Start advice on sun exposure early

Pediatricians should be offering advice about ultraviolet radiation (UVR) exposure at 1 or more health-maintenance visits a year, beginning in infancy, according to a new policy statement on UVR recently issued by the American Academy of Pediatrics (AAP).

The guidelines also strongly advocate against adolescents visiting tanning salons.

Exposure to UVR causes basal cell carcinoma, squamous cell carcinoma, and cutaneous malignant melanoma, the 3 major forms of skin cancer. Awareness of UVR risk is not what it should be, compliance with sun protection lacks consistency, and the incidence of melanoma has continued to climb, says the AAP. In addition, teens and adults continue to visit tanning parlors.

The policy outlines the following additional recommendations for pediatricians:

• Provide advice about UVR exposure such as avoiding suntans and sunburns, dressing in protective clothing, applying sunscreen, and wearing hats and sunglasses when in the sun. Outdoor activities should be scheduled before 10 AM or after 4 PM.

• Suggest sunscreen use for children or adolescents who might sunburn. Sunscreens with an SPF of at least 15 should be applied regularly (every 2 hours) and after swimming, sweating, or drying off with a towel. Avoid sunscreens containing oxybenzone.

• Advice on UVR exposure is especially important for children at highest risk for skin cancer. These children have light skin, nevi and/or freckling, and a family history of melanoma.

• Sun-protection practices wane in early childhood, so discuss UVR risk with both parent and child starting at 9 years of age and encourage joint responsibility to ensure that the child is protected from the sun.

• Recommend that infants younger than 6 months be kept out of direct sun and covered with protective clothing and hats. Sunscreen should be applied to exposed areas when the sun cannot be avoided.

• Follow guidelines for vitamin D supplementation for infants, children, and adolescents. At least 400 IU of vitamin D is recommended daily. Overexposure to the sun or to artificial sources (ie, sunlamps and tanning beds) to increase vitamin D concentrations should be avoided.

The AAP also suggests that pediatricians support and advocate for legislation to ban access to tanning salons for children younger than 18 years. The World Health Organization, the American Medical Association, and the American Academy of Dermatology already support legislation to ban the use of artificial tanning devices by adolescents.

Council on Environmental Health and Section on Dermatology. Policy statement-ultraviolet radiation: a hazard to children and adolescents. Pediatrics. 2011. Epub ahead of print.