Kids and Sun Exposure: The AAP's Standing

If you watched the news yesterday, you may have heard a story amongst the Libya and Oscar stories that brings together 2 very different aspects of my life. Beauty blogging and my "normal" job, pediatrics. On March 1st the AAP released their latest Policy Statement—Ultraviolet Radiation: A Hazard to Children and Adolescents.

So, what does the policy statement say? It's not exactly earth shattering, at least in my mind. Really, it's stuff that everyone should know already, especially if you read my blog. Though, it is full of things likely to make the indoor tanning industry upset.

You can read the entire statement if you want, but actual recommendations come at the very end. Here's what they said and some of my thoughts.

1. Pediatricians should incorporate advice about UVR exposure into health-supervision practices. Advice includes avoiding sunburning and suntanning, wearing clothing and hats with brims, and applying sunscreen. When feasible, outdoor activities should be planned to limit exposure to peak-intensity midday sun (10 AM to 4 PM). Sunglasses should be worn when working, driving, participating in sports, taking a walk, running errands, or doing anything in the sun.

• This is pretty much common sense advice when it comes to being sun-safe, though it is amazing how few pediatricians discuss sunscreen and such in their well child visits. Hopefully this policy statement is a little bit of a reminder!

2. Sunscreen should be used when a child or adolescent might sunburn. Sunscreen with an SPF of 15 or higher should be applied every 2 hours and after swimming, sweating, or drying off with a towel. People may wish to avoid using sunscreens that contain oxybenzone, which may have weak estrogenic effects when absorbed through the skin. However, using sunscreen is recommended to decrease the known risks of sun exposure and sunburning, both of which raise the risk of developing skin cancer.

• Yes, wear sunscreen and make sure that you reapply. I would argue that this actually not far reaching enough. The SPF of 15 could be raised given how few people actually apply enough sunscreen, advocating a higher SPF would give everyone a little more "buffer" for poor application. As well, the UV coverage should be broad spectrum, many products on the market don't cover the full UVA and UVB spectrum.
• A quick note about the Oxybenzone estrogenic effects: I'm a bit surprised that they showed up here given the current status of the literature. A search of the literature finds studies conducted in mice, rats and fish. The main article quoted (1) was in rats, and did demonstrate estrogenic activity. However, it's unclear that the amount of chemical that a rat will absorb is the same as a human, if it interacts the same as a rat as in a human, etc. I agree that more studies need to be done, but just know that the jury is still out on this one, so if you use one with oxybenzone it isn't the end of the world. Currently the risk of skin cancer out weighs the estrogenic findings.

3. Advice about UVR exposure is important for all children and especially for children at high risk of developing skin cancer: children with light skin, those with nevi and/or freckling, and those with a family history of melanoma.

4. Skin cancer prevention is a lifelong effort. Although time is at a premium for most pediatricians, an important aim is to incorporate UVR exposure advice into at least 1 health-maintenance visit per year, beginning in infancy. Not all children sunburn, but all are at risk of adverse effects of UVR exposure on the eyes and immune system. In northern states, advice can be given in the spring and summer. Advice can also be given before anticipated sunny vacations. “Teachable moments” may be found during visits for sunburns.

• I wish the sentence "In northern states, advice can be given in the spring and summer" wasn't present. Remember that UV rays can come through the clouds and the snow is really good at scattering it around.

5. Outdoor physical activity should be strongly encouraged; messages should be framed in the context of promoting outdoor physical activity in a sun-safe manner.

6. Sun-protection practices tend to wane in early childhood. In later childhood, it may be advisable for pediatricians to discuss sun protection with children and parents together beginning at 9 or 10 years of age, thus encouraging joint responsibility for ensuring that the child is protected.

7. Infants require special advice. Infants younger than 6 months of age should be kept out of direct sunlight and covered with appropriate protective clothing and hats. Parents may apply sunscreen when sun avoidance is impossible and, then, only on exposed areas. Preterm infants, because of a thinner stratum corneum, may have a higher susceptibility to the absorption of sunscreen ingredients.

8. Pediatricians should gain familiarity with chemical photosensitizing agents. People who take medications or use topical agents known to be sensitizing should do their best to limit sun exposure and avoid all UVA from artificial sources. They should wear fully protective clothing and apply sunscreen with a high SPF that also blocks UVA wavelengths when sun exposure is inevitable.

9. Guidelines regarding vitamin D supplementation for breastfed and formula-fed infants and other children should be followed. All infants, children, and adolescents should receive at least 400 IU of vitamin D daily. If a child is at risk of hypovitaminosis D because of low intake or other factors, laboratory evaluations of the adequacy of his or her 25(OH)D concentration should be considered.

10. Deliberate UVR exposure to artificial sources and overexposure to sun with the goal of increasing vitamin D concentrations, or for other reasons, is to be avoided. UVR exposure raises skin cancer risk. Guidance should be given about vitamin D adequacy obtained through the diet and supplements.

11. When feasible, pediatricians should advocate for adoption of sun-protective policies such as shaded playgrounds, outdoor time before 10 AM, and allowing hats at schools and child care facilities.

12. Pediatricians should support and advocate for legislation to ban access to tanning parlors for children younger than 18 years.

• This is the big recommendation and makes me do a little happy dance. Amazing!

American Academy of Pediatrics

Likely not what the FTC had in mind when they said they wanted bloggers to disclose kickbacks and formal relationships, but I do have a relationship to disclose. I'm a pediatrician and a member of the AAP, so yes, I do have those spiffy FAAP initials after my name.


Segments of Life said...

A bit lengthy, but I read through it...Very informative. Thanks for sharing. Everybody needs to be aware :)

Jean said...

Thank you for sharing and reminding me to get out and buy my kids MORE hats. I always make them wear sunscreen but sometimes forget how important hats (and sun glasses) are for everyone in the family. I think elementary schools should make hats mandatory for recess/pe, especially in Arizona where I live. I always enjoy your informative articles.

Find Hair Stylists said...

I used to tan in high school. The thing is that teens get way too carried away with it. I know I did.

Cynthia Bailey MD, Dermatologist said...

I'm doing the happy dance with you! Hallelujah.

The best part is at the end of this policy statement, plus the fact that it's a call to action for the entire pediatric community. This will make a difference for the kids growing up in the US today.

I would have liked to see more emphasis on sun protective clothing over sunscreen, and like you, an SPF of 30 with emphasis on good UVA blockers.
But, we got our start. There are going to be a lot of kids getting cool sunglasses as a fun positive payoff for learning to master new sun protective behaviors.

Bless the AAP for having the courage to clearly recommend oral vitamin D and testing over the crazy and willy-nilly 'get a tan for your vitamin D' that many docs recommend. This means less skin cancer and less cosmetic surgical procedures for me when these kids grow up and that's fantastic!

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