Slip! Slap! Slop! The happy sounds of summer

Unprotected exposure to the sun while children are outside playing during the summer months may result in sunburn, permanent damage to the skin, and increase the risk of developing skin cancer. The Slip! Slap! Slop! mnemonic, first promoted jointly by the Canadian Cancer Society and the Canadian Dermatology Association, is sensible and easy to remember.

Slip!     Slip on a shirt

Slap!    Slap on a hat

Slop!    Slop on some sunscreen

What is sunburn?

The typical symptoms of sunburn are redness, extreme tenderness, pain and swelling. The redness develops two to six hours after exposure and usually peaks between 20 and 24 hours. Mild, or first-degree sunburn, resolves within two to five days usually with skin scaling and peeling. The more ultraviolet radiation (UVR) received from the sun, the worse the sunburn can become. The redness and pain of second-degree sunburn are more intense and last longer. There is considerable swelling over a period of days and blistering of the skin occurs. This type of sunburn may take three to 14 days to heal. Pain, nausea, vomiting, chills, fever and delirium may occur with any sunburn. These symptoms may last for 24 to 72 hours.

Sunburn may not be immediately apparent even though it is the most obvious short-term effect of excessive exposure UVR. Freckles, wrinkles, and changes in skin texture occur as the result of excessive exposure to UVR over many years. Continued overexposure to UVR for many years, especially in children, can increase the risk of developing skin cancer in later life. Sun exposure and ultraviolet damage have also been implicated in the development of cataracts of the eye.

What causes sunburn?

The UVR produced by the sun causes sunburn, skin damage, and increases the risk for skin cancer. There are three bands of ultraviolet light, called A, B, and C. Ultraviolet B (UVB) rays have a short wavelength and affect mainly the skin’s outer layers. These rays are thought to be the primary cause of sunburn, skin aging, and skin cancer. This type of UVR is more intense during the summer months, in locations closer to the equator, and at higher altitude. Ultraviolet A (UVA) rays have a longer wavelength and are not as powerful as UVB rays, but they penetrate more deeply into the skin. These rays are responsible for contributing to the wrinkling and premature aging of the skin and skin cancer. Ultraviolet C rays are the strongest form of ultraviolet radiation produced by the sun. They are usually filtered by the ozone layer and do not reach the Earth.

Skin cells can detect damage to their DNA caused by UVB rays and may commit cellular suicide if their repair systems are overwhelmed. This is a normal response to sunburn. If too many cells die, either rapidly or slowly over many sunburns, fundamental elements of the structure and function of the skin are changed, leading to premature skin aging. On the other hand, if the damaged cells survive, a skin cancer cell might arise.

Protecting our children against the sun’s radiation

Protection against the sun’s UVR can prevent sunburn, reduce skin damage, and decrease the risk of developing skin cancer. It has been estimated that about 80% of our total lifetime exposure to the sun occurs during the first 18 years of life. Therefore, sun protection should begin very early in life to decrease the risk of developing skin cancer. Children should be protected from infancy and encouraged to take precautions to protect themselves from the sun for their entire lives.

Several simple precautions have the potential to protect children’s skin against sunburn, skin damage and the development of skin cancer.

• Check the current UV index forecast for your region.
• Reduce your child’s exposure to the sun all year round.
• Plan outdoor activities early or late in the day to avoid peak sunlight hours, between 10 am and 4 pm, when the UVR levels are highest.
• Encourage your child to stay in the shade as much as possible whenever outside.
• Dress your child for sun protection.
• Dress your child in protective clothing to cover the upper back, arms and legs, a hat with a wide brim and sunglasses. Be sure to cover your child’s upper back when she is swimming.
• Use sunscreen to protect your child’s skin.
• Use a sunscreen that protects against both UVA and UVB rays with a SPF, or sun protection factor, equal to 15 or higher.
• If your child has light-coloured skin, eyes and hair, or tends to burn, choose a sunscreen with a higher SPF.
• Apply sunscreen at least 20 minutes before exposure to the sun.
• Apply sunscreen liberally — you can never apply too much.
• Reapply every two hours, or more frequently, if sunny or your child is perspiring heavily.
• Use a water resistant sunscreen whenever your child is swimming.
• Protect your child’s skin on cloudy days and during the winter.

Choosing a sunscreen for your child

Sunscreens protect against UVR by absorbing the quantity and nature of UVR reaching cells in the skin. Experts recommend using a sunscreen that contains zinc oxide, titanium dioxide, or avonbenzone. Sunscreens are usually promoted according to the degree of protection against UVR as estimated by the SPF. An SPF 15 sunscreen blocks 93% of the UVR, SPF 30 sunscreen blocks 97% of the UVR, while an SPF 50 sunscreen blocks 98%. Sunscreens should be applied at least 20 minutes before going outside so that the active ingredients can penetrate into the skin before exposure to UVR.

Before purchasing a sunscreen:

• Make sure the product offers both UVA and UVB protection.
• Make sure the sun protection factor is equal to 15 or higher
• Make sure it’s water resistant

Sunscreens offer varying degrees of protection against UVR but no sunscreen completely prevents damage caused by sunlight. If you need help in choosing a sunscreen, talk to your pharmacist, your child’s public health nurse, or your child’s physician.

Sun protection is important at any age to protect the skin against the short-term and long-term damaging effects of sunlight. Parents should not only protect their children from infancy but also act as role models so children can acquire attitudes and behaviours that protect their skin against the sun’s ultraviolet radiation.

For more information about sunburn, please see the page on Sunburn in the AboutKidsHealth A-Z Health Library.

Andrew James, MBChB, FRACP, FRCPC
Chief Medical Editor
AboutKidsHealth.ca