. I would look for products that contain zinc oxide and or titanium dioxide as their active ingredients. And you want to look for broad spectrum coverage. I recommend an SPF, sun protection factor minimum of 30. Many products particularly if they are marketed for children will be 50 or more. The American Academy of Pediatrics recommends a minimum of SPF 15, but I recommend 30 because you do get somewhat more protection from UVB radiation particularly when you go from 15 to 30. Once you get above 50, you are really not getting a lot more bang for your buck, so you really don’t need to spend a lot of money for a product that claims to have SPF 100.

The other thing is look for water resistant. There’s really no such thing as waterproof sunscreen. They are all going to be somewhat susceptible to coming off with sweating and swimming, so they do need to be reapplied. We recommend reapplying at least every two hours, more often if you are sweating a lot or swimming. But you want to look for a product that says it is water and or sweat resistant because it will be a little bit better at staying on with those activities.

The other things to look for I would say I typically prefer that you are using a lotion or a cream. Sticks can be good especially for delicate areas like the nose or tops of the ears or the part in the hair on the scalp. But there are also questions about sprays and I find sometimes number one, parents may not do a good job of applying a good layer with the spray because the kids are running around or jumping around, and you are not getting a good even layer with the spray. But there have also been some safety concerns about sprays and the possibility of inhalation which could irritate the airways or cause some health problems in children. So, generally, I recommend avoiding sprays, if possible.

Host: So, that’s really good advice when it comes to looking for a sunscreen. Look for an SPF with a minimum of 30, look for water resistant and then you prefer lotion or creams over sprays. So, let’s talk amounts. Because if you don’t put enough on, you’re not going to be protected, right? So, how much should we be putting on?

Dr. Wright: That’s an extremely important point. Because your sunscreen will only provide you with the level of protection it claims if you are using enough product. And so a good rule of thumb to remember is that an average size adult will need at least one ounce of a lotion or cream sunscreen product, that’s equivalent to 30 milliliters or sic teaspoons of the product to adequately cover all exposed skin. So, obviously, you have to kind of take that and extrapolate to a smaller person’s body, a child. But I think the take home is just use it generously. Don’t skimp with it. If you are using it regularly, you should be going through sunscreen in the summertime and when you are outdoors and using sunscreen regularly. You shouldn’t have sunscreen that expired five years ago. You should be going through it. you should be using it.

Host: Right. Even six teaspoons sounds like it might be conservative. I don’t think I can cover my whole body with six teaspoons and I’m not an overly big guy.

Dr. Wright: Yes, so think of that as a minimum and just keep that in mind so if you are not applying it generously, it is not going to do it’s job. And also reapply it.

Host: Right, more is better and like you said, you don’t want it – at the end of the season, you don’t want it sitting there expiring over the winter. Use it. If you’ve got it, use it.

Dr. Wright: Exactly. It does lose its effectiveness when it expires, when it gets old, it does lose its effectiveness. So, it is important to also to make sure that your product is not old and not expired.

Host: So, you’ve been giving us some really good advice on sunscreen protection. But what about sunscreen for infants? Is it harmful?

Dr. Wright: Right. So, for infants, it’s really important particularly for infants under six months of age to try to keep them in the shade as much as possible. So, really have them adequately covered with clothing, try to keep them shaded and out of direct sunlight. If you are in a situation where you have inadequate shade or inadequate protective clothing, it is okay to use small amounts of a physical blocker based sunscreen. So, that would mean a product containing zinc oxide or titanium dioxide as the main sunscreen ingredients. It is okay to use small amounts of that type of product on exposed areas such as the tops of the hands, the tops of the feet, the cheeks. It’s okay to use small amounts but it’s really preferable to try to shade infants as much as possible.

Host: And at what age can kids start wearing sunscreen?

Dr. Wright: Well the American Academy of Pediatrics recommends that limitation for infants below the age of six months. So, technically, after six months, you have less of a concern. But again, for children of all ages; as a pediatric dermatologist; I always recommend sticking with products that contain physical blocking agents and just avoiding the products that contain the chemical blockers. I see more allergic reactions and more sensitivity to those chemical ingredients sometimes and kids just generally have more sensitive skin and you are going to be much less likely to have a problem with a sunscreen that contains zinc oxide or titanium dioxide than the ones that contain the chemical blockers.

Host: And what about other sun safety tips? Wearing sunscreen is great but what about protective swim clothing and covering up? That’s always a good idea, right?

Dr. Wright: Exactly. Trying to encourage children to wear a hat, I know that can be challenging but if you start early and really set a good example by doing it yourself when you are outdoors with activities in the sun, then kids will usually get used to that over time and cooperate. You want a hat that preferably has a broad brim all the way around. A baseball cap is better than nothing, but it doesn’t shield your ears and your neck. So, a hat with a broad brim all the way around. Sunglasses are important because sun contributes to damage within your eyes over time too. And then sun protective clothing and they make great swimwear, rash guards, things with long sleeves, things that meant to really be cool because typically if you are out and are swimming it’s in warmer and hotter weather and people think if they put on something with long sleeves or pants that they are going to be overheated. But there’s clothing that’s specifically made for those activities and made of fabrics that are meant to keep you cool as well as protect you from the sun.

Host: Right. So, this question seems to come up a lot. Is sunscreen more important for people with fairer skin and why is it important for people of all ethnicities and skin tones to protect themselves from the harms of UV rays?

Dr. Wright: Right. So, I think it’s really important for everyone to pay attention to this and for everyone to be mindful about using sunscreen and not getting too much sun exposure. Definitely people with fairer skin are going to burn more easily than people with more pigment or melanin in their skin. However, the sun can still cause burns and damage even in people with darker skin. And we know that those effects can be cumulative and that burns particularly in childhood have a significant impact on increasing your risk for skin cancer later in life particularly melanoma.

So, I tell all of my patients, I tell all of their parents even if they have tan or brown skin, even if they tend to tan easily in the summer, sometimes even with using sunscreen these kids will get a little bit of color in the skin. But I really emphasize avoid burns at all costs. Never tan deliberately. And try to limit tanning as much as you can because tan skin is damaged skin and regardless of your background complexion, again, the damage from the UV rays of the sun is cumulative and everyone is at risk for skin cancers. Everyone, no matter what the color of their skin is.

Host: Tan skin is damaged skin. That’s something we all should remember. So, you were talking about burns. Lets keep talking about that for a minute. Because it still does happen. What should we do if our methods of prevention failed? Is there ever a time when a child with a bad sunburn should see a doctor or dermatologist?

Dr. Wright: I would say if a child has a severe burn where they have severe pain or there’s visible swelling or they have blisters, fluid filled vesicles or blister on the skin, it would probably be best to be seen by their pediatrician or a dermatologist just to have them checked and get some advice from the pediatrician especially regarding pain relievers and things like that.

At home though, if you have a more minor burn things you can do are cool compresses, cool baths, there are some over-the-counter cooling type lotions which can be soothing to some kids. But certainly if they’re in severe pain or you see blisters, I would seek the advice of a physician.

Host: So, with the recent news and questions about sunscreen safety Dr. Wright, what’s your big take away for parents who are worried by what they are hearing? Give us your best advice.

Dr. Wright: I would say just keep in mind we know that excess sun exposure is bad for us. It definitely increases your risk of skin cancers and so there’s no question and it’s important to be vigilant about sun protection and really make it part of your daily routine, make it a habit for yourself and for children, for the entire family.

And remember that sunscreen is really just one component of an adequate sun protection regimen. You should also be mindful about being in shade whenever you can, avoiding the hours of the day where the sun is brightest which tends to be between 10 a.m. and 4 p.m. So, if you have a choice to do more activities before or after those times, keep that in mind.

Also use sun protective clothing, wear hats and wear sunglasses. And all of that in addition to sunscreen. And when it comes to choosing a sunscreen, if you are concerned about these questions surrounding safety of chemical ingredients in sunscreens, just avoid those for now. The FDA is supposed to be coming out with a more official recommendation sometime later this year regarding those recent concerns, that study that came out and those questions. And I think until then, we just try to avoid use of the products with chemical blockers particularly in children. So, just look for something that has zinc oxide or titanium dioxide. Those have been around for decades. Zinc oxide is used in diaper barrier creams. It’s a very safe inorganic compound. It’s not absorbed into your body and it’s very effective sun protection.

So, we can still use sunscreen. It’s just a matter of being selective about those ingredients.

Host: Well Dr. Wright, you’ve given us a great prescription for sun safety. Look for zinc oxide and titanium dioxide in your sunscreen, make sure it’s at least an SPF of 30, look for water resistant and as you said, you prefer lotion and creams over sprays. And then wear that protective swim clothing and cover up. That’s for sure. Dr. Wright, thank you so much for your time. We appreciate it. To learn more all you have to do is visit www.lebonheur.org/podcast and be sure to subscribe to the Peds Pod in Apple Podcasts, Google Play or wherever you listen to your podcasts. You can also check out www.lebonheur.org/podcast to view our full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children’s Hospital. I’m Bill Klaproth. Thanks for listening.