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The Abcs of Sun Protection for Children

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The Abcs of Sun Protection for Children DERMATOLOGY NURSING The ABCs of Sun Protection for Children Maryellen Maguire-Eisen Karen Rothman Marie France Demierre Excessive sun exposure in childhood is a critical variable Objectives This educational activity is designed for nurses and other health care influencing skin cancer risk. providers who care for and educate patients regarding sun protection for Nurses must teach parents how children. For those wishing to obtain CE credit, an evaluation follows. After studying the information presented in this article, the nurse will be able to: to properly protect their 1. Describe the risk of skin cancer in children. children from excessive sun 2. Discuss sun-protection policies recommended for children. exposures by demystifying UV 3. List characteristics of sun-protective clothing. 4. Describe the characteristics of sunblocks for protecting children from radiation and teaching proper the sun. sun-protection measures. Protecting children from excessive sun exposure, while kin cancer is the most prevalent can get skin cancer but inherent risk cancer in our society with over factors are very important (Mag- not curtailing recreation, 1 million new cases annually. uire-Eisen, 2003). Skin color, eye should be the goal of all nurses SSkin cancer is becoming more color, freckling tendency, nevi common in children and accounts for count, and family history increase caring for children. approximately 4% of pediatric malig- one’s risk of developing skin cancer. nancies. It is estimated that 90% of all However, the individual’s child- skin cancers are preventable (Schmid- hood sun-exposure history appears Wendtner et al., 2002). This is a stag- to significantly influence the risk of gering statistic when you consider that skin cancer (Kennedy, Bajdik, one American dies every hour from Maryellen Maguire-Eisen, MSN, RN, Willemze, & Gruijl, 2003; Rhodes, OCN, is an Oncology Certified Nurse, and skin cancer. Nurses can play a pivotal 1995; Silverberg, 2001; Tsao, Executive Director, Sun Protection role in prevention and early detection Atkins, & Sober, 2004). Skin can- Foundation, Hingham, MA. of this serious cancer by teaching cers are associated with both proper sun protection to children and intense, sporadic sun exposure (sun- Karen Rothman, MD, is an Assistant their parents. burn) and with chronic sun expo- Professor of Medicine and Pediatrics, Division sure (tanning) (Koh, Geller, Miller, of Dermatology, University of Massachusetts Background Medical School, Worcester, MA. Grossbart, & Lew, 1996). Skin cancers are malignancies Overexposure to ultraviolet Marie France Demierre, MD, that develop in the epidermis, der- radiation is a growing health con- FRCPC, is an Assistant Professor, and mis, or the adnexal structures of the cern for children in our society due Director, Skin Oncology Program, Boston skin most often due to overexpo- to environmental changes and cul- University School of Medicine, Boston, MA. sure to both natural and artificial tural trends. The ozone layer acts as sources of ultraviolet light. There a planetary “sunscreen” reflecting Acknowledgment: The authors thank are three major types of skin cancer: and absorbing ultraviolet radiation. Jane Shanney and Rachel Butler for their edi- torial review. basal cell carcinoma, squamous cell Ozone depletion has resulted in carcinoma, and melanoma. Anyone increasing levels of ultraviolet (UV) DERMATOLOGY NURSING/December 2005/Vol. 17/No. 6 419 DERMATOLOGY NURSING radiation reaching the Earth’s sur- and cutaneous melanomas are the snow create reflective surfaces that face. Between 1983 and 1993, there most serious health risks. increase scatter by 10%, 15%, and was a 6% drop in total ozone. It is 80% respectively (Environmental estimated that for every 1% drop in Sun-Protection Actions Protection Agency [EPA], 2004) ozone there is a 1% to 5% increase Sun-protection policies recom- Educating parents and teachers in skin cancer (Grant-Kels, 1993). mend avoiding artificial and natural how to use the Global UV Index to Sunburn incidence among ultraviolet light sources, proper use gauge the potential for sun damage American children is extremely of sunscreens, and the appropriate from natural sources is an impor- high, ranging from 29% to 83% for use of shade or sun-protection gear tant way to protect children from the previous summer season and (see Table 1) (American Academy excessive exposures to the sun. The between 7% and 13% for the previ- of Pediatrics, 1999; Centers for UV Index, developed by the ous summer weekend (Geller et al., Disease Control [CDC], 2002). National Weather Service and the 2002; Robinson, Rigel, & However, studies indicate that sun- EPA, is a prediction or estimate of Amonette, 2000). Repeated and protection measures are infrequent- UV intensity and the associated severe sunburns affect 12% of ado- ly utilized to prevent sun damage. risk of overexposure to human lescents with reports of five or more Sunscreens, hats, sunglasses, and skin. There are sun precautions or sunburns during one summer sea- avoiding midday sun are routinely actions that correspond to UV son (Davis, Cokkinides, Weinstock, used by less than one-third of chil- intensity levels. These actions O’Connell, & Wingo, 2002). Sun- dren (Banks, Silverman, Schwartz, include sunglasses, sunscreens, burn incidence is associated with & Tunnessen, 1992; Hall, McDavid, physical protection, and sun avoid- increasing age, fair skin, time spent Jorgenson, & Kraft, 2001; Geller et ance (see Table 2). outdoors, sporadic sunscreen use, al., 2002; Olson et al., 1997). Most Dermatology nurses should be and inadequate protective clothing schools in the United States lack pragmatic regarding limiting mid- (Geller et al., 2002). These factors sun-protection policies. The CDC day exposures and outdoor play. are important because one sunburn (2002) and the National Association Instruct parents that when the UV may double a child’s risk for devel- of State Boards of Education (2005) intensity is high, early morning, oping melanoma. Parental attitudes have sample school policies on skin late afternoon, or early evening that a child looks “healthier with a cancer prevention. Recently, states outdoor activities should be tan” may be a contributing factor began introducing legislation that planned whenever possible. If mid- influencing sun damage and skin addresses skin cancer prevention day activities are unavoidable, rec- cancer risk (Robinson, Rigel, & for children at school. California ommend portable shade including Amonette, 1997). has led the way in this effort with parasols, beach umbrellas, and sun Overexposure to ultraviolet the ratification of the Billy Bill (CA- tents, as well as protective clothing radiation via indoor tanning is SB 310). This bill prevents schools and sunblock. They are all practical another growing concern. Artificial from prohibiting children from and easy to employ. tanning is a billion dollar industry wearing sunglasses or hats on cam- Advising parents about the real frequented by an increasing num- pus (Sun Safety for Kids, 2005; risks of indoor tanning is impera- ber of teenage girls (Lazovich & William S. Graham Foundation for tive. There is no such thing as a Forster, 2005). Tanning rates for Melanoma Research, 2005). “safe tan” despite advertisements to teenage girls double between ages the contrary. Indoor tanners are at 14 to 15 and 15 to 16 (Geller et al., Ultraviolet Protection increased risk of developing all 2002). Indoor tanning is driven by Ultraviolet radiation varies dra- forms of skin cancer (Lazovich & social pressures, appearance moti- matically both daily and seasonally. Forster, 2005). Legislation forbid- vation, physiologic effects on mood, Peak readings occur at midday dur- ding indoor tanning in young teens and having a parent who tans ing noon time and seasonally on has been ratified in Wisconsin and (Feldman et al., 2004; Lazovich, et the Summer solstice, June 21st. UV Illinois. Many other states are al., 2004; Stryker et al., 2004). intensity is higher in May than in working on bills to protect this pop- Health risks associated with indoor August, leading to a high incidence ulation (Lim et al., 2005). tanning include severe skin or of sunburn in the Spring. Altitude is corneal burns, cataract formation, another important variable to con- Sun-Protective Clothing skin infections, photoaging, exacer- sider, because UV intensity is Sun-protective clothing is an bation of photosensitive disorders, greater at higher altitudes, increas- excellent way to shield children and skin cancer. Basal cell carcino- ing by 2% for every 1,000 feet from ultraviolet radiation exposure. mas, squamous cell carcinomas, above sea level. Water, sand, and Sun-protective clothing can range 420 DERMATOLOGY NURSING/December 2005/Vol. 17/No. 6 DERMATOLOGY NURSING Table 1. Sun Protection Glossary Sun Term Definition Application UV Intensity Ultraviolet light intensity is influenced by rotation and revolution of the Meters are available to planet (daily and seasonal variations), proximity to the equator, ozone measure UVB intensity and concentration, altitude, and weather (cloud cover and wind velocity). the scales may range from 0-15. Ultraviolet Index A measure of the risk for sunburn on a given day. Collected via satellite Global UV Index ranges and adjusted for environmental conditions including humidity, wind, and from 1-11+ with color clouds. coding for risk estimates. Sun Protection The ratio of time to develop a sunburn wearing a specific sunscreen as SPF >15 is recommended
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