Baby Skin Requires Extra Diligence
By Jennifer Linder, MD
In adults, sunburns are painful, and cause tissue damage that can lead to skin cancer. But in babies, sunburns can be a medical emergency, causing dehydration, high fever, blisters, infections, chills, and heatstroke, not to mention vastly increasing their lifetime skin cancer risk.1
Babies are not only likelier to become seriously ill from sun overexposure, but also more apt to develop sunburns: their sensitive skin contains less melanin, the pigment that gives our hair and eyes their color and offers some sun protection. In short, parents must do everything they can to keep babies safe from sunburn.
Sun Safety ABCs
Shade and Shelter
To Sunscreen or Not to Sunscreen
Infant Skin Is Different
Why is using sunscreen on newborns controversial? There are key differences between infant and adult skin. First, infants’ skin is thinner, with a thinner stratum corneum, the dead outermost skin layer. It thus protects the body less effectively against outside agents; the chemicals in sunscreen might penetrate deeper, making newborns more vulnerable to contact dermatitis (skin reactions, like rashes), allergies, or inflammation. Newborn skin is also missing a functioning acid mantle, the film on the skin’s surface that protects the skin from bacteria, viruses, and transepidermal water loss (TEWL), a condition that can lead to dehydration.3,4,5 Lack of the acid mantle could leave babies more vulnerable to the chemicals in sunscreen.
In addition, babies also have a higher surface area-to-body weight ratio than older children and adults. A baby’s body surface area is about four times the body surface area-to-weight ratio in adults, which again leaves them exposed to greater penetration by chemicals. In adults, most sunscreen ingredients don’t get absorbed systemically (by the bloodstream) — and those that do are absorbed in insignificant amounts — but a baby’s skin may be considerably more vulnerable to this absorption; thus, it is wise to avoid any ingredients that could cause babies problems.
Whether or not the ingredients in sunscreen can penetrate babies’ skin significantly, they are not meant to be ingested, and infants could very well lick them off their fingers or any other reachable body area. That’s the main reason The Skin Cancer Foundation recommends holding off on sunscreen until baby is at least six months old.
Guidelines for Sunscreen Use in Babies
Whenever you begin using sunscreen on your infant, perform a patch test first (trying sunscreen on a small area of skin) to make sure your baby can tolerate the product. Sunscreens that consist primarily of physical or mineral sunscreen agents, like zinc oxide and titanium dioxide, are less likely to irritate babies’ skin than chemical sunscreens. Most sunscreens made for young children are mineral/physical formulations. While some question whether the new micronized/nanoparticle-sized physical sunscreens (which don’t leave the classic white smears on the skin) penetrate the skin too invasively, no study has ever shown these ingredients to penetrate deeper than the stratum corneum in humans. If you would prefer to use chemical sunscreens and skip the micronized products, avoid sunscreens containing PABA or oxybenzone, which have been associated with skin reactions.6,7
While the effects of sunburn in babies can be serious, luckily, numerous sun protection methods give parents multiple options for keeping their young ones sun-safe. With 3.5 million skin cancers in more than 2 million people diagnosed in the US each year,8 the earlier we can begin using sun safety with our children and instilling this behavior in them, the better.
Jennifer Linder, MD, is a dermatologist and fellowship-trained Mohs surgeon in Scottsdale, AZ, and Chief Scientific Officer at PCA SKIN®. She holds a clinical faculty position in the Department of Dermatology at the University of California, San Francisco. Dr. Linder is a member of numerous societies, including the American Academy of Dermatology, the American Society of Dermatologic Surgery, and the American College of Mohs Surgery. She is a member of The Skin Cancer Foundation’s Amonette Circle.
- American Academy of Pediatrics. Sunburn: treatment and prevention. Healthychildren.org. Page last updated Dec. 3, 2012. http://www.healthychildren.org/English/safety-prevention/at-play/Pages/Sunburn-Treatment-And-Prevention.aspx
- American Academy of Pediatrics Committee on Environmental Health. Ultraviolet light: a hazard to children. Pediatrics 104(2) 1999:328-333. http://pediatrics.aappublications.org/content/104/2/328.full.pdf.html
- Rudy SJ. Skin care for infants and young children: using new evidence to address common myths. Medscape Education. Available at: http://www.medscape.org/viewarticle/743532.
- Hoath SB. Physiologic development of the skin. In: Polin RA, Fox WW, Abman SH, eds. Fetal and Neonatal Physiology. Philadelphia, PA: Elsevier; 2004.
- Consumer Updates. Should you put sunscreen on infants? Not usually. http://fda.gov/forconsumers/consumerupdates/ucm309136. htm. Last updated June 25, 2012; visited April 30, 2013.
- Scheuer E, Warshaw E. Sunscreen allergy: a review of epidemiology, clinical characteristics and responsible allergans. Dermatitis 2006; 17(1):3-11.7
- Palm MD, O’Donoghue MN. Update on photoprotection. Dermatol Ther 2007; 11(5):360-76.
- American Cancer Society. Cancer Facts and Figures 2011. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-029771.pdf