Scott Webb (Host): Though it can sometimes be a struggle to get our kids to cooperate, it's important that they wear sunscreen. And joining me today to emphasize this point and offer some suggestions on how to make wearing sunscreen a fun habit for kids is Dr. Lauren Strelitz. She's a pediatrician with Stanford Medicine Children's Health.

This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Doctor, it's so nice to have you back again. Today, we're going to talk about sunscreen protection, and I was sort of jokingly telling you that I still fight with my kids. They're 16 and 21, and still trying to get them to put sunscreen on, just like when they were little kids, and they still don't want to listen to me. But maybe some of the folks who are listening, the parents and their kids will heed your advice better than my kids do. So, let's start there. At what age should kids start wearing sunscreen?

Dr. Lauren Strelitz: That's a great question. So, kids should start wearing sunscreen at six months old. And the reason for that is because kids under six months old should not be exposed to direct sunlight. They can't really regulate their body temperatures the way they can when they reach that milestone. And so, they just shouldn't be in direct sunlight, so they wouldn't be at risk of getting burnt.

Host: Yeah. I was going back in my mind, remembering when my daughter was six months old and she didn't get a vote, right? We just did it. We just slathered her in sunscreen and she didn't get a vote, and she was ticklish. And so, it was, you know, kind of fun. So when should kids wear it? Is it an everyday thing? Summer, sunny days, swimming, vacation? I'm guessing you're going to say, you know, if you're going to be out in the sun, you wear sunscreen, right?

Dr. Lauren Strelitz: Yeah. Even when it's not sunny, you're still getting exposed to UV light. And even when it's cold out, like if you're skiing or snowboarding, ice skating, the sun reflects on those surfaces, snow, puddles of water, cement. And so, that can cause a burn. So, anytime you're outside is the right time to wear sunscreen. The time of the day where you're at the highest risk of exposure to that UV light is between 10:00 a.m. and 4:00 p.m. So, you know, those are times where you want to limit the sun exposure, take breaks, be really generous with the sunscreen, go into the shade at times when you can. But yeah, 10:00 to 4:00 is the worst time for burns and UV exposure.

Host: Yeah. I learned from my wife to check the UV. Don't just look outside and say it's sunny or it's not sunny. Check the UV. And now, my daughter's doing that too, which is her defense, of course, for not using sunscreen, but maybe that's a different podcast. So, I feel like the bill comes due, doctor, for our youthful transgressions, if you will. So, like when I was a kid growing up in the '70s, we didn't have sunscreen. We put on suntan oil or lotion or whatever we used in the '70s. I don't remember anybody worrying about protecting our skin. And of course, that bill comes due and we're all paying for that now, presumably. So why is sunscreen so important for kids?

Dr. Lauren Strelitz: Well, the most important thing is that it, you know, decreases the risk of skin cancer. Anybody can get skin cancer regardless of your skin tone, regardless of whether you burn or tan. And sunscreen is the most important thing you can do to prevent skin cancer. For people that are more worried about aesthetics, it also really slows aging of the skin. You know, exposure to sun and UV light ages our skin. And so, wearing sunscreen from infancy, youth decreases the amount of wrinkles you'll have over time.

Host: Absolutely. I asked my wife to borrow some sunscreen at our daughter's softball game the other day, and I went to put it on and it was tinted. You know, and I said, "Do you know this is tinted?" And she says, "Well, yeah, it's tinted so that it doesn't go on white, you know, and then get in your hair and turn everything white." And I was marveling at the technology of how far sunscreen has come, that it comes tinted, and then it just kind of blends in with your skin. I'm sure you're familiar with some of the new-fangled, you know, versions of sunscreen. They're pretty cool.

Dr. Lauren Strelitz: Yeah. There's tinted sunscreen. There's also sunscreen that's clear. So, you don't necessarily get that white cast. For younger kids, I do recommend starting with a mineral sunscreen, which is going to always have a little bit of a white cast, just because people are less sensitive to it. They have less skin sensitivities to it. But, if your child does have sensitivities to a mineral sunscreen, which they still can, a chemical sunscreen is-- well, they're all made of chemicals-- but a non-mineral sunscreen is the next best option and is safe.

Host: Yeah. And I'm recalling when I went for swimming lessons when I was a kid, the lifeguards, their noses were always white, right?

Dr. Lauren Strelitz: Yeah, zinc oxide.

Host: Is that what it was? Okay. I always wonder like, "Why are their noses all white?" Okay, good. I knew this was going to be helpful and informational if for no one else but myself, but I'm sure listeners as well.

Dr. Lauren Strelitz: And for some kids, that can actually be fun. You can get colorful sunscreen, blue, purple, things like that. Draw pictures. You know, I mean, of course, you want to cover the whole surface. So, maybe put on some white sunscreen first, but that can make it a little more fun for them too.

Host: Well, you must have read my mind there, because I wanted to ask you the $64,000 question. How do we encourage/help our kids to wear sunscreen? How do we get them to do it, especially when they're not around mom and dad and they get a vote, you know?

Dr. Lauren Strelitz: Yeah. It's certainly harder when they're not around mom and dad. I mean, you know, some of the colorful zinc sticks, they can draw pictures. You can make it a game. There's also foam sunscreen you can put on and then they can rub it in. Start when they're really young and have it be part of their going outside routine so that they're really used to it. I think if you're going to be out in the sun for a while and your child is refusing to wear sunscreen, that might be a moment to say," Okay. Well, we're not going outside without it."

Host: Right. Sometimes you do have to put your foot down. And I have a few golf shirts that have UV protection built in, you know? And I don't know how well they work, but I bought them, because, I don't know, it seems like the thing to do, the right thing to do, the prudent thing to do. What are your thoughts about that? All these UV protected clothing and hats and things.

Dr. Lauren Strelitz: Yeah, those are great. I mean, you know, the thicker the weave of a fabric, the more likely it is going to be to have UV protection. If you're wearing a really loose weave fabric, you can still get burnt all over your body with that. And there are fabrics that have been tested. Australia has been a big place where a lot of these things have come from because sunburns are so bad there, being close to the equator. But you can get clothing that is ultraviolet protection factor-rated. And, you know, that can be great. But the thing is, if it's long-sleeved, if it's pants, kids might get hot and might not want to wear that, but hats are super important, not spending a ton of time in direct sunlight is super important, having a shady place, but I think those clothes are great. I use those myself.

Host: Yeah. Like I said, I don't know if they work or not, but I feel pretty cool, because, you know, I put sunscreen on, I've got my UV-protected clothing. I feel like I've done everything I can. Is that what it's really about, doctor, is avoiding those really bad sunburns, especially when we're young.

Dr. Lauren Strelitz: yeah, I mean, definitely avoiding really bad sunburns, but also just generally, even people who don't burn can still have the negative consequences of sun exposure, like cancer and wrinkles, aging. We do need some sun exposure, but we want to protect ourselves from the harshest UV light. Also, on airplanes, there's a lot higher UV exposure than on the ground. And so, putting on sunscreen on your face, especially when you're on an airplane, is also really important.

Host: Absolutely. Yeah. Some folks like to take a vitamin D supplement, of course. And some folks like to just be out in the sun. But if you're going to be out in the sun, protect yourself, all good advice, of course. We touched on this a little bit earlier, but I just want to finish up and get your recommendations on the right sunscreen. How do we find the right sunscreen for us? Is it the most expensive one? How does that work? I go to the store, I go to Target and I just stand there and my head starts spinning. I'm like, "There's just too many. I don't know. I don't know which one to buy."

Dr. Lauren Strelitz: There are a lot. It definitely doesn't have to be the most expensive one. For kids, like I said, especially six months old, I would recommend starting with mineral sunscreens, those zinc oxide ones. Make sure it's broad spectrum, so it covers both types of UV rays, water resistant, and that the SPF is 30 or higher. Even things that are labeled as for sensitive skin, some people may still have a reaction to it. So, I do recommend patch testing. So, putting a small amount of it under the jawline before bed, doing that a few nights in a row. And if there's no rash, then go for your whole body.

Host: Yeah. My daughter has that. She has very beautiful, but sensitive skin. And so, we always have to sort of, as you say, patch test a little, like, "Okay, put this on your leg and we'll see how it looks tomorrow. And if there's no rash, then we're good, right?

Dr. Lauren Strelitz: Yeah, absolutely. You know, going back to the clothing for sun protection, I would also recommend, when thinking about a hat, not just a hat with a brim in the front, like a baseball cap, but a hat that has a brim that goes all the way around, so it gets that extra protection to the ears, the face, the back of the neck. Sunglasses are also really good for additional sun protection. They don't replace the sunscreen, but it adds to the protection.

Host: Right, anything we can do. I don't like the way I look in those big floppy hats, but kids seem to embrace that kind of thing more so maybe than adults do, but I totally understand what you're saying, protect your neck too, it's not just protecting your face, right?

Dr. Lauren Strelitz: And I think also making sure to use enough sunscreen. I think sometimes we just dab it on. You really need to use like one and a half to two tablespoons per application. You know, you need to put it on at least 30 minutes before the sun exposure, and it's really important to reapply during the day, follow the instructions on the bottle. But generally, it's at least every hour and a half to two hours, although it's going to be more frequently if you're in water, if you're sweating a lot. And the nice thing about those brimmed hats is they cover spots that we often forget, like the back of the neck and the ears, but trying to apply sunscreen to those places too.

Host: Yeah, absolutely. Well, it's always a pleasure to have you on. Anytime I get to speak with a pediatrician, it's a good day for me. It's win. But especially you, you always have all the answers. I really appreciate your time. Thanks so much.

Dr. Lauren Strelitz: Oh, you're so kind. It was so nice talking to you too, Scott. Take care.

Host: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.