Sun protection and prevention recommendations for children – September 2023

This text is the product of collaboration between the Dermatological and Venereological Society of Cyprus (DAEK), the Oncological Society of Cyprus (OEK) and the Pediatric Society of Cyprus (PEK) and aims to inform and guide parents and educators.

Edition: September 2023

Sun protection and prevention recommendations for children

Introduction
The skin is the largest organ of the human body. It covers and protects the internal organs from injuries, germs and fluid loss. It helps control body temperature as well as eliminate toxic substances. It has sensory cells responsible for sensation, i.e. temperature, touch and pain.

Skin cancer is the most common type of cancer, especially in countries with long periods of sunshine such as Cyprus.

The sun emits ultraviolet radiation (UVA, UVB and UVC), which is invisible to the human eye. These radiations are absorbed by melanin, a substance in human skin, causing the skin to darken after exposure to the sun.

The sun is particularly useful for the healthy development of children as it helps in the production of vitamin D, which is necessary for the absorption of calcium, a key component for bone development. In order for the sun to have the above beneficial effect, a short period of daily exposure to the clear sky is required, without direct exposure to the sun being necessary.

Excessive sun exposure, without appropriate protection measures, can cause damage to the skin and eyes while significantly increasing the risk of developing skin cancer in the future.

A direct result of excessive exposure to sunlight greater than that which melanin can absorb is sunburn. An indirect result is the appearance of cancer after many years.

Purpose
The purpose of this text is to record instructions for parents and teachers on sun protection and skin cancer prevention in preschool and school-age children.

Recommendations:
In general, the following factors contribute to the development of skin carcinomas:

• Excessive exposure to solar ultraviolet radiation/artificial tanning.
• Light skin (Phenotype I-II – blonde/red hair, blue, light
eyes).
• Exposure to chemicals/radiation.
• Heredity.
• Presence of multiple unusual moles (olives).
• Burns in childhood.

Burns in childhood are a significant factor in the development of skin cancer after adulthood.

Special sun protection is required for infants and children with light skin color, moles (olives) on the skin or a hereditary history of skin cancer.

Below are some simple measures to protect children from the sun:
➢ Keep infants and young children away from strong sunlight and glare.
➢ During the hot months of the year, try to minimize your child’s exposure to the sun during midday hours (11:00-15:00).
➢ Encourage children to play in shady places, e.g. under trees.
➢ Do not let children stay in the sun for a long time wearing only their swimsuit.
➢ Put on a t-shirt with sleeves after swimming.
➢ Wear loose, comfortable, cotton, light-colored clothes.
➢ Wear a wide-brimmed hat, preferably one that creates shade for both the face and neck.
➢ Discuss with your pediatrician/ophthalmologist the appropriate age for using sunglasses.
➢ Apply sunscreen with the highest possible sun protection factor (SPF) to the exposed parts of the child’s body, preferably up to 50 SPF (sun protection factor). Studies have shown that sunscreens with a protection factor of more than 50 SPF do not offer further protection. The packaging should state that it protects against UVA and UVB ultraviolet radiation, red infrared radiation and blue light.
➢ Sunscreen should be applied half an hour before any outdoor activity and exposure to the sun and replaced every 2 hours as well as after swimming.
➢ Sunscreen should also be used on cloudy days since ultraviolet radiation also penetrates clouds.
➢ Note that the action of sunscreen is also reduced by sweat, therefore it needs to be renewed even in activities outside the beach.
➢ Be careful where you get your sunscreen from, since there is a loss of action if it is exposed to the sun.
➢ Note that on sandy beaches, using an umbrella does not provide sufficient protection since the sun’s rays are reflected on the sand, resulting in tanning and possible burns.
➢ Note that staying in the sea does not protect the parts of the body that are in the water, since the sun’s rays are refracted, resulting in tanning and possible burns.
➢ Pay special attention to the shoulders, back and neck area, because sunburns occur most frequently in these areas.
➢ Remember to apply special sunscreen to the face area as well, since the face is constantly exposed to the sun (forehead, nose, behind the ears).
➢ Make sure children drink plenty of fluids (mainly water). Remember that children do not necessarily feel thirsty when they are playing.

Epilogue
The sun is a friend but at the same time it can be harmful in case of excessive exposure to solar radiation. The result of prolonged exposure appears immediately with sunburn and in the long term with the appearance of cancer. Therefore, by following specific rules, skin cancer, which is mainly due to excessive exposure to the sun, can be prevented. The responsibility for protecting children lies with parents and teachers since children are under their supervision for many hours every day. It is also the duty of parents and teachers to guide children so that they acquire the appropriate education to protect themselves today and their children in the future. 

Sources and information
1. Sun safety: babies, children and teenagers. Suitable for 0-18 years. Raising Children Network (Australia)..8 Feb 2021 Available at:  https://raisingchildren.net.au/newborns/safety/outdoor-sun-safety/sun-safety
2. NHS, Department of Health, Birth to Five, 2023. Available at:  https://www.publichealth.hscni.net/sites/default/files/2023 06/Birth%20to%20five%202023%20complete.pdf
3. American Academy of Pediatrics. Sun Safety: Information for Parents About Sunburn & Sunscreen. 14 Jul 2021. Available at: https://www.healthychildren.org/English/safety prevention/at-play/Pages/Sun-Safety.aspx
4. The Nemours Foundation. Sun Safety. Available at:  https://kidshealth.org/en/parents/sun-safety.html
5. Canadian Paediatric Society. Sun Safety. Available at:  https://caringforkids.cps.ca/handouts/safety-and-injury-prevention/sun_safety
6. Skin Layers. National Library of Medicine. Review Date 20/6/2023. Available at: https://medlineplus.gov/ency/imagepages/8912.htm# :~:text=The%20skin%20is%20the%20largest,bacteria%2C%20chemicals%2C%20and%20temperature.
7. Children’s Hospital experts offer advice to stay safe in the sun. NHS Birmingham Women’s and Children’s. Available at: https://bwc.nhs.uk/news/childrens-hospital-experts offer-advice-to-stay-safe-in-the-sun-8757/
8. American Skin Association. Sun Safety. Available at:  https://www.americanskin.org/resource/safety.php# :~:text=Protective%20Clothing, The%20best%20protective&text=A%20wide%2Dbrimmed%20hat%20that,possible%2C%20
and%20always%20wear%20sunscreen.
9. European Commission. Sunscreen products: Be smart and protect yourself this summer. Memo 30 June 2009. Available at:  https://ec.europa.eu/commission/presscorner/detail/en/MEMO_09_306