"How do I choose the best sunscreen for my kids?" is one of the more common questions I get in the office each summer. As parents, we always want to do what's best for our children, and most of us by now have heard that excess sun exposure causes skin cancer. Over the past few years, conflicting messages have emerged from some media sources and websites regarding whether or not sunscreens are safe, with some even questioning whether they should be used at all. As a dermatologist and a mother of two young children, this issue is very dear to me, and I'd like to address some of the misinformation out there by writing about this topic.
This post discusses a number of issues surrounding sunscreens and sun protection. For those unable to read to the end, some of the take-home messages are as follows:
- Excess sun exposure causes skin cancer. Children may be especially vulnerable to the effects of radiation from the sun.
- Protect children with a combination of sun-protective clothing, hats, and sunscreen. Have them seek shade whenever possible between 10am and 4pm.
- Scientific evidence overwhelmingly supports the benefits of sunscreen use in preventing skin cancer.
- Choose a sunscreen for your child that has an SPF of 30 or higher and is labelled as "broad spectrum". Use water-resistant sunscreens if your child will be swimming.
- Look for the ingredients avobenzone, ecamsule (Mexoryl SX) and/or zinc oxide when choosing a sunscreen. Examples of products that contain these ingredients are listed below.
- A well-formulated chemical sunscreen will often provide a higher degree of protection than a sunscreen that is composed of only mineral active ingredients
- Apply sunscreen generously, and re-apply it every 2 hours (more frequently after water exposure). Make sure to cover all exposed areas.
Skin cancer is the most common and one of the most preventable types of cancers in Canada and the United States. Fifty years of skyrocketing increases have led to the point that there are now more cases of skin cancer diagnosed each year than of all other cancers combined. While most of these malignancies are curable, some are not, and an estimated 10,000 Americans and 1150 Canadians will lose their lives to melanoma this year.
There is a consensus amongst the scientific community regarding the fact that ultraviolet radiation (UVR) emitted by the sun causes skin cancer. Despite what some fringe websites may tell you, there really is no debate regarding this issue among credible scientists. The causal relationship between UVR and skin cancer is as well-established as the one between smoking and lung cancer.
Research also suggests that childhood may be a particularly vulnerable time for our skin. Many studies have shown a link between sunburns and the subsequent risk of developing melanoma (the most serious type of skin cancer), and several studies have found that sunburns in youth may pose a greater risk than those later in life. Only a single blistering sunburn in childhood has been estimated to raise a child's risk of going on to develop melanoma by about 50%, and five sunburns between the ages of 15 and 20 have been associated with an 80% increase in risk. That doesn't mean you should panic if your child has had a few sunburns, but you should be aware that protecting his or her skin is important to their health.
What Is The Best Way To Protect My Child's Skin?
The best way to protect your child's skin is with a combination of sun-protective clothing, sunscreen, and sun-safe behaviour. Children should be primarily protected with clothing, hats, and sunglasses, and sunscreen should be relied on for areas that remain exposed (babies under six months of age should be kept out of the sun). Clothing and swimsuits ("rash guards") labelled with a UPF (ultraviolet protection factor) of 40 or higher are now readily available, and dark-coloured clothing with a dense weave will similarly provide a high degree of protection. Unlike sunscreen, clothing doesn't wash off, nor does it depend on one's application technique, making it an ideal form of sun protection. Finally, encourage sun-safe behaviour in your children; have them play in the shade whenever possible during the peak UV exposure hours of 10am - 4 pm.
What Makes A Great Sunscreen?
Creating a great sunscreen is actually a greater challenge for manufacturers than most people realize. The ideal sunscreen protects well throughout the entire spectrum of ultraviolet radiation that reaches the earth (which is divided into UVB and UVA). Most (not all) sunscreens with an SPF rating of 30 or higher will protect reasonably well from the UVB part of the ultraviolet spectrum. Good UVA coverage, especially from the longest UVA rays (known as UVA1) is more difficult to achieve, and is what sets a great sunscreen apart from a weaker one. This is largely because there are only three sunscreen ingredients (UV filters) available in North America that protect well from this part of the ultraviolet spectrum: avobenzone, zinc oxide and ecamsule.
So What Should I Look For In A Sunscreen?
When choosing a sunscreen for your child, look for a product that has an SPF of at least 30 (preferably 40-50 for days at the beach, pool, or when your child will be outside for long periods of time). If your child will be in water, make sure to choose a sunscreen that is labelled as "water resistant". Finally, look for a product that is labelled as "broad-spectrum", which means that it offers protection from a broader portion of the UVA/UVB spectrum. To find a sunscreen that protects well from longer UVA rays, check the label for the presence of avobenzone, ecamsule (Mexoryl SX) or zinc oxide. I have listed a number of examples at the bottom of this post.
I've Heard That Sunscreens Cause Skin Cancer...Is that True?
No. Sunscreens do not cause skin cancer. In fact, research in both animals and humans has shown that regular sunscreen use can prevent skin cancer. A randomized controlled trial (the highest quality of medical research) conducted in Australia showed that daily sunscreen use reduced the risk of squamous cell carcinoma (a common type of skin cancer) by 39% when compared with discretionary sunscreen use. Long-term follow-up of this study found those who used sunscreen daily also had a 50% reduction in their risk of melanoma.
Aren't Sunscreens Full of Dangerous Chemicals?
Sunscreens, like all things in our lives (including the water we drink and all the foods we eat), are made up of chemicals. Despite their extensive use over decades there is no scientific evidence that is of reasonable quality that shows that any of the sunscreen ingredients currently in use in the US or Canada are harmful when used in human beings. Because they are regulated as over-the-counter drugs in these countries, all of the active ingredients have undergone rigorous safety testing prior to being approved by Health Canada or the FDA. I have written a long post on the safety of sunscreens and the fear-mongering that has taken over the discourse around these products.
What About "Natural" Sunscreens?
Products marketed as "natural" are often mineral sunscreens, which use only zinc oxide and titanium dioxide as their active ingredients. These are known as physical filters; inert metals that sit on the skin and absorb, scatter or reflect light (in contrast to chemical filters such as avobenzone or octocrylene that absorb ultraviolet light and convert it to heat). While chemical filters can sometimes irritate sensitive skin and can rarely cause allergic reactions, physical filters have the advantage of being gentle, stable (meaning that they are not degraded by sunlight) and non-allergenic. They are often a good choice for young children (older than 6 months), and for those with eczema or sensitive skin. Their disadvantage lies with the fact that zinc oxide is a less efficient ingredient, meaning that ounce for ounce it provides a lesser degree of protection.
The lesser efficiency of some mineral sunscreens has been illustrated by Consumer Reports, who in their testing have found that almost 75% of "natural" sunscreens don't meet their SPF claims, a finding that concerns me given how popular these products are with parents. In general, a well-formulated "chemical" sunscreen will provide a higher degree of protection than most mineral sunscreens, and it is for this reason that I usually select sunscreens that use chemical filters for myself and for my family. For more information on this topic please see this post.
Ultimately, whether one should choose a mineral or chemical sunscreen really depends on which active ingredients a product contains and at what concentrations, such that there isn't a "one-size-fits-all" answer. If you choose to use a mineral sunscreen on your child, look for one with a high SPF and apply it generously. For better protection from UVA rays, choose one that contains zinc oxide alone (in high concentrations of at least 16-18%), or zinc oxide in combination with titanium dioxide.
Why Does My Child Still Burn or Tan When I'm Using A Good Sunscreen?
Like most people, you're not applying your sunscreen properly. Studies have repeatedly shown that we don't apply sun protection creams in the way they're meant to be used. A sunscreen's SPF is calculated based on the very generous application of product (specifically 2 milligrams of sunscreen per square centimetre of skin). Most people use between 20% and 50% as much sunscreen as is needed, which means that your child's SPF 30 is really giving her an SPF of between 6 and 15.
You can buy the best sunscreen out there, but if it's used improperly it will only offer you a fraction of the protection it was meant to provide. An average-sized adult will need 2 tablespoons (a shotglass full) to protect them, and a child will need proportionately less depending on their size. Don't forget to cover areas like the ears, the back of the neck and the tops of the feet, and remember that your child needs sunscreen even on cloudy days. Sunscreen should then be reapplied every 2 hours, and more frequently if your child has been swimming.
Should I Buy Sunscreens That Are Specifically Labelled As Being For Kids?
Not necessarily. In many cases, the only difference between kids' sunscreens and adult versions is marketing. There are no sunscreen ingredients that are specifically approved (or banned) in children vs adults. The sunscreen you use on yourself can generally be used on your children.
What About Spray Sunscreens?
I don't love spray sunscreens for use in kids. Some experts have cautioned that there may be health risks associated with inhaling the sunscreen's ingredients when they are aerosolized. Because they go on clear, they are also more difficult to see on the skin, and "skip areas" may be more likely to develop.
Are There Some Sunscreens I Should Avoid?
Avoid any sunscreen that does not provide "broad-spectrum" protection. These sunscreens allow users to stay in the sun longer without burning, but do not provide adequate protection from longer UVA rays. Sunscreens like this may actually be dangerous, allowing us to get more UVA radiation than we would otherwise get.
So Which Sunscreens Do You Recommend?
As a dermatologist, I'm often asked about which products I choose for my own family. While the details change from year to year, what remains consistent is my insistence on strong UVA protection, and the products I use reflect that. At the moment, the sunscreens I use on my children use a combination of the chemical UVA filters avobenzone, Mexoryl SX and Mexoryl XL to achieve a high degree of protection. These, along with other products I recommend, are listed below.
There are many great choices out there in terms of sun protection, such that I'm usually reluctant to recommend only a handful of products. That being said, I realize it's easier to head to the store knowing what to look for, and so I've put together a list of a few of the sunscreens that I use on my own children, and that I recommend to my patients who have kids. Please realize that this list is by no means exhaustive...there are dozens of very good options.
For Canadian Audiences
Many of the sunscreens sold under the trade names Anthelios, Vichy and Ombrelle contain avobenzone with Mexoryl SX, often in combination with Mexoryl XL. These sunscreens offer a high degree of stable UVA protection and are often an excellent choice.
- La Roche Posay Anthelios Dermo-Kids SPF 50 Lotion
- Vichy Ideal Soleil Lotion SPF 50 For Kids
- Ombrelle Kids SPF 50+ Water Resistant Lotion
- La Roche Posay Anthelios XL Melt-In Cream SPF 60
Coppertone makes a number of very good options that are more economical than the sunscreens listed above. Their "sensitive skin" product contains a good amount of zinc oxide in combination with two UVB filters, and their "water babies" product performed exceptionally well when tested by Consumer Reports over the past few years.
- Coppertone Sensitive Skin Sunscreen Lotion SPF 50
- Coppertone Water Babies Sunscreen Lotion SPF 60
I don't have any personal experience with these, but both of the sunscreens listed below contain reasonably high concentrations of the active ingredients titanium dioxide and/or zinc oxide:
- Green Beaver Natural Mineral Sunscreen Lotion for Kids SPF 40
- Badger Sport Unscented Sunscreen Cream SPF 35
For American Audiences:
For those living in the US I recommend reviewing Consumer Reports' sunscreen buying guide. They independently test sunscreens for both UVB and UVA protection, along with water resistance. Unlike the Environmental Working Group, they do not profit from the sale of products they recommend. Of the list that follows, the first two sunscreens scored highly on Consumer Reports' testing this year.
- Anthelios 60 Melt-in-Sunscreen Milk
- Coppertone Water Babies SPF 50 Lotion
- Coppertone Water Babies Pure & Simple SPF 50 Lotion
- Ocean Potion Protect & Nourish SPF 50 Sunscreen
- Blue Lizard Sensitive Skin Sunscreen SPF 30
- Badger Sport Unscented Sunscreen Cream SPF 35
Both the Skin Cancer Foundation and the Canadian Dermatology Association maintain lists of sunscreens that bear their respective seals of approval. While these organizations do not independently test sunscreens, they do have panels of doctors and/or scientists that review the composition of a product and the scientific testing it has undergone. The Skin Cancer Foundation also reviews products such as hats, sunglasses, and protective lip balms, all of which are important parts of a good sun-protection program.
Skin cancer is the most common type of cancer in North America, and one of the few that is largely preventable. Protecting your child's skin now may reduce their risk of developing these malignancies later in life. From sun-protective clothing, to sunscreens, hats and sunglasses, increased awareness of the risks of excess sun exposure have been met with a plethora of products that can help protect your little ones' skin and eyes. Choose your sunscreens and sun-protection products carefully, use them as directed, and send your children off to enjoy their summer vacations. Happy summer!