Sun Protection for Children: What Parents Do

Abstract

Source: Johnson K, Davy L, Boyett T, et al. Sun protection practices for children: knowledge, attitudes, and parent behaviors. Arch Pediatr Adolesc Med. 2001;155:891–896.To determine the frequency with which parents used sun protection measures for their children, these authors from the University of South Florida and the H. Lee Moffitt Cancer Center and Research Institute surveyed parents whose children attended a university-based medical clinic in Florida during August 1999. Parents or primary caretakers completed a self-administered questionnaire that elicited sociodemographic information, current sun protection methods used for their children, and their attitudes and knowledge about sun protection. One hundred caretakers were invited to participate and 77 completed questionnaires. The mean age of caretakers was 34.6 years, 82% were female, 56% had greater than a high school education, and 65% resided in an urban area. Fifty-six percent of caretakers were white, 26% African-American, and 15% Hispanic.Forty-three percent of parents usually or always used sun protection for their child. Strategies included sun-screen application (used by 67%), hats (34%), short-sleeved shirts (21%), long-sleeved shirts (7%), sunglasses (34%), staying in the shade (41%), and staying indoors during peak hours (51%). Among caretakers who used some form of sun protection, the most common reasons stated for using sun protection were to prevent sunburn (n=55), skin cancer (n=41), or premature aging of the skin (n=22); because of information from the media (n=12); or because their doctor recommended it (n=11). Caretakers were more likely to report the use of sun protection for their children if they were white (60% versus 23% reported using sun protection measures usually or always; P=.001), reported being knowledgeable about sun protection (64% versus 27%; P=.001), used sun protection themselves (61% versus 21%; P=.001), and reported teaching their children about sun protection (57% versus 10%; P=.001). In multivariate analysis, the 2 factors that were statistically significant predictors of sun protection use were female gender of the primary caretaker (OR 9.8; 95% CI, 1.1–89.6, P=.04) and increased score on the knowledge and attitudes scale (OR 1.63; 95% CI, 1.1–2.5, P=.02). The authors conclude that regular use of sun protection measures for children is infrequent. In addition, protective measures are aimed primarily at sunburn prevention and consist mainly of sunscreen application, not reduction of sun exposure. Reliance on these less effective measures of sun protection may increase the overall sun exposure of children.An estimated 1 million Americans were diagnosed with skin cancerin the year 2000.1 Although the majority of these were basal and squamous cell carcinomas that generally have a good prognosis, approximately 47,700 persons developed malignant melanoma, of whom 7700 will die from their disease.2 The incidence of malignant melanoma is rising dramatically, and today the risk of an American developing melanoma in his or her lifetime is 1 in 74.2 Although the factors underlying the increase in skin cancer incidence are incompletely understood, cumulative sun exposure is associated with non-melanoma cancers while intermittent intense exposure appears important for malignant melanoma.1 Eighty percent of one’s lifetime sun exposure occurs before age 20. By one estimate, routine sunscreen use during the first 18 years of life could decrease the development of skin cancer by 78%.3The study by Johnson et al, although limited by potential overreporting of the use of sun protection measures and a study sample that may not be representative, illustrates that only 43% of parents usually or always employed sun protection measures for their children, and that many parents employ sub-optimal measures. Sunscreen was the measure most often employed, while physical barriers (such as protective clothing) and sun avoidance were used less often. These data suggest that pediatricians and other primary care providers should renew their efforts to emphasize the importance of sun protection during health maintenance visits. Parents should be advised to limit their child’s sun exposure between the hours of 10:00 am and 4:00 pm and to use protective clothing on their child.4 A sunscreen with an SPF of at least 15 that offers ultraviolet (UV) A and UVB protection should be applied 30 to 45 minutes before a child goes outdoors (to permit absorption) and reapplied after swimming and at least every 2 hours if the child remains in the sun.4 To achieve optimal protection, sunscreen should be applied liberally. Studies indicate that most individuals apply only 1/4 of the recommended amount, thereby reducing the effective SPF.5 For example, using 1/2 of the recommended amount reduces the effective SPF by at least 50%.6 It has been estimated that 35 mL of sunscreen is needed to cover an adult completely.7 Based on this assumption, 15 mL would be required for the average 4-year-old. Finally, eye protection with sunglasses that provide 99% to 100% UVA and UVB protection should be encouraged to prevent cataract formation and retinal damage.4These authors point out that preventing skin cancer requires reducing exposure to the sun. Studies have shown that sunscreen, by preventing sunburn, may lead to increased sun exposure and the subsequent development of more nevi, whereas protective clothing is associated with a reduced number of nevi.8,9 We must advise parents to reduce their child’s (and their own) sun exposure and not rely solely on sunscreens to prevent skin cancers.