Clinical Reference Systems: Pediatric Advisor 10.0
Sunburn is caused by overexposure of the skin to the
ultraviolet (UV) rays of the sun or a sunlamp. Most people
have been sunburned many times. Vacations can quickly turn
into painful experiences when the power of the sun is
Unfortunately, the symptoms of sunburn do not begin until 2
to 4 hours after the sun's damage has been done. The peak
reaction of redness, pain, and swelling is not seen for
24 hours. Minor sunburn is a first-degree burn which turns
the skin pink or red. Prolonged sun exposure can cause
blistering and a second-degree burn. Sunburn never causes a
third-degree burn or scarring.
Repeated sun exposure and suntans cause premature aging of
the skin (wrinkling, sagging, and brown sunspots). Repeated
sunburns increase the risk of skin cancer in the damaged
area. Each blistering sunburn doubles the risk of
developing malignant melanoma, which is the most serious
type of skin cancer.
- Pain relief
The sensation of pain and heat will probably last
48 hours. Ibuprofen products started early and
continued for 2 days can greatly reduce the discomfort.
Nonprescription 1% hydrocortisone cream or moisturizing
creams applied three times a day may also reduce
swelling and pain but only if the cream is used soon
after your child was sunburned. Continue using the
cream for 2 days. Do not use petroleum jelly or other
ointments because they keep heat and sweat from
The symptoms can also be helped by taking cool baths or
putting cold wet cloths on the burned area several times
a day. Showers are usually too painful.
Your child should drink extra water to replace the fluid
lost into the swelling of sunburned skin and to prevent
dehydration and dizziness.
Peeling usually occurs in about a week. Put a
moisturizing cream on the skin.
If your child has broken blisters, trim off the dead
skin with small scissors. Then apply an antibiotic
ointment (for example, bacitracin). Wash off and
reapply the ointment twice a day for 3 days.
- Common mistakes in treatment and prevention of sunburn
Avoid putting ointments or butter on a sunburn. They
are painful to remove and not helpful.
Don't buy any first aid creams or sprays for burns.
They often contain benzocaine, which can cause an
Don't confuse sunscreens, which block the sun's burning
rays, with suntan lotions or oils, which mainly
lubricate the skin.
Prevention of Sunburns
The best way to prevent skin cancer is to prevent sunburn.
Although skin cancer occurs in adults, it is caused by the
sun exposure and sunburns that occurred during childhood.
Every time you protect your child from too much sun
exposure, you are helping prevent skin cancer.
Apply sunscreen any time your child is going to be outdoors
for more than 30 minutes a day. Set a good example. Apply
sunscreen to your own skin as well as your child's skin.
- High-risk children. About 15% of white children have
skin that never tans but only burns. These fair-skinned
children need to be extremely careful about sun exposure
throughout their lives. If a child has red or blond
hair, blue or green eyes, freckles, or excessive moles,
he or she is at increased risk for sunburn and skin
cancer. These children need to use a sunscreen
throughout the summer even for a brief exposure. They
should avoid the sun whenever possible.
- Infants in the sun. The skin of infants is thinner than
the skin of older children and more sensitive to the
sun. Therefore, babies under 6 months of age should be
kept out of direct sunlight. Keep them in the shade
whenever possible. If they have to be in the sun,
sunscreens, longer clothing, and a hat with a brim are
essential. Don't put sunscreen on areas where the
infant may lick it off.
- Tanning. For teenagers who are determined to have a
suntan, guide them as to the limits of sun exposure
without a sunscreen. Try to keep sun exposure to small
amounts early in the season until a tan builds up.
(Caution: While people with a suntan can tolerate a
little more sun, they can still get a serious sunburn.)
Start with 15 or 20 minutes of sun per day and increase
by 5 minutes a day. Decrease daily exposure time if the
skin becomes reddened. Because of the 2- to 4-hour
delay before the symptoms of sunburn appear, don't
expect symptoms (such as redness) to tell you when it's
time to get out of the sun. After 1 hour of sun
exposure, always apply a sunscreen.
- Time of day. Avoid exposure to the sun during the hours
of 10:00 AM to 3:00 PM, when the sun's rays are most
intense. Don't let overcast days give you a false sense
of security. Over 70% of the sun's rays still get
through the clouds. Over 30% of the sun's rays can also
penetrate loosely woven fabrics (for example, a T-
- High altitude. Be especially careful about exposure to
the sun at high altitudes. Sun exposure increases 4%
for each 1000 feet of elevation above sea level. A
sunburn can occur quickly when a child is hiking above
timberline. Remember also that water, sand, or snow
increases sun exposure. The shade from a hat or
umbrella won't protect your child from reflected rays.
- Eyes, nose, and lips. Protect your child's eyes from
the sun's rays. Years of exposure to ultraviolet light
increases the risk of cataracts. Buy sunglasses with UV
protection. To prevent sunburned lips, apply a lip
coating that contains PABA. If the nose or some other
area has been repeatedly burned during the summer,
protect it completely from all the sun's rays with zinc
There are good sunscreens on the market that prevent sunburn
but still permit gradual tanning to occur. Choose a broad-
spectrum sunscreen that screens out both UVA and UVB rays.
The sun protection factor (SPF) or filtering power of a
sunscreen product determines what percentage of the
ultraviolet rays get through to the skin. An SPF of 15
allows only 1/15 (7%) of the sun's rays to get through and
thereby extends safe sun exposure from 20 minutes to 5 hours
without sunburning. An SPF higher than 15 protects against
sunburn for more than 5 hours. However, an SPF higher than
15 is rarely needed in most parts of the U.S. because
protection against sunburn during the 5 hours between 10 AM
and 3 PM is usually sufficient.
Fair-skinned children (with red or blond hair) need a
sunscreen with an SPF of 30. The simplest approach is to
use an SPF of 15 or greater on all other children.
Apply sunscreen 30 minutes before exposure to the sun to
give it time to penetrate the skin. Give special attention
to the areas most likely to become sunburned, such as the
nose, ears, cheeks, and shoulders.
Most products need to be reapplied every 3 to 4 hours, as
well as immediately after swimming or profuse sweating. A
"waterproof" sunscreen stays on for about 30 minutes in
water. Most people apply too little sunscreen (the average
adult requires 1 ounce of sunscreen per application).
Call Your Child's Physician Immediately If:
- Your child starts acting very sick.
Call Your Child's Physician During Office Hours If:
- The sunburn looks infected (red streaks, yellow pus,
- You have other questions or concerns.