Skin cancer, sun protection, sunscreens and children

Skin cancer, sun protection, sunscreens and children

 

Sun protection in children is more important than at any other age. Even though skin cancer is rare in children, sunburn in childhood is a major risk factor for later skin cancer. Babies and very young children can be harder to protect due to their sensitive skin, and older children need encouragement to stay safe in the sun.

Why is sun protection so important during childhood?

A sunburn in the first 18 years of life is one of the highest risk factors for skin cancer when older.1

High sun exposure in the first 10 years of life more than doubles the risk of melanoma.2

Fortunately, the risk of melanoma in later life is lower if sunburn is prevented during childhood.3

Other skin cancers are also more common following sun exposure in childhood: Intensive sun exposure from time to time increases risk of basal cell carcinoma while long term low grade exposure increases the risk of squamous cell carcinoma.1

Young boy with sunburnt back
Young skin burns easily and sunburn early in life is a major skin cancer risk factor. 

Children’s skin

Children start to develop moles in the first years of life. They are genetically determined; in other words, if you have lots of moles your children are more likely to get lots of moles.4

Moles can develop due to sun exposure in childhood.5 

This is important because high numbers of moles are a risk factor for development of melanoma in later life.1

People with more than 100 moles have almost 7 times greater risk of developing melanoma.6

Birthmarks are a type of mole, also known as a congenital mole. They are almost always harmless. In rare cases, very large congenital moles more than 20 cm diameter are present at or shortly after birth. Melanoma can occasionally develop in this type of mole.7  8

Skin cancer in childhood

Skin cancer in children is very rare. Australian statistics show that in 2017, a child under 15 is approximately 100 times less likely to develop a melanoma than a 50-year-old, and 200 times less likely to develop a melanoma than an 80-year-old.910

This means it’s not usually considered necessary for children to have regular skin cancer check-ups.

Sun protection for children

How to reduce exposure to ultraviolet radiation

The first step in preventing ultraviolet-induced sun damage is to reduce exposure to excessive sunlight. In infants under 6 months old, try to use these methods only (i.e. minimise or avoid sunscreen use if possible).

The Cancer Council suggests these approaches for reducing sun exposure:11

  • Cover as much skin as possible with loose-fitting clothing made from light but tightly woven fabric.
  • Use a hat that covers the ears and neck. Broad brimmed, bucket or legionnaire-style hats are suitable. Babies may be more comfortable in a hat which crumples when the head is down.12
Young girl on beach standing underneath an umbrella while wearing a broad brimmed hat
A broad brimmed hat and an umbrella offer better protection than either alone.

Shade prams and strollers by draping fabric over them.

  • Check regularly to make sure that children’s hats and clothing are still providing adequate coverage.
  • Keep outdoor activities to the times of the day when ultraviolet radiation is least intense, usually before 10am and after 3pm.
  • Stay in the shade if possible, and encourage children to play in the shade. But remember that even in the shade ultraviolet radiation can reach you after being reflected off surfaces outside. Make sure that you use other forms of sun protection as well.
  • Provide a good example for children by protecting yourself against the sun.

Children and sunscreens

Children’s skin is easily damaged by ultraviolet radiation, but possibly also by sunscreen. It might not be possible to completely avoid sunscreen use, but in very young children, sunscreen should be considered the “last line of defence” against the sun.13

Reactions to sunscreen are unusual and can be due to sensitivity or allergy to one of many ingredients in sunscreen. Commonly, the ingredients which cause reactions are fragrances and preservatives, but sometimes reactions are due to the active ultraviolet absorber or shield.14

Sunscreens formulated for children don’t necessarily offer higher protection than sunscreens for adults. The main difference is that irritant ingredients such as pigments and fragrances are often left out to reduce the risk of a reaction.

Children’s sunscreens are more likely to include physical ingredients such as zinc or titanium dioxide. These ingredients form a barrier which blocks ultraviolet radiation and may be less likely to cause irritation or sensitivity in children’s skin than so-called than chemical sunscreens which react with ultraviolet radiation to absorb it and reduce its effect on skin cells.14

Children are more likely to apply enough sunscreen if they use a pump dispenser

Babies under 6 months are a special case. As well as having very sensitive skin, they have a large surface area in relation to their overall size. This means that sunscreen ingredients can theoretically be absorbed at a higher concentration. In general, it is probably safest to avoid sunscreen on very young babies and instead use clothing, hats and shade for sun protection.15 Fortunately, there is not strong evidence that sunscreen has caused harm to infants and it is most likely safe to use in small amounts on limited parts of the body.16

How to choose sunscreen for a child

When choosing a sunscreen for an infant or young child, there are several factors to consider:13

  • Most important: The sunscreen must provide adequate ultraviolet protection. Check for SPF (sun protection factor) of at least 30+, and broad-spectrum protection against both ultraviolet-B and ultraviolet-A radiation
  • There should be minimum risk of irritation or other reactions. Use a sunscreen which has the minimum possible amount of non-essential ingredients such as pigment or fragrance.
  • Consider using physical (i.e. based on zinc or titanium dioxide) rather than chemical sunscreens for infants.
  • Sunscreen should be easy to apply, and preferably non-greasy and non-staining.
  • Less important: Water resistance and transparent appearance may be important for adults and older children but may not be relevant for infants and toddlers.

Encourage children to use sunscreen

When children are old enough to apply their own sunscreen (e.g. primary school age), they must be encouraged to apply sunscreen as part of their daily routine whenever the ultraviolet index is forecast to rise above 3. Children are more likely to apply enough sunscreen if they use a pump dispenser rather than a squeeze bottle or roll-on applicator.17

Boy sitting on beach with mother applying sunscreen to his back
Encourage children to apply sunscreen as part of their own routine.

The Cancer Council suggests these methods and techniques:18

  • Let children practise applying sunscreen at about three years of age. By the time they start at pre-school or school they should have mastered this skill.
  • Set up a “sunscreen station”: provide a mirror and somewhere for the child to wipe their hands.
  • Keep sunscreen in an insulated lunch box so that it is cool when applied. This can be refreshing on a hot day.
  • Clip-on sunscreen can be attached to a bag, providing a constant visual reminder.
  • Make sunscreen application a fun activity by drawing shapes and squiggles before rubbing it in.
  • Be a role model to children. They learn from what they see adults doing. If you apply sunscreen consistently and properly, they will learn from your example.

Sunscreen “failure” in children

In recent years there have been reports of sunscreens, particularly spray-on formulations, either allowing or “causing” burns on children.19 In fact, these reports have sometimes been shown to be misleading.

It’s important to consider:

  • Was enough sunscreen applied? Spray on sunscreens are easy to under apply because they are diluted with propellant. When using spray-on sunscreen always rub it into the skin to make sure the entire area is covered.
  • Did the sunscreen contain irritants? Maybe the “sunburn” was actually a rash caused by ingredients in the sunscreen.
  • Had the sunscreen been properly stored? Sunscreen can be less effective if it was stored at an inappropriate temperature (for example, in a car in the summer) or if it is past its use-by date.

Spray on sunscreen in itself is no less effective than other sunscreens, but it might be better to avoid because it’s harder to get adequate coverage.

Are skin checks necessary for children?

Parents frequently ask about children and skin cancer checks. At what age should they start?

It can be concerning when your child starts to develop new moles and spots, especially if they've had recent sun exposure. But in almost all children, the risk of skin cancer is very low and routine screening isn't recommended.

It's normal for children and young adults to develop new moles. The number of moles a person develops is influenced mainly by genetic factors. People with many moles tend to have children with many moles. Some are present from birth, and more will appear up to about 40 years of age. Some appear in response to sun exposure, but most will appear irrespective of the amount of time the child spends in the sun.

Having many moles can be a risk factor for skin cancer and adults with more than 100 moles are usually advised to have a full body skin check once per year.20

Because skin cancer in children is rare, routine screening isn't usually recommended under the age of 15. After that, regular skin checks might be recommended for high risk teenagers.21

Risk factors include:

  • Family history of melanoma in a parent, brother or sister
  • Many moles (more than 100)

Our recommendation for children:

  • Be familiar with your child's spots.
  • If you notice a spot that looks "odd" or different from your child's other spots, ask a doctor to check it. This could be your GP.
  • If your GP thinks the spot looks abnormal, have it checked by a skin cancer specialist.

Recommendations

Since sun damage in children is much more likely to result in skin cancer; it’s extremely important to avoid excessive sun exposure.

The most effective forms of sun protection stop the ultraviolet radiation from reaching the skin. These include:

  • Sun-protective clothing and hats
  • Sunglasses
  • Staying out of the sun (ie indoors or in shaded environments)

Choose sunscreen carefully to ensure that it provides maximum protection, minimal irritation and is not unpleasant or difficult to apply in adequate amounts.

Girl on the beach holding a bottle of sunscreen while wearing a broad brimmed hat, protective clothing and sunglasses.
When children go out into the sun, best practice is to use sunscreen and to wear protective clothing, a broad brimmed hat and sunglasses.