Safe in the sun
From sunburn to heat stroke, sunny days can pose many threats to babies and children. But with the right precautions, little ones can stay safe and enjoy the summer, writes Deirdre Rooney
Summer is here and the great outdoors is calling. Parents with young ones in tow flock to beaches, parks and playgrounds; eating becomes al fresco; and back gardens become the new playrooms. But with these fun-filled sunny days come extra dangers for babies and children, who are amongst those most vulnerable to the harmful effects of the sun's rays.
The sunlight that reaches us is made up of two types of harmful rays - UVA and UVB. UVA makes up most of the UV that reaches the earth's surface. It reaches the deeper layers of the skin causing ageing, eye damage and skin cancer. UVB is mostly absorbed by the ozone layer and other substances before it reaches the earth's surface. It causes sunburn and is the major cause of skin cancer, according to the Irish Cancer Society.
"Special care needs to be taken to protect babies' skin in the sun," says Dr Mary Laing, Consultant Dermatologist at Galway University Hospital. Dr Laing has a special interest in skin cancer.
"Infant skin is 40-60pc thinner than that of an adult," she explains. "It is less hairy and has a weaker attachment between the epidermis and dermis, so the infant is at an increased risk for skin injury from UV radiation."
Not only are babies and toddlers at a greater risk to the dangers of the sun, but if and when they are harmed, the results can have more devastating longer term effects than compared to an adult.
"Sunburn in babies can pose future threats to their skin health," says Dr Laing. "Sunburn causes apoptosis or cell death of keratinocytes, the most common cell type in the skin. One episode of blistering sunburn in childhood doubles a person's risk of melanoma, the deadliest form of skin cancer. Skin damage is cumulative so any measures you put into place now will help your growing children in the long run. Sun protection in the early years is recommended to reduce the risks of UV, including skin cancer and photoaging."
According to the Irish Cancer Society, skin cancer is the most common cancer in Ireland. Just over 11,000 new cases were diagnosed in this country in 2015. Most cases are caused by UV rays from the sun.
Is there a safe amount of sun that babies and children should be getting, for sufficient vitamin D?
"There is no scientifically validated, safe threshold level of UV exposure from the sun, or indoor tanning devices, that allows for maximal vitamin D synthesis without increasing cancer risk," says Dr Laing. "Getting vitamin D from a healthy diet that includes foods naturally rich in vitamin D, foods and drinks fortified with vitamin D, and/or vitamin D supplements in breastfed babies is advised."
Dr Laing also highlights the importance of keeping little ones well hydrated in the sun.
"It is important that babies are well hydrated in hot weather. Babies and young children can't tell you that they are thirsty, so it is important to offer drinks or breastfeeds frequently," she says.
According to the Irish Cancer Society, no sunscreen gives 100pc protection from the sun. Also, people tend not to use enough sunscreen and as a result get a fraction of the protection they were hoping for. So, the main protection for babies and children is therefore avoidance - keep them out of the sun, in the shade, and covered up.
Aside from sunburn and the long-term damage to skin health that comes with the sun, there are other dangers that summer inevitably brings with it. And no doubt, even the most fastidious of parents will encounter some of them. Below, the experts give their advice on the prevention - and treatment - of some common summer ailments.
Prevention: All the experts are in agreement - babies and young children should be kept out of the sun, especially during peak hours (10am-4pm). If outdoors, they should be kept in the shade at all times. "The best form of sun protection for baby skin is clothing, including long sleeves, pants, sun hats and onesies for swimming," says Dr Laing. "In small areas that can't be covered by clothing, i.e. the cheeks of the face, I would recommend a broad spectrum (which means UVB and UVA coverage), zinc oxide-containing sunscreen, which is less likely to irritate babies' sensitive skin, and be less irritant to eczema-prone skin. Also remember to protect your babies in the car with car sunshades in rear side windows, as window glass blocks UVB but not all UVA."
Treatment: Frequent cool baths or showers can alleviate the pain of sunburn. Emollients with menthol are soothing to the skin injured by sunburn. "If a particular area is especially uncomfortable, you may apply a hydrocortisone cream," says Dr Laing. Drinking water helps prevent dehydration and take extra care to sunburned skin while it heals.
Prevention: Heat rash, also known as miliaria rubra, is a common dermatoses caused by sweat retention due to prolonged sweating which causes obstruction of the sweat (eccrine) ducts. Dr Laing advises avoiding excessive heat and humidity as a method of prevention.
Treatment: The lesions of miliaria are self-limited but simple strategies such as cool baths, light clothing and use of air conditioning can alleviate discomfort. "Topical preparations are of little value and may further propagate the condition by compounding eccrine obstruction," says Dr Laing.
Prevention: Cover up with sleeves, pants and mosquito nets. DEET 30pc is deemed safe for use over two months of age by the American Academy of Paediatrics, and it lasts five hours. DEET 10pc lasts two hours so it will need to be reapplied.
Treatment: "For painful bites, such as a bee sting, an over-the-counter analgesic such as paracetamol or ibuprofen may be taken," says Dr Laing. "For bites that itch, apply an ice-pack or an over-the-counter anti-itch cream, such as hydrocortisone. If there are any serious symptoms after an insect bite, such as a rash, fever or body aches, see your doctor immediately."
Prevention: Heatstroke is a condition caused by your body overheating, usually due to prolonged exposure to or physical exertion in high temperatures. Heatstroke can occur if body temperature rises to 40 degrees C (104F) or higher. Never leave anyone in a parked car, even if the car is in the shade. "When parked in the sun, the temperature in your car can rise more than 6.7 degrees C in 10 minutes," says Dr Laing. "When your car is parked, keep it locked to prevent a child from getting inside." Certain medication such as stimulants for attention-deficit/hyperactivity disorder (ADHD) can increase vulnerability to heat stroke.
Treatment: Heatstroke requires emergency treatment and untreated can cause damage to the brain, heart, kidneys and muscles. "If you think a person may be experiencing heatstroke, seek immediate medical help; get into shade or indoors; remove excess clothing and cool the person down," says Dr Laing.
Prevention: Sunburn can trigger eczema, so sun protection is important, says Dr Laing. "Clothing is the best form of protection. A fragrance-free sunscreen with the active ingredient titanium dioxide and/or zinc oxide, broad-spectrum protection, with an SPF 30+ is advised, as this is less irritant to eczema-prone skin."
Treatment: It should be treated exactly as advised to treat any eczema - cool baths, moisturisers, and whatever your GP suggests.
Prevention: Travel sickness, or motion sickness, is feeling sick when you travel by car, boat, train or plane. Lots of children suffer from travel sickness, though it tends not to start until after the age of two, according to the NHS. Breathe fresh air, if possible, for example by opening a car window, or breaking up the journey. Keep children distracted by talking to them, listening to music or singing songs. Try not to give your toddler a full meal just before travelling.
Treatment: If your toddler vomits, give small sips of water. Dry crackers can be useful for older toddlers.
Prevention: Hay fever is a type of allergic rhinitis caused by pollen or spores - an allergen makes the inside of your nose inflamed. It causes sneezing, a runny nose and itchy eyes, and usually occurs in spring and summer when there is more pollen in the air. It is difficult to completely avoid pollen or spores, but you can reduce your child's exposure to the substances that trigger it by avoiding playing or walking in grassy areas, as advised by the HSE. Keep windows and doors shut in the house. Pollen grains can also get stuck in clothes, so if your child has been out on grass, change his outfit afterwards.
Treatment: Wipe your child's eyes with cotton wool and cool water to soothe the symptoms. For other treatments in young children, consult your doctor or pharmacist.
Sun smart code
Protecting yourself from the sun is not just for sunny days, or for holidays abroad - even in Ireland you need to protect your skin every day from April to September, whatever the weather, as UV levels can still cause damage. Follow the SunSmart code for best protection possible.
1. Seek some shade
2. Slip on some clothes, slap on a hat
3. Wear sunglasses
4. Use sunscreen
5. Know the UV index
(Source: Irish Cancer Society)