Michael Ramsey, a dermatologist at the Geisinger Medical Center in Danville, Pennsylvania, coaches his son's Little League team these summery days when he's not removing patients' skin cancers.
"The last thing I want is to someday see one of my baseball players as a patient," he remarked recently in The Skin Cancer Foundation Journal.
And so, while encouraging the players to do their best on the field, he also pays close attention to their need to protect themselves from the sun's skin-damaging ultraviolet rays. For he knows all too well that more than 90 percent of all skin cancers are caused by sun exposure; that the risk for a future skin cancer doubles with five or more sunburns; and that while the jury is still out, the risk of future melanoma, the deadliest form of skin cancer, may well be increased by even one blistering sunburn in childhood.
PHOTO: NY TIMES NEWS SERVICE
Moreover, while children may find it hard to imagine ever being old (over 50), repeated sun exposure also ages the skin, causing premature wrinkling and a mottled, leathery hide that resembles an elephant's. It may also be hard to impress children with the possibility of cumulative sun damage to their eyes, like cataracts.
Children - as well as their parents and school authorities - have a lot to learn about protection against sun damage. Arrangements should be made in school, for example, for children to apply sunscreen and wear hats at recess. A child's skin is especially vulnerable to the damaging effects of ultraviolet radiation. Most children will have had nearly a quarter of their lifetime exposure to this radiation by age 18, and the resulting damage is compounded repeatedly by subsequent exposure.
I'd be the last person to suggest that children spend the glorious months of summer indoors. I want them out playing actively year-round, and the warm months are ideal for such activities as running through sprinklers, swimming, boating, playing ball, riding bicycles and scooters, playing in sandboxes and on playground equipment, and otherwise having a grand old time being children.
But just as children must be protected against the hazards of traffic and predators, so must they also be protected against the downside of that life-giving force, the sun. Yet a study in Florida in 2001 found that only 33 percent of parents used any form of sun protection for their children, and those who did relied solely on sunscreen, which other studies have found is used incorrectly most of the time.
Some parents worry about a possible deficiency of vitamin D in babies kept out of the sun, since this essential nutrient is produced in skin in the presence of sunlight. But it takes only a few minutes of exposure to ultraviolet light two or three times a week during the summer months to make enough vitamin D to last all year. And child health experts, including the American Academy of Pediatrics, suggest that a safer alternative is to take 200 International Units of vitamin D a day, starting at the age of 2 months, through infant formula, fortified cows' milk or soy milk, or a vitamin. Short of remaining indoors, there are three main approaches to sun protection, regardless of age:
- Wearing clothes that block much of the sun's radiation.
- Applying a complete sunscreen throughout the day every day.
- Staying out of the midday sun and in the shade as much as possible.
Protective Clothing
Dermatologists consider "covering up" to be the first line of defense against skin-damaging ultraviolet radiation. That means wearing long-sleeved shirts and long pants, a hat that shields the face, ears and back of the neck, and sunglasses. I don't know about you, but I sure wouldn't want to have my arms and legs covered in clothing with temperatures above 32oC, especially not when I'm running around playing. Nor would I expect my grandsons to be so attired.
However, for as long as parents can get away with it, clothing is the ideal sunblock. In fact, for infants under 6 months old it is the only sunblock, far more effective than keeping babies in the shade. The skin of very young children is highly susceptible to sunburn and other harmful effects of ultraviolet radiation.
Wise parents will start putting hats on their children as soon as they are born and never stop. That greatly reduces battles about wearing a hat when they're older. A baseball-style cap is not enough. The hat should have a full wide brim or desert-type flap that shields the face, ears and back of the neck.
Dark-colored clothing (again, not ideal for a hot summer day) is a better sunscreen than something light-colored. A white T-shirt, which some children wear in the water, has a sun protection factor, or SPF, of only about two when wet.
Instead of buying your child a costly toy this summer, consider investing in clothing specially designed with a built-in SPF of 30 that offers 97 percent ultraviolet protection. One popular brand, Solumbra, includes neck-to-ankle swim suits for toddlers and swim shirts and leggings for older children, as well as everyday sun-protective clothing for children through size 12. The Web site is www.sunprecautions.com.
The fabric in this and other brands is designed to retain sun-protective properties through scores of washings, and the clothes can be handed down to younger children. Alternatively, try washing your children's clothes with SunGuard, which treats fabric with Tinosorb, offering 96 percent ultraviolet protection that is retained through about 20 washings.
And don't forget sunglasses with full ultraviolet protection (check the label), which should be worn by babies and children as well as adults. An elastic band can keep them on and not easily lost.
The Sunscreen Necessity
This is a must for everyone starting at age 6 months, and there are now many effective products to choose from, including some that incorporate a light artificial tanning agent. Make sure the product provides full ultraviolet protection, against both UVA and UVB rays. The SPF rating, which should be 15 or higher, refers only to UVB, the burning rays. Products with higher SPF ratings offer minimal added protection.
Whether it is sunny or overcast and whether the child's skin is light or dark, sunscreen should be applied daily, 20 minutes before the child goes outdoors so the chemicals can interact with skin. And it should be reapplied every two hours, because sun gradually degrades the chemicals. Each application should fully cover the child's exposed skin, including ears and feet. Add a lip balm with an SPF of 15 or higher.
Look for water-resistant products, though even these should be reapplied after swimming or heavy sweating. And check the expiration date because old sunscreen may lose some effectiveness.
Made in the Shade
While staying in the shade is better than nothing, a lot of ultraviolet radiation is reflected off the ground or nearby objects when you are under an awning or beach umbrella. Infants should be protected by shade as well as clothing.
Even with sunscreen on, it is best to keep children out of the sun from 10am to 4pm. Parents may have to lobby their schools to provide shaded areas for children during recess.
Finally, set a good example by following the above advice yourself.
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