Sun Protection in Infants (“Are Sunscreens Safe?”)

Effects of Sun Exposure

The ‘bad’ effects of sun exposure are widely documented in adults – immunosuppression, skin cancer, ageing – just to name a few).

Less information exists with regards to the effect of the sun on bub’s skin, however it’s known that the skin’s barrier protection remains immature throughout at least the first 2 years of life.

Infamous Bondi Beach

Infamous Bondi Beach

Australia has one of the highest rates of skin cancer globally (you only need to look at the above picture to know why!)

  • Lifetime risk of skin cancer is associated with childhood sun exposure;
  • The accumulation of UV radiation-induced changes begin as early as the first summer of life;
  • One single episode of sunburn in childhood more than doubles that person’s risk of developing melanoma later in life;
  • Obviously it’s not good enough to start covering up in adulthood; sun protection needs to start in infancy.

“Wait!” I hear you say. “The sun helps improve mood and is necessary for Vitamin D production.” Well, yes, but not in the amounts most people are getting in Australia.

Check out this guide to how much sun is enough from the Cancer Council. I’m guessing you exceed your recommended sun allotment. I know I do. Oops.

(Click on the image to view larger image)

How much sun is enough? Only a little apparently...

How much sun is enough? Only a little apparently…

Protecting Your Child From The Sun

How do we improve sun protection in infants?

  • It’s unlikely that infants are so amazingly advanced (yes, even yours!) that they can slip-slop-slap in between (1) Drooling like a psych patient on too many meds and (2) Smiling, babbling, feeding, peeing, pooing, and generally taking up your whole day.  Therefore it’s important to first educate parents and carers on the effects of sun exposure. Some additional nerdy facts:

– Sunscreen use in parents is predictive of use in their children, however this relates more to the parents’ experience of sunburn than with concerns about future skin cancer risk;
– Skin cancer prevention programmes in Australia have resulted in an increased popularity of swim-shirts and sunscreen, however have had no effect on the duration of sun exposure in early childhood;
– The method of sun protection used for the child is most likely the mother’s own personal sun-protection method.

  • Use the following sun protective behaviours:

– Avoid the outdoors from 10am to 4pm;
– Play in the shade as much as possible;
– Dress your child in light-coloured, loose-fitting clothing;
– Have your child wear a hat (that covers face, ears, neck);
– Have your child wear sunglasses (beware children’s ‘play’ sunglasses that offer no UV protection, and good luck keeping sunglasses on your kid’s face. Ha!);
– Use sunscreen.

This brings me to the main reason for posting this entry: the inconsistency in information regarding sun protection in infants less than 6 months of age… specifically “is it safe to use sunscreen on infants?”

Safety of Sunscreen for Infants

Here’s the information out there:

  • We were firmly told by our community nurse that in no circumstances was sunscreen to be used on an infant less than 6 months of age;
  • The Australian Skin Cancer Foundation says that “infants under 6 months of age should be kept out of the sun. Their skin is too sensitive for sunscreen.”
  • In fact most Australian authorities don’t recommend sunscreen under the age of 6 months “since babies under 6 months of age have thinner skin they may absorb more of the sunscreen, and the long-term effects of sunscreen are unknown.”
  • The American Academy of Dermatology believes that “sunscreen should only be applied to exposed skin not covered by long sleeves, pants, wide-brimmed hats, and sunglasses. Sunscreens that use the ingredients zinc oxide or titanium dioxide or special sunscreens made for infants or toddlers may cause less irritation to the sensitive skin of infants and toddlers.”
  • The American Academy of Pediatrics also recommends that “sunscreen may be applied to babies younger than 6 months to small areas of skin uncovered by clothing and hats.”
  • The American Pediatric Society advises that “sunscreen be used when physical protection, such as clothing, hats, and shade, is not adequate, and that it is reasonable to tell parents what is known about the safety of sunscreens in infants.”

Types of Sunscreen

  • Sunscreen comes in two main forms: check out the main differences between physical and chemical sunscreens;
  • Interestingly, the two main ingredients in physical sunscreens are titanium dioxide and zinc oxide; these are the same ingredients in cream for nappy rash;
  • Even with the limited functioning of my post-baby-still-on-maternity-leave-without-gainful-employment-brain, it’s obvious that if the argument exists that sunblocks shouldn’t be used because baby’s skin is “sensitive” and “thin”, leading to greater “absorption of dangerous products”, then logic would suggest that nappy rash creams are dangerous too. Ha! I still got it.

Common-sense Approach to Sun Protection in Infants

Cutting through the mumbo-jumbo (which with respect to child rearing seems to be A LOT… we new mothers are always being judged and based on our actions it seems you are either (1) Next-in-line-for-a-papal-medal-mother-of-the-year, or (2) Evil-mother-going-to-rot-in-hell-for-not-doing-enough-tummy-time)…

Sorry I digress… back to sun protection in infants:

  • Don’t bake your infant in the sun. As we say in Hong Kong, “crispy kid no taste good”;
  • Use appropriate sun protection measures (hats, clothes, sunglasses);
  • I assume it’s unlikely you’re going to whack a balaclava on the poor kid, so use physical block sunscreen on areas not covered by clothing/ hat (eg. Cheeks, ears, hands, feet);
  • Follow usual instructions about applying sunscreen before heading out, and reapplying regularly (more often if in water) blah blah…

Physical Block Sunscreens

Here are some out on the market (with their blocking agent in brackets):

Invisible Zinc (zinc oxide)

Invisible Zinc (zinc oxide)

Grahams Sun Clear (zinc oxide)

Grahams Sun Clear (zinc oxide)

Natralia Nourish Sunscreen (titanium dioxide)

Natralia Nourish Sunscreen (titanium dioxide)

Natural Instinct Sunscreen (zinc oxide)

Natural Instinct Sunscreen (zinc oxide)

Soleo Organics Sunscreen (zinc oxide)

Soleo Organics Sunscreen (zinc oxide)

WotNot (zinc oxide)

WotNot (zinc oxide)

Of these I’ve only tried Invisible Zinc (which I liked) – so if anyone out there has tried the others, please give feedback! (by using the “Comment” link at the bottom of this post.)

Titanium Dioxide vs Zinc Oxide

As you can see from the following diagram (thanks FDA), zinc oxide offers better protection than titanium dioxide across the sun’s UV spectrum:

sun titanium-dioxide-zinc-oxide

Titanium dioxide also creates a stronger whitish tint than zinc oxide at comparable concentrations.

sun geisha

Too much titanium dioxide…
(Girl on the far right too much LSD before applying makeup)

Nanoparticles

  • No discussion about today’s sunscreens/ sunblocks would be complete with mentioning nanoparticles;
  • A nanoparticle is a particle measured in nanometres (1 nanometre is one-billionth of a metre);
  • It is therefore a very very very very very very very very very very very (repeat a hundred times more) small particle;
  • It is thought that as nanoparticles are so small, they can penetrate the skin and be toxic to cells;
  • A scientific review report by the Australian Government Department of Health Therapeutic Goods Administration (TGA) has found that neither titanium dioxide nor zinc oxide nanoparticles are likely to cause harm when used as ingredients in sunscreens. (If you believe the report – good. If you don’t, continue to debate ‘nanoparticle or not’ in your spare time…)

(Just FYI, the sunblocks pictured about don’t contain nanoparticles)

Bottom line – sun protection in infants:

  • Avoid harsh sun;
  • Use physical sun protection methods (clothing, hat, sunglasses);
  • For those bits that remain unprotected, it’s safe to use sunblock (preferably physical) – yes, even on infants less than 6 months of age.

REFERENCES
Bolognia JL, Berwick M, Fine JA, Simpson P, Jasmin M. Sun protection in newborns. A comparison of educational methods. Am J Dis Child. 1991 Oct;145(10):1125-9.
Zinman R, Schwartz S, Gordon K, Fitzpatrick E, Camfield C. Predictors of sunscreen use in childhood. Arch Pediatr Adolesc Med. 1995 Jul;149(7):804-7.
Lowe JB, McDermott LJ, Stanton WR, Clavarino A, Balanda KP, McWhirter B.Behavior of caregivers to protect their infants from exposure to the sun in Queensland, Australia. Health Educ Res. 2002 Aug;17(4):405-14.
Paller AS, Hawk JL, Honig P, Giam YC, Hoath S, Mack MC, Stamatas GN.New insights about infant and toddler skin: implications for sun protection. Pediatrics. 2011 Jul;128(1):92-102. doi: 10.1542/peds.2010-1079. Epub 2011 Jun 6.
Dobbinson S, Wakefield M, Hill D, Girgis A, Aitken JF, Beckmann K, Reeder AI, Herd N, Spittal MJ, Fairthorne A, Bowles KA. Children’s sun exposure and sun protection: prevalence in Australia and related parental factors. J Am Acad Dermatol. 2012 Jun;66(6):938-47. doi: 10.1016/j.jaad.2011.06.015. Epub 2011 Sep 3.
Smith A, Harrison S, Nowak M, Buettner P, Maclennan R.Changes in the pattern of sun exposure and sun protection in young children from tropical Australia. J Am Acad Dermatol. 2013 May;68(5):774-83. doi: 10.1016/j.jaad.2012.10.057. Epub 2012 Dec 23.
Australian Skin Cancer Foundation (http://www.skincancer.org)
American Academy of Dermatology (http://www.aad.org)
American Academy of Pediatrics (http://www.aap.org)
American Pediatric Society (www.aps-spr.org)
Australian Government Department of Health Therapeutic Goods Aministration ([http://www.tga.gov.au)
Cancer Council (www.cancer.org)

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