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Sara Scranton, MD

Advocacy April 2012

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Anticipatory Guidance Summer SafetyYou are concluding a well child visit with a 6 month old male and his(first time) parents. It is April, the sun is shining, the weather is warm,and the mosquitoes are starting to hatch. You know this family is veryactive, likes to hike, and spends a lot of time outdoors. You know that

you should talk about summer safety as part of your anticipatoryguidance. What do you plan to say about sun protection and insectrepellents?

How would your advice be different if the child wastwo months old? two weeks old?

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Sun ProtectionWhy should we protect

against sun and sun burns?

What is the best way to

protect children from the sun?What is the right sunscreen

for children?

Can the sunscreen be used on

small children?What is the correct way to

apply the sunscreen?

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Sun ProtectionWhy is sun protection important?

Prevent painful and harmful sunburns

Protect against sun damage to the skin Prevent skin cancer

Sun exposure is the most preventable riskfactor for all skin cancers, including

melanoma. You can have fun in the sun andreduce your risk of skin cancer. In 2010, newresearch found that daily sunscreen use cutthe incidence of melanoma, the deadliest

form of skin cancer, in half. AAD.org

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Sun Protection Keep babies younger than 6 months out of direct

sunlight!

If they are outside, keep them in shade, either under atree, umbrella, or stroller canopy.

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Sun ProtectionWhy no direct sunlight?

In children less than 6 months:

Functional sweating is impaired. Sunburn occurs more easily

because their skin contains lessmelanin.

Sunscreen may give parents a falsesense of security and they maykeep infants in the sun longer.

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Sun ProtectionFor older children:

Dress them in cool, comfortable

clothing that covers the body,such as lightweight pants, longsleeve shirts, and hats.

Select clothing with a tight weave

(to check weave hold it up to thesunlight).

Wear a hat with a brim that facesforward to shield the face.

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Sun ProtectionWear sunglasses with at least

99% UV protection; look forchild sized sunglasses.

Limit sun exposure between 10AM and 4 PM when UV raysare strongest.

Use sunscreen!

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Sun Protection Set a good example. Promote that parents practice

sun protection themselves.

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Sun ProtectionAustralia Skin CancerPrevention Campaign (Slip,Slap, Slop, Seek, and Slide) is an

example of these preventionmeasures making a difference.

Rates of skin cancer aredeclining in Australians lessthan 60 years of age.

Suntans are now lessfashionable with decreasedrates of intentional suntanning.

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Sun Protection

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Sun ProtectionSome Good Examples

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SUNSCREEN!

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Sunscreen Everyone, regardless of skin type,

needs to wear sunscreen.

It should be used year round, notjust in the summer months.

It should be used any day that thechild will be in the sun for 20

minutes or more. Even on cloudy days, 80% of the

suns rays pass through the clouds.

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Sunscreen Sunscreen can help protect the skin from sunburn and

some skin cancers, but only if used correctly.

Remind parents that sunscreen should be used for sunprotection while outside, but not as a reason to stay inthe sun longer.

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Sunscreen Sunscreen should be used

anytime a child will be indirect sunlight.

Even on cloudy days childrencan sunburn.

UV rays reflect off of water,

sand, snow, and concrete, somake sure they are protected!

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Sunscreen How to pick the right sunscreen: Use a sunscreen with broad-

spectrum on the label (both UVA &

UVB). Use a sunscreen with an SPF (Sun

Protective Factor) of at least 15,which deflects 93% of UVB rays. The

higher the SPF the more UVBprotection.

Look for the new UVA star ratingsystem (4 stars is the highest UVA

protection available OTC).

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Sunscreen For sensitive areas of the body (nose, cheeks, tops of

the ears, and shoulders), choose a sunscreen or sunblock with zinc oxide or titanium dioxide.

These sun blocks stay visible on the skin, and nowcome in fun colors for kids.

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Sunscreen Use lip balms that contain SPF 30 or higher to protect

the lips as skin cancer can also form there.

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SunscreenSunscreen for Babies:

Less than 6 months - As already mentioned, ideallythey should not be in direct sunlight. Sunscreens areonly indicated for children greater than 6 months.However, if shade is not available then sunscreenshould be used in small amounts to protect exposedskin (face and back of hands).

Older than six months Apply to all areas of the body,but be careful around they eyes.

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SunscreenApplication Tips:

USE A LOT! Use enough to cover all exposed areas.

Small children require at least an ounce of sunscreen. Focus on the face, nose, ears, hands, and feet.

Dont forget areas such as the back of the knees.

Rub in well.

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SunscreenApplication Tips:Apply 15 to 30 minutes before going

outside to give time for the

sunscreen to bind to and absorb intothe skin. Reapply sunscreen at least every two

hours. It wears off in water, fromsweating, and just from soaking into

the skin. Water resistant sunscreen loses its

effectiveness after 80 minutes in thewater.

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Sun Protection - ReviewDO DONT

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BUG SPRAY!

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Insect Repellents From what diseases are we protecting children?

What kind of insect repellent is best? Can it be used on small children?

What is the safest way to use it?

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Insect RepellentsWhy should we prevent insect bites?

Ticks carry: Lyme Disease

Rocky Mountain Spotted Fever

Mosquitoes carry:

West Nile Virus

Not to mention avoiding the itchy bites themselves!

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Insect Repellents Prevent BITES from biting insects

Mosquitoes, Flies, Ticks, Fleas, and Chiggers

DO NOT prevent STINGS from stinging insects

Bees, Wasps, and Hornets

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Insect Repellents Come in many forms (aerosols, sprays, liquids, creams,

wipes, and sticks)

3 main types:

1) Chemical - DEET

2) Chemical - Permethrin

3) Natural Ingredients

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Insect Repellents - DEETDEET (N,N-Diethyl-3-Methylbenzamide) Considered the best defense against biting insects.

Should be used in areas with concern for West Nile

Virus.Amount of DEET varies product to product. Higher amounts of DEET protect people longer.

Studies show that products with DEET of ~10% repel

pests for about 2 hours, while products with DEET of~24% last around 5 hours.

Studies also show that products with amounts of DEETgreater than 30% don't offer any extra protection.

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Insect Repellents - DEET Caution should be used when

applying DEET to children: Products with DEET should

never be used on childrenunder 2 months of age.

Never use products with morethe 30% DEET on children of

any age. Apply with care (refer to

application Dos and Donts).

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Insect Repellents - Permethrin This repellent kills insects on contact.

When applied to clothing, it lasts evenafter several washings.

This repellent should only be applied toclothing, NOT directly to skin.

May be applied to outdoor equipment

such as sleeping bags or tents.

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Insect Repellents - Natural Ingredients Natural repellents are made

from essential oils found inplants, such as citronella, cedar,

eucalyptus, and soybeans. They are generally much LESS

effective repellents as most giveonly short-term protection,usually less than 2 hours.

Allergic reactions are rare, butcan occur.

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Insect RepellentsThe following are types of repellents that are not

effective:

Wristbands soaked in chemical repellents

Garlic or vitamin B1 taken orally

Ultrasonic devices that give off sound wavesdesigned to keep insects away

Bird or bat houses Backyard bug zappers, as insects may actually be

attracted by them to your yard

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Insect Repellents - DOs Read the label carefully and follow all directions and

precautions.

Only apply insect repellent on the outside of yourchild's clothing and on exposed skin.

Spray repellent in open areas to avoid inhalation.

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Insect Repellents - DOs Limit use of repellent as using more doesn't make it

more effective; avoid reapplying unless necessary.

Assist young children when applying insect repellenton their own. Older children also should be supervisedwhen using these products.

Wash your children's skin with soap and water to

remove any repellent when they return indoors, andwash their clothing before they wear it again.

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Insect Repellents DONTs Never apply insect repellent to children younger than 2

months.

Repellents should not be sprayed directly onto yourchild's face. Instead, spray a little on your hands firstand then rub it on your child's face; avoid the eyes andmouth.

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Insect Repellents DONTs Insect repellents should not be applied on

areas with cuts, wounds, or irritated skin.

Don't buy products that combine DEET withsunscreen. The DEET may reduce theproducts effective SPF. Further, theseproducts can overexpose your child to DEETbecause the sunscreen needs to be reappliedoften.

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Insect RepellentsAdditional Bug Safety Tips:

Dont use scented soaps,perfume, hair spray.

Avoid areas where insectscongregate such as stagnantwater or gardens in bloom.

Avoid dressing your childrenin bright colors or floweryprints.

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References A Parent's Guide to Insect Repellents (American Academy

of Pediatrics)

A Parents Guide to Sun Safety (American Academy of

Pediatrics) AAD.org sunscreen skin cancer (American Academy of

Dermatology)

http://www.cancer.org.au

HealthyChildren.org Immunizations and Infectious Disease: An Informed

Parents guide (American Academy of Pediatrics)

www.skincancer.gov.au

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