Thursday, March 17, 2011

Latest American Academy of Pediatrics Recommendations (2011) for Limiting Sun Exposure in Children & its relevance to indian children

Specific recommendations for pediatricians for Limiting Sun Exposure in Children include the following:

  • Health-supervision practices should include advice about UVR exposure, such as avoiding sunburn and suntan, wearing clothing and hats with brims, using sunglasses, and applying sunscreen. If possible, outdoor activities should be scheduled to limit exposure to peak-intensity midday sun (10 AM to 4 PM).
  • When a child or adolescent might sunburn, he or she should use sunscreen to reduce the known risks for sun exposure and sunburn, including the increased risk for skin cancer. Sunscreen with a sun-protection factor (SPF) of at least 15 should be applied every 2 hours and after swimming, sweating, or drying off with a towel. People may prefer avoiding sunscreens containing oxybenzone, as these may have weak estrogenic effects when absorbed through the skin.
  • Although all children need counseling about UVR exposure, this is particularly true for children at high risk for the development of skin cancer, including those with light skin, nevi, and/or freckling; and/or a family history of melanoma.
  • Skin cancer prevention is a lifelong effort, and beginning in infancy, at least 1 health maintenance visit per year should include advice about UVR exposure. All children are at risk for adverse effects of UVR exposure on the eyes and immune system, although not all children sunburn. Especially appropriate times for counseling about UVR exposure include during the spring and summer in northern states, before anticipated sunny vacations, and during visits for sunburns.
  • Because outdoor physical activity should be strongly encouraged, this should be promoted in a sun-safe manner.
  • Sun-protection practices tend to wane in early childhood. Beginning at age 9 or 10 years, it may be helpful for pediatricians to discuss sun protection with children, together with parents, to encourage joint responsibility for the child's sun protection.
  • Infants younger than 6 months should be kept out of direct sunlight and covered with protective clothing and hats. When sun avoidance is impossible, parents may apply sunscreen only on exposed areas. Absorption of sunscreen ingredients may be higher in preterm infants.
  • Pediatricians should become familiar with chemical photosensitizing agents. People using these oral or topical agents should limit sun exposure and avoid all UVA from artificial sources. When sun exposure is inevitable, they should wear fully protective clothing and high SPF sunscreen that also blocks UVA wavelengths.
  • Breast-fed and formula-fed infants and other children should receive vitamin D supplementation in accordance with guidelines, for a total intake of at least 400 IU of vitamin D daily. Children at risk for hypovitaminosis D may need laboratory testing of 25-hydroxyvitamin D concentration.
  • Deliberate UVR exposure to artificial sources and overexposure to sun with the goal of increasing vitamin D concentrations or for other reasons should be avoided.
  • Pediatricians should advocate for adoption of sun-protective policies (eg, shaded playgrounds, outdoor time before 10 AM, and allowing hats at schools and child care facilities).
  • Pediatricians should support and advocate for legislation banning use of tanning parlors by children younger than 18 years.
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These are impressively detailed and well thought out recommendations. Being a tropical country we have a very high rate of UV exposure via sunlight in our children in India. The good news is that being dark-skinned we are naturally protected against high rates of skin cancer by the high melanin content in our skin. However there are a few important points regarding sunscreen usage that should be of interest to everyone.
Sunscreens of around SPF 15 are generally as effective as the higher SPF (& more expensive) ones. However liberal use 15-30 minutes before and repeated use after every 2 hours, swimming, bathing, toweling etc is important.
Avoid Sunscreens below 6 months if possible (though they can be used in sun exposed areas if needed), and avoiding Sunscreens with oxybenzone if possible. The US FDA approves Zinc Oxide and Titanium Dioxide for usage in Sunscreens.
For more information about sunscreens and children safety & UV radiation hazard read theAAP policy statement here