Pediatric Sunburn

Sunburn is a red, painful skin reaction after exposure to ultraviolet (UV) light. The skin absorbs UV light from sunlight as well as artificial sources of light such as tanning beds. UV rays can also cause invisible damage to the skin. Excessive or multiple sunburns cause wrinkling and premature aging of the skin. Sun exposure is also the leading cause of skin cancer. 

Children often spend a good part of their day playing outdoors in the sun, especially during the summer. Children are more likely to develop skin cancer in later years if they have:

• Fair skin, moles, or freckles.
• Multiple blistering sunburns.
• A family history of skin cancer.

Exposure to the sun during daily activities and play causes the most sun damage. Overexposure to sunlight before age 18 is most damaging to the skin.

UV rays are strongest during summer months when the sun is directly overhead. This is normally between 10 a.m. and 4 p.m.

• Sunburn is a visible reaction of the skin's exposure to ultraviolet (UV) radiation, the invisible rays that are part of sunlight. Ultraviolet rays can also cause invisible damage to the skin.
• Excessive and/or multiple sunburns cause premature aging of the skin and lead to skin cancer. Skin cancer is the most common type of cancer in the U.S. and exposure to the sun is the leading cause of skin cancer.
• Children often spend a good part of their day playing outdoors in the sun, especially during the summer. Children who have fair skin, moles or freckles, or who have a family history of skin cancer, are more likely to develop skin cancer in later years.
• Exposure to the sun during daily activities and play causes the most sun damage. Overexposure to sunlight before age 18 is most damaging to the skin.
• UV rays are strongest during summer months when the sun is directly overhead (normally between 10 a.m. and 3 p.m.).

The most common symptoms of sunburn are:

• Redness.
• Swelling of the skin.
• Pain.
• Blisters.
• Dry, itching, and peeling skin three to eight days after the burn.

More severe cases may cause:

• A fever.
• Nausea.
• Chills.
• Weakness, confusion or faintness.

The symptoms of sunburn may look like other skin conditions. Always see your child's doctor for a diagnosis if you are unsure.

If your child gets a sunburn, these tips can help make your child more comfortable.

• Have your child take a cool bath or use cool compresses on the sunburned area.
• Give your child acetaminophen or ibuprofen for discomfort and fever. Be sure to follow the directions on the container. Do not give aspirin to children or teens unless your child’s doctor says it is safe. Aspirin can put your child at risk for Reye syndrome, a rare but serious condition.
• If your child's doctor tells you to, put a moisturizer, aloe gel, hydrocortisone cream, or a topical pain reliever on the sunburned skin.
• If your child's skin has blisters, don't break them open. They can get infected.
• Keep your child out of the sun until the burn is healed.
• Give your child extra fluid for several days to prevent dehydration. 

Specific treatment for sunburn depends on the severity of the sunburn and age of the child. In general, contact your child's doctor right away if:

• The sunburn is severe or forms blisters.
• Your child has symptoms of heat stress, such as a fever (see Fever and children, below), chills, nausea, vomiting, dehydration or feeling faint.
• Your baby is younger than one year and gets a sunburn.

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than three years, a rectal temperature is the most accurate.
• Forehead (temporal). This works for children age three months and older. If a child under three months old has signs of illness, this can be used for a first pass. The doctor may want to confirm with a rectal temperature.
• Ear (tympanic). Ear temperatures are accurate after six months of age, but not before.
• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The doctor may want to confirm with a rectal temperature.
• Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least four years old.

Use a rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it, and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel okay using a rectal thermometer, ask the doctor what type to use instead. When you talk with any health care provider about your child’s fever, tell them which type you used.

Below is when to contact the doctor if your child has a fever. Your child’s doctor may give you different numbers. Follow their instructions.

When to contact a doctor about your child’s fever

For a baby under 3 months old:

• First, ask your child’s doctor how you should take the temperature.
• Rectal or forehead: 100.4°F (38°C) or higher
• Armpit: 99°F (37.2°C) or higher

For a child age 3 months to 36 months (3 years):

• Rectal or forehead: 102°F (38.9°C) or higher
• Ear (only for use over age 6 months): 102°F (38.9°C) or higher

In these cases:

• Armpit temperature of 103°F (39.4°C) or higher in a child of any age
• Temperature of 104°F (40°C) or higher in a child of any age

Protect your child from the sun starting at birth and continuing throughout your child's life.

To prevent sunburn in children older than 6 months, follow these ABCs of sun safety:

• Away. Stay away from the sun in the middle of the day. This is when the sun's rays are the most damaging.
• Block. Block the sun's rays using a sun protection factor (SPF) 30 or higher sunscreen. Apply the lotion 30 minutes before going outside and reapply it often during the day. Use broad-spectrum sunscreens that block the greatest amount of ultraviolet A (UVA) and ultraviolet B (UVB) rays.
• Cover up. Cover up using protective clothing, such as a hat and long-sleeve shirt when in the sun. Use clothing with a tight weave to keep out as much sunlight as possible. Sunglasses and hats with brims are important. Clothing rated with UPF (UV protection factor) can also be worn.

Note: Keep babies younger than six months out of direct sunlight at all times. The American Academy of Pediatrics recommends using sunscreen on small areas of the infant's body only, such as the face and backs of the hands, if protective clothing and shade are not available. 

A sunscreen or sunblock protects the skin from sunburn and minimizes suntan by absorbing or reflecting UV rays. Using sunscreen correctly is important to protect the skin. To protect your child:

• Choose a sunscreen that's labeled for children. Test it on your child's wrist before using it. If your child has skin irritation, choose another brand. Apply the sunscreen very carefully on the face to avoid the area around the eyes.
• Choose a broad-spectrum sunscreen that filters out both UVA and UVB rays. More expensive sunscreen doesn't always mean it is better.
• Apply sunscreen to all exposed areas of skin, including easily overlooked areas. These include the rims of the ears, the lips, the back of the neck, and tops of the feet.  
• Use sunscreens for all children older than six months. It doesn’t matter what skin tone or complexion your child has. All children need protection from UV rays. Even children with darker skin can have painful sunburns.  
• Watch for ingredients that may irritate your child's skin or give them an allergic reaction. 
• Apply sunscreen 30 minutes before going out into the sun to give it time to work. Put on a thick layer and reapply it every two hours after being in the water or after exercising or sweating. Sunscreens are not just for the beach. Use them when your child is playing outdoors in the yard or playing sports.
• Use a waterproof or water-resistant sunscreen.
• Use an SPF of 15 or 30. The American Academy of Dermatology recommends using sunscreen with SPF of 30 or higher, while the American Academy of Pediatrics recommends an SPF of at least 15 up to SPF 50. High SPF sunscreens provide more protection than sunscreens with a lower SPF. Talk with your child or teen about why using sunscreen is important. Set a good example by using sunscreen yourself.
• Teach your teen to avoid tanning beds and salons. Most tanning beds and salons use UVA bulbs. Research has shown that UVA rays may contribute to premature aging of the skin and skin cancer.
• Keep children younger than six months out of the sun if possible. Dress your child in lightweight clothing that covers most surface areas of skin. 

Always ask your child's doctor for more information.