Pediatric Sunscreen and Sun Safety Guidelines

Sunscreen Label Marketing Towards Pediatric Populations: Guidance for Navigating Sunscreen Choice

INTRODUCTION

 Sunscreen marketing to specific demographics is largely unregulated. Marketing specifically targeting pediatric populations has the potential to drive consumer behavior. The American Academy of Pediatrics (AAP) and American Academy of Dermatology (AAD) provide recommendations for sunscreen use in children over the age of six months. This study sought to determine if sunscreen products marketed toward pediatric populations align with healthcare guidelines.

MATERIALS AND METHODS

Sunscreens available in major retail outlets in the Philadelphia area were cataloged and reviewed for marketing targeting specific demographics such as "baby", "babies", "children", "kids", "sports", and "active". The products were reviewed for sun protection factor (SPF), broad-spectrum ultraviolet (UV) protection, water resistance, active UV filters, and application method.  Results: Of 410 sunscreens cataloged, 27 were marketed towards "baby" or "babies", 44 towards "children" or "kids", and 71 towards "sports" or "active". All of the sunscreen products reviewed targeting the pediatric population offered water resistance for up to 80 minutes and broad-spectrum UV coverage. Sunscreens targeting "baby" or "babies" aligned most closely with AAP guidelines for sunscreen use in pediatric populations, with 92.6% offering an SPF between 15 to 50 and no products including oxybenzone as a UV filter. However, sunscreens targeting "children", "kids", "sports", and "active" bore a close resemblance to the overall sunscreen profile for all demographics but with a higher percentage of products containing oxybenzone. Oxybenzone was found in 11.4% of "children" and "kids" products and 16.9% of "sports" and "active" sunscreen products, compared to 7.6% of all sunscreen products available, and was also found in most sunscreen products with an SPF of 70 or higher.

CONCLUSION

 Sunscreen products marketed towards "baby" and "babies" tend to align closely with guidelines for sunscreen use in the pediatric population for children over six months of age; however, those with brand marketing towards "children", "kids", "sports", and "active" do not. Limiting recommendations for a sunscreen product with an SPF of 30 to 50 targeting this demographic, however, sufficiently meets guidelines set forth by the AAP and AAD.

Allergen Composition, Marketing Claims, and Affordability of Pediatric Sunscreens

BACKGROUND

Childhood sun exposure is associated with development of future skin cancers. Sunscreens are an important tool to prevent harmful ultraviolet rays.

OBJECTIVES

The aims of the study are to evaluate sunscreens targeted to children and to analyze cost, marketing claims, ingredients, and allergens to help consumers select products.

METHODS

The top 50 pediatric sunscreens across retailers were analyzed for their cost, marketing claims, ingredients, vehicles, and containers. Ingredients were compared with the American Contact Dermatology Society 2020 Core Allergen List.

RESULTS

The mean price was $6.20 per ounce (range, $0.25-$39.98). The mean sun protection factor was 48.5 (range, 30-100; SD, 48.5). There was a mean of 17.5 ingredients and a mean of 1.1 allergens in products. On average, products marketed as "sensitive skin" were not only significantly more expensive ($8.90 vs $3.50 per ounce, P = 0.01) but also were significantly more likely to not contain any allergens (36.0%, n = 18 vs 12%, n = 6; P = 0.05). Products with mineral-only UV blockers were significantly less likely to have any allergen when compared with products that had chemical UV blockers (5.6%, n = 1 vs 94.4%, n = 17; P = 0.02).

CONCLUSIONS

The current market of pediatric sunscreens varies significantly in price, marketing claims, and active ingredients. Products marked as suitable for sensitive skin had significantly fewer allergens, but a majority of these products still had at least one allergen. Many sunscreens contain contact allergens, which is an important selection consideration.

Sun Exposure in Pediatric Age: Perspective of Caregivers

Excessive sun exposure during childhood increases the risk of skin cancer. This study characterized the knowledge and attitudes of caregivers regarding exposure and sun protection of children and adolescents. One hundred and ninety-eight caregivers (38.5 ± 8.0 years) who resorted to the consultations of a Pediatrics Service or a Family Health Unit answered a questionnaire. The age of children/adolescents was 6.5 ± 5.1 years. On average, caregivers presented a high level of knowledge regarding exposure and sun protection. One hundred and twenty-six caregivers indicated that they obtained more information about sun protection on social communication, and 66% considered the information provided by healthcare professionals to be enough. One-hundred and fifteen caregivers reported that the child/adolescent was more exposed to the sun after 4 a.m., and 88% reported applying sunscreen on the beach/pool and outdoor activities. Fifty-seven percent of caregivers renewed sunscreen application on the child/adolescent every 2 h, and 94% applied a sun protection factor ≥ 50 in the child/adolescent. There was a significant association (p < 0.001) between education level and caregivers’ self-knowledge about sun protection (the higher the education, the higher the knowledge), and between the knowledge of the hour of sun exposure avoidance and the time when the child/adolescent was more exposed to the sun. This study shows that caregivers are highly knowledgeable about exposure and sun protection in children/adolescents, and their attitudes follow the general recommendations.

Clinical Characteristics in Early Childhood Associated with a Nevus-Prone Phenotype in Adults from Tropical Australia: Two Decades of Follow-Up of the Townsville Preschool Cohort Study

Having numerous melanocytic nevi increases melanoma risk. Few studies have enumerated nevi in children and re-examined them as adults. We aimed to determine if childhood nevus-counts predict nevus-prone adults, and further explore the relevance of host-factors and sun-exposure. Fifty-one Caucasian residents of Townsville (19.16° S, Queensland, Australia) had full-body nevus-counts aged 1–6 and 21–31 years-old. Sun-exposure was determined from questionnaires. Children in the upper-quartile of nevus-counts acquired nevi more rapidly than those in the bottom-quartile (13.3 versus 4.7 nevi/year; p < 0.0005). Children sunburnt before 7 years-old acquired more incident nevi by adulthood (238 versus 126, p = 0.003) particularly if sunburn was severe (321 versus 157.5, p = 0.003) or erythema occurred annually (380 versus 132, p = 0.008). Fair-skinned, freckled children with some nevi ≥ 3 mm, solar lentigines, or a family history of melanoma acquired more incident nevi than children without these attributes. Nevus-prone adults exhibit distinguishing features earlier in life (<7 years-old in Queensland) than has been shown previously. In addition to intervening with sun-protection counselling early enough to reduce risk, being able to reliably triage children into high- and low melanoma-risk groups may inform more efficacious and cost-effective targeted-screening in melanoma-prone populations. Further longitudinal research is needed to confirm that these attributes can reliably separate risk-groups.

[Effects of solar radiation and an update on photoprotection]

Sunburn, immunodepression, photoaging, and photocarcinogenesis, are some of the most significant adverse effects of solar radiation in humans. Children are population group of special vulnerability, due to the fact that exposure to the sun has more pronounced biological effects compared to adults. Furthermore, childhood is a critical period for promoting the development of photo damage and photocarcinogenesis in the later stages of life if adequate measures at not put into place. This is because it is estimated that between 18 and 20 years of age is when 40% to 50% of the accumulative exposure to ultraviolet radiation up to 60 years of age is received. The most important strategy for the photoprotection of children is changes in behaviour and habits associated with exposure to the sun at all levels (school, society, family, etc.). Resorting to the shade, reduction in overall time of exposure to the sun, and physical protection (clothes, hats, and sunglasses) are the best and least costly photoprotection strategies. The photoprotectors must be incorporated into the daily routine of children in the same way as adults, and must complete a series of requirements in order to make them effective, safe, and in line with the environment.

The Role of Dispensing Device and Label Warnings on Dosing for Sunscreen Application: A Randomized Trial

Drug manufacturers are expected to provide labeling information needed to yield safe and effective product use. However, it is not clear that consumers dose sunscreen, an over-the-counter drug, appropriately; in fact, existing evidence suggests underdosing as a common phenomenon. The objective of this study was to evaluate the effect of dispensing device and labeling on self-administered doses of sunscreen in young adults. To investigate those effects, a 2 × 2 factorial laboratory experiment crossing dispensing device (two levels) with labeling treatment (two levels) was conducted. Participants applied sunscreen from each of the four treatments; dosing concentration, measured in mg/cm², served as the response variable. Participants (n = 94) were recruited on the campuses of Michigan State University (East Lansing, MI) and California Polytechnic State University (San Luis Obispo, CA). Each participant applied sunscreen from each unique treatment to sites on their arms and legs (four applications). Postapplication, a survey was completed to characterize demographics, risk perception, and sunscreen use patterns. Results indicate participants applied approximately 30% less sunscreen from the pump bottles than the squeeze bottles (difference estimate of 0.3059 mg/cm², standard error = 0.0607, p < .0001); there was no evidence of a difference based on label treatments. Post hoc recognition tests indicated only 55% of participants were able to recognize the two experimental labels they had viewed immediately following sunscreen application. Sunscreen application density was directly related to level of worry regarding skin cancer and frequency of sunscreen use (α = .05). Our results suggest the dispensing device used to deliver sunscreen impacts the dosage amount consumers apply.