Kids sunburn

Sunburn is superficial skin damage that occurs when your child’s unprotected skin is exposed to the sun’s harmful ultraviolet (UV) rays. Two types of UV waves, called ultraviolet A (UVA) and ultraviolet B (UVB), are responsible for most of the damage to the skin. If your baby or young child is sunburned, the sunburn can damage the DNA of skin cells. Damaged skin cells can lead to moles or even skin cancer.

Sunburn can happen within 15 minutes of being in the sun, but the redness and discomfort may not be noticed for a few hours. Repeated sunburns can lead to skin cancer. Unprotected sun exposure is even more dangerous for kids who have moles or freckles, very fair skin and hair, or a family history of skin cancer.

Any part of the body can burn – from the scalp, to ear tips, to arms, chest and face. Only minutes of intense sun exposure can cause sunburn. Sunburns usually appear a few hours after your child has been exposed to the sun.

Sunburn is typically at its worst at 24 to 36 hours after sun exposure and resolves in 3 to 5 days.

After a few days, the skin tries to repair itself by peeling away the top layer of damaged skin.

Most sunburns occur during daily playtime and not necessarily special trips to the beach.

First-aid for sunburn

• Have your child get out of the sun right away.
• Have your child take a cool (not cold) shower or bath, or apply cool compresses on the sunburned area as often as needed.
• Give extra liquids for the next 2 to 3 days.
• Give acetaminophen or ibuprofen for discomfort. Be sure to follow the directions on the container
• Apply a topical moisturizer, aloe gel, hydrocortisone cream, or a topical pain reliever to sunburned skin. Avoid commercial products that contain Benadryl or benzocaine, because of the possibility of skin irritation or allergy
• If blisters are present, do not break them open, as infection can occur
• Keep the child out of the sun until the burn is healed
• When going outside, all sunburned areas should be fully covered to protect the skin from the sun until healed.
• Do not attempt to break any blisters that may form; you can cover these with gauze if necessary. If any break on their own, a topical antibiotic ointment can be applied. A moisturizer can help with skin peeling afterward. Avoid topical products that end in “-caine” as they can sometimes further irritate the skin.

What causes sunburn?

To better understand the causes of sunburn we need to take a look at some basic principles of the electromagnetic (light) spectrum. This spectrum is divided according to wavelength into the ultraviolet (< 400 nm), visible (400–760 nm), and infrared (> 760 nm). The ultraviolet (UV) spectrum is divided into three broad areas:

• Ultraviolet A (UV-A) = 320–400 nm. UV-A is less potent than UV-B but is the wavelength that reaches the surface of the earth most (about 90% at midday). Penetrates the middle skin layer (dermis) and subcutaneous fat causing damage to the site where new skin cells are created. Long-term exposure causes injury to the dermis resulting in ageing skin.
• Ultraviolet B (UV-B) = 290–320 nm. UV-B is much more potent at causing erythema. About 90% is absorbed by the surface skin layer (epidermis). Epidermis responds by releasing chemicals that cause the reddening and swelling characteristic of the early signs of sunburn. Repeated exposure causes injury to the epidermis resulting in ageing skin.
• Ultraviolet C (UV-C) = < 290 nm.

UV-C radiation is filtered out or absorbed in the outer atmosphere so does not pose a problem to humans. UV-A and UV-B radiation are the primary causes of sunburn. The skin reacts differently to each waveband.

Figure 1. Spectrum of solar radiation

Figure 2. Ultraviolet radiation

Sunburn prevention

Prevention is very important. To reduce risk of skin cancer later in life, sunburns should be prevented.

One of the most important tips for preventing sunburns is to remember that infants younger than 6 months old should be kept out of direct sunlight, according to the American Academy of Pediatrics. The best way to prevent sunburn in children over 6 months of age is to follow the ABCs recommended by The American Academy of Dermatology:

• Avoid direct sun in the middle of the day (10 AM to 3 PM). Remember: snow and water reflect light to the skin, and clouds still let a lot of light through, so you may still be exposed to ultraviolet light even on cloudy days. Keep babies less than 6 months old out of direct sunlight at all times.
• Block. Block the sun’s rays using a SPF 30 or higher sunscreen. Apply the lotion 30 minutes before going outside and reapply it often during the day. Sunscreen should not be used on infants under 6 months of age.
• Cover up. Cover up using protective clothing, such as a long sleeve shirt and a hat with a wide brim when in the sun. Use clothing with a tight weave to keep out as much sunlight as possible. Some manufacturers make specialty clothing with a high sun protection factor (SPF) rating, or you can purchase a special ingredient to be added to your washer that can “wash” SPF into your clothing.
• Use sunscreen on all exposed skin areas, including the lips, before going outdoors. A broad spectrum (blocks UVB and UVA light), with an SPF of at least 30, is best. Apply generously 30 minutes before going outdoors, and reapply every 2 hours or after swimming or sweating a lot.
• Do not use tanning beds!

Here are more tips from the American Academy of Pediatrics:

• Dress yourself and your kids in cool, comfortable clothing that covers the body, like lightweight cotton pants, long-sleeved shirts and hats.
• Select clothes made with a tight weave – they protect better than clothes with a looser weave. If you’re not sure how tight a fabric’s weave is, hold it up to see how much light shines through. The less light, the better.
• Wear a hat or cap with a brim that faces forward to shield the face.
• Limit your sun exposure between 10 am and 4 pm, when UV rays are strongest.
• Wear sunglasses with at least 99 percent UV protection (look for child-sized sunglasses with UV protection for your child).
• Use sunscreen.
• Set a good example. You can be the best teacher by practicing sun protection yourself. Teach all members of your family how to protect their skin and eyes.
• Ask your physician if extra care is needed for sun exposure if your child is taking an antibiotic, anti-seizure medication or acne preparation.

What are sunscreens?

Sunscreens protect the skin against sunburns and play an important role in blocking the penetration of ultraviolet (UV) radiation. However, no sunscreen blocks UV radiation 100 percent.

The terms used on sunscreen labels can be confusing. The protection provided by a sunscreen is indicated by the sun protection factor (SPF) listed on the product label. A product with an SPF higher than 15 is called a sunblock.

Choosing a sunscreen

According to the U.S. Food and Drug Administration (FDA), no sunscreen is fully waterproof, so parents should reapply often.

• Read the label – choose a sunscreen that is labeled “broad spectrum” to protect you and your family from both UVA and UVB rays.
• Buy a sunscreen with an SPF of at least 30+.
• Apply sunscreen 15 minutes before sun exposure.
• Maintain caution on overcast days because UV rays can penetrate cloud cover.
• Reapply sunscreen at least every two hours; more often if you are swimming or sweating.

How are sunscreens used?

A sunscreen protects from sunburn and minimizes suntan by absorbing UV rays. Using sunscreens correctly is important in protecting the skin. Consider the following recommendations:

• Choose a sunscreen for children and test it on the child’s wrist before using. If the child develops skin or eye irritation, choose another brand. Apply the sunscreen very carefully around the eyes.
• Choose a broad-spectrum sunscreen that filters out both ultraviolet A (UVA) and ultraviolet B (UVB) rays.
• Apply sunscreens to all exposed areas of skin, including easily overlooked areas, such as the rims of the ears, the lips, the back of the neck, and tops of the feet.
• Use sunscreens for all children over 6 months of age, regardless of skin or complexion type, because all skin types need protection from UV rays. Even dark-skinned children can have painful sunburns.
• Apply sunscreens 30 minutes before going out into the sun to give it time to work. Use it liberally and reapply it every two hours after being in the water or after exercising or sweating. Sunscreens are not just for the beach – use them when the child is playing outdoors in the yard or participating in sports.
• Use a waterproof or water-resistant sunscreen.
• Using a sunscreen with SPF of 50+ offers substantial protection from sunburn and prevents tanning. High SPF sunscreens protect from burning for longer periods of time than sunscreens with lower a SPF.
• Talk with older children or teenagers about using sunscreen and why it’s important. Set a good example for them by using sunscreen.
• Teach teenagers to avoid tanning beds and salons. Most tanning beds and salons use ultraviolet-A bulbs. Research has shown that UVA rays may contribute to premature aging of the skin and skin cancer.
• The American Academy of Pediatrics states that sunscreen may be used on infants younger than 6 months old if adequate clothing and shade are not available. Using sunscreen on small areas of skin on an infant is safe, according to the American Academy of Pediatrics.
• Avoid sun exposure for infants and dress the infant in lightweight clothing that covers most surface areas of skin. Apply a minimal amount of sunscreen to the infant’s face and back of the hands. Consult the infant’s physician for more information.

Sunburn signs and symptoms

The following are the most common symptoms of sunburn. However, each child may experience symptoms differently. Symptoms may include:

• Redness
• Swelling of the skin
• Pain
• Blisters
• Fever
• Chills
• Weakness
• Dry, itching, and peeling skin days after the burn

Sunburn may occur on any sun-exposed area. Sunburn appears as redness within 4 hours following exposure followed by deep redness and blister formation in severe situations. Long-lasting redness may be present for weeks after the actual burn.

The symptoms of sunburn may resemble other skin conditions. Always consult a physician for the correct diagnosis.

Mild sunburn:

• skin redness and warmth
• pain
• itchiness

Severe sunburn:

• skin redness and blistering
• pain and tingling
• swelling
• headache
• nausea
• fever and chills
• dizziness.

Severe sunburns may cause a person to become dehydrated and even go into shock. This is characterized by fainting, low blood pressure, and profound weakness. Immediate medical attention is necessary if this happens. By the time redness and pain appear, the damage has been done. Pain is usually at its worst 6 to 48 hours after the burn. While the symptoms of a sunburn may be temporary, the skin damage is permanent. The symptoms of a sunburn may resemble other skin conditions. Always talk with your healthcare provider for a diagnosis.

Although it may seem like a temporary condition, sunburn—a result of skin receiving too much exposure from the sun’s ultraviolet (UV) rays—can cause long-lasting damage to the skin. This damage increases a person’s risk for getting skin cancer, making it critical to protect the skin from the sun.

Long-term consequences of sunburn

It is now clearly apparent that the long-term consequences of overexposure to the sun or other sources of UV radiation are significant. One blistering sunburn at least doubles the likelihood of developing skin cancer later. Skin cancer is the most common type of cancer in the U.S., and exposure to the sun is the leading cause of skin cancer.

• Premature skin ageing and wrinkling
• Brown spots and freckles (lentigines)
• Development of premalignant lesions (actinic keratoses)
• Development of skin cancer (eg, melanoma, basal cell carcinoma, squamous cell carcinoma)

Sunburn treatment

The treatment of sunburn is to provide relief of the discomfort it can cause with the use of analgesics (pain-killers), cool baths, aloe vera lotions and moisturizers.

However, sunburn is better prevented than treated. Sun protection is your best defense against sunburn and other damaging effects of UV radiation.

• Avoid sun exposure, especially between 10 am to 3 pm
• Wear protective clothing, including wide-brimmed hats
• Regularly apply sunscreen with a Sun Protection Factor (SPF) of 50+

An oral food supplement containing Polypodium leucotomas may provide additional oral photoprotection and reduce sunburn.

If you are inadvertently exposed and expect to be sunburned, you may lessen the severity of the burn with the following measures:

• To alleviate pain and heat (skin is warm to the touch) caused by the sunburn, take a cool (not cold) bath, or gently apply cool, wet compresses to the skin.
• Cool milk soaks are an alternative.
• As soon as you get out of the bathtub or shower, gently pat yourself dry, but leave a little water on your skin. Then, apply a moisturizer to help trap the water in your skin. This can help ease the dryness.
• To rehydrate (add moisture to) the skin and help reduce swelling, apply topical moisturizing cream, aloe vera or 1% hydrocortisone cream that you can buy without a prescription. Apply a topical steroid to exposed areas twice daily for two or three days.
• Do not treat sunburn with “-caine” products (such as benzocaine), as these may irritate the skin or cause an allergic reaction.
• Drink extra water. A sunburn draws fluid to the skin’s surface and away from the rest of the body. Drinking extra water when you are sunburned helps prevent dehydration.
• Acetaminophen and ibuprofen to help decrease the redness and relieve the discomfort.
• If your skin blisters, allow the blisters to heal. Blistering skin means you have a second-degree sunburn. You should not pop the blisters, as blisters form to help your skin heal and protect you from infection.
• If the sunburn is severe and blisters form, talk with your healthcare provider right away.
• Stay in the shade until the sunburn is healed. Additional sun exposure will only increase the severity and pain of the sunburn.
• Take extra care to protect sunburned skin while it heals. Wear clothing that covers your skin when outdoors. Tightly-woven fabrics work best. When you hold the fabric up to a bright light, you shouldn’t see any light coming through.
• For severe reactions, prednisone, an oral steroid, may also help reduce the inflammation.