It's summer, the kids are out of school, and that means getting them outside – to the playground, the sports field, or lakeside at a cottage or camp. But such activities also mean exposure to the sun and the damage its penetrating rays can do to children's tender and vulnerable skin.
Dermatologists say sunscreen can be one of the best ways to protect youngsters from painful burns and subsequent DNA damage, but with recent media reports about a spate of adverse reactions, many parents may be wondering whether they should be slathering their kids with the products before sending them outdoors.
"Overall, sunscreens are very safe," said Dr. Jennifer Beecker, national chairwoman of the Canadian Dermatology Association's sun awareness program, noting that they need to have a sun protection factor, or SPF, of 30 or more.
Still, the Ottawa dermatologist said sunscreen should be used as an adjunct to other protective measures, including seeking shade, avoiding sun exposure during the peak hours of 11 a.m. to 3 p.m., and covering up with clothing, a hat and sunglasses.
"Those are always the preferred methods in children and those are the ideal methods in children under the age of six months," she explained. Sunscreen is not recommended for babies under six months because safety data have not been established for that age group.
"Above six months, obviously (apply sunscreen) as much as possible, but then there are some areas that can't be protected, such as the hands or the face, and so in those areas we suggest using a limited amount of sunscreen."
Concerns about using sunscreen on young children recently hit the headlines when a number of parents claimed their youngsters had suffered burns and blisters following application of Banana Boat products.
As of last week, Health Canada had processed 139 consumer complaints about the lotions made by U.S.-based Edgewell Personal Care, with 133 of those received since May 11.
A Health Canada spokesperson said a review of the company's certificates of analysis – laboratory documents confirming a product meets specifications – and available test results identified no problems.
However, the agency is now conducting its own screening of Banana Boat samples to identify "all drugs present, whether they appear on the label or not," the spokesperson said. Analysis to quantify all active ingredients is also underway.
In an e-mailed statement, Banana Boat Canada said its sunscreens fall within a neutral pH range and cannot cause chemical burns, but noted that some people may have a sensitivity to a particular ingredient that can be triggered or exacerbated by the sun.
"This type of photoallergic reaction can result in an exaggerated skin rash or sunburn. In more severe cases, blistering may also develop," the company said. "We suggest consumers carefully test the product before use or consult their physician in advance if concerned about the possibility of sensitivity to certain ingredients."
Dr. Cheryl Rosen, a dermatologist at Toronto Western Hospital, agreed that testing a sunscreen on a small patch of a child's skin is a good idea. If the product is tolerated, parents can then try the lotion on a larger area of the skin and see if there are any adverse reactions outdoors in the sun.
"We don't know whether they would react to the sunscreen if they didn't go out in the sun or if it's only in combination with the sun," she said.
"We do know that there are some compounds that can cause a problem in combination with ultraviolet A, so if you use the product (indoors) ... you might not have a problem. But if you go outdoors and get sun exposure, there may be a reaction."
While not a common occurrence, Rosen said some people are sensitive to one or more ingredients in sunscreens.
"It could also be an allergy to a part of the sunscreen that's not a UV absorber. It could be to a fragrance or a preservative or some other compound used in making up a lotion or a cream."
Beecker advises parents to use sunscreens for kids that are fragrance-free and made with minimal preservatives. One common skin product preservative she suggests avoiding is methylchloroisothiazolinone, which is known "to have a very high rate of allergy."
Cosmetic creams, including sunscreens like Banana Boat, often contain tocopheryl acetate – a combination of vitamin E and acetic acid that can be a skin irritant in some people.
Even so-called "natural" plant-based ingredients like aloe, chamomile and feverfew may cause problems because they can act as "photo sensitizers," causing some people to become more susceptible to the sun's rays.
"I have a big problem with (them) because we see so many reactions ... people become allergic all the time," said Beecker.
But despite the potential for adverse reactions in children who may have sensitivities, Rosen stressed that the risk of skin damage from the sun "is worse than the risk of sunscreen use."
"You don't want little kids to be burning," she said. "Sun damage, some of it can be repaired, but it also can build up over time, and so the sun damage that we see in an older person is not from that particular summer, it's from all the summers of their life."
And that damage can lead to skin cancer, including potentially deadly melanoma, the seventh most commonly diagnosed cancer in Canada and one whose incidence has risen significantly over the last several decades. The Canadian Cancer Society now predicts that one in 56 males and one in 74 females in this country will develop melanoma in their lifetime.
"That's a lot of people," said Beecker, underscoring the need for kids to be well-protected from the sun.
"Because we know that damage when you're a child carries through for the rest of your life."