What to Expect the Toddler Years (161 page)

With the earth’s ozone layer shrinking, skin cancer rates soaring, and scientists linking more than 90% of all skin cancers to ultraviolet radiation from the sun, the days of unprotected sunning should be gone for good. Everyone needs to be shielded from both the sun’s ultra violet A (UVA) rays, which causetanning,
aging of the skin, and skin cancer, and ultraviolet B (UVB) rays, which cause sunburn and skin cancer. But children need special protection. There is some evidence that serious sunburns during childhood may be a more important factor in the development of adult malignant melanoma (skin cancer) than total lifetime exposure to the sun. Sunburns also represent an immediate hazard to young children: Because children have a larger proportion of skin to body mass than adults, severe burns can cause serious fluid and electrolyte imbalances. And although tanning seems innocent enough, there is no such thing as a safe tan. Tan ning is a sign of skin damage; contrary to what many people think, it doesn’t protect the skin from further harm.

To prevent sun damage, take these precautions whenever your toddler steps outside (and make sure that other care-givers are instructed to do the same):

Protect year-round.
While we associate sunburn with summer, the sun can also be a threat in winter, especially when there is snow on the ground. In fact, the sun’s rays reflected on the snow can be as intense as those from summer sun. And, although less of the burning UVB reaches the earth in winter, the also-harmful UVA rays remain constant year-round. Since the sun’s rays also get more intense as you go up in elevation (an increase in 4% with every 1,000 feet above sea level) or get closer to the equator, more precautions need to be taken year-round in high altitudes or equatorial regions.

And don’t skip the sunscreen when it’s hazy out, especially if you’re at the beach; much of the sun’s ultraviolet light can penetrate a light cloud cover.

Schedule outdoor time wisely.
Try to limit your child’s exposure to the sun—even when he or she is properly protected—during the hours when its rays are at their most intense, between 10
A.M.
and 3
P.M.
or when your shadow is shorter than you are. Think of the sun as a source of radiation or a giant nuclear reactor and you won’t feel so guilty about keeping your toddler out of its reach.

Encourage play in the shade.
Look for playgrounds that are well-shaded, and set up play areas in your own yard, if possible, that are in shade all or part of the day.

Beware of glare.
On the beach, where you are unlikely to find natural shade, don’t rely on a beach umbrella—it can’t shield your toddler adequately from the reflected glare of sun on sand. Instead, pitch a beach tent, which will provide shelter from the sun while your toddler plays. Be wary, too, of the sun’s reflection on snow, concrete, and water (the toddler who’s splashing in the pool is even more vulnerable to sunburn than the one who’s playing beside it). And since UVA passes through glass, as any greenhouse gardener can tell you, a child sitting near a car window (unless it’s tinted for sun screening) or playing indoors near a broad expanse of window is also susceptible to the damaging rays.

Cover up.
When you’re out and about with your toddler during the hours when the sun is most intense, keep the rays at bay with a stroller canopy or umbrella, a wide-brimmed hat or cap (you can even get one with a brim in front and a flap in the back to protect the neck), as much clothing coverage as is comfortable, shoes and socks (bare feet burn quickly), and sunscreen on exposed parts of the body. (If a toddler with thin, fair hair refuses to wear a hat, spread—or spray—some sunscreen on his or her head). Keep in mind, however, that the sun’s ultraviolet rays can penetrate sheer and lightly woven, light-colored fabrics; the typical T-shirt has a sun protection factor (SPF) of only 7 or 8, which means that most toddlers (darker-skinned children included) need a layer of sunscreen under their T’s when they are going to spend extended time outdoors. To test a fabric, hold it up to a light; the less light that shows through, the better protection from the sun it affords. Wet fabrics are a third less protective than dry ones; dark colors are more protective than light (but they are more uncomfortable in hot weather); tight weaves are more protective than loose ones. Denims seem to provide the most protection of all (a denim sun hat might be a good idea for a particularly sun-sensitive toddler). If your child takes a medication or has a condition that makes exposure to the sun particularly risky, ask your doctor for information on the special sun-protective apparel that’s now available for children.

Slather up.
No matter what your toddler’s wearing, sunscreen is a smart accessory when you’re headed for an outing in the sun. While sunscreen is essential, it isn’t foolproof, which is why it’s important to combine its use with other sun protection steps, such as covering up with a hat and clothing and limiting time in the sun. Still, make applying it as routine as donning shoes, and as non-negotiable as sitting in the car seat. You’re less likely to face resistance to sunscreen in the future if you make putting it on a habit now. (It’s a habit everyone in the family would do well to develop.)

Be sure that a baby-sitter or nanny gets in the habit of applying sunscreen to your toddler, too. If your child goes to day care or preschool, do it yourself every morning (using a long-lasting product); you can’t always rely on a teacher to take this task over for you.

When shopping for a sunscreen, look for one that’s designed for children (it’s more likely to be gentle and—because many children are sensitive to PABA, a common ingredient in sunscreens—PABA free) and that has the words “broad-spectrum” on the label, which means that it will screen out both ultraviolet B (UVB) and ultraviolet A (UVA) rays. Choose an SPF of at least 15, unless your child has very fair or sensitive skin, in which case opt for an SPF of at least 30 or 45. (See the box that follows for more on SPFs.) Creamy and oily products are less drying and stay on the skin longer. But sprays are usually easier to apply—and since a sun-screen can only be effective for your toddler if you manage to get it
on
him or her, ease of application is a prime consideration (don’t use a spray near your toddler’s eyes, however). And avoid
scented sunscreens; they may be attractive to insects. Even once you’ve chosen a product that’s recommended for young skin, it’s still a good idea to test your child for sensitivity to it. To do this, spread or spray a thin layer on a small patch of your child’s skin; if redness or a rash develops, don’t use the product on your child. Instead, try another with different ingredients. Check the expiration date on any sunscreen you’re using and be sure to toss what’s left after that date has been reached—potency can be affected by age.

Though toddlers are wont to want to do it themselves, applying sunscreen is adult’s work, not child’s play. A toddler isn’t likely to be able to apply the screen evenly (necessary for complete protection), keep it out of eyes and mouth, or off clothing. If it makes an older toddler more cooperative, you might try a little “You cover my back, I’ll cover yours.” But if you do let your toddler spread a bit of sunscreen on you, be sure to wipe the sticky little hands immediately.

If it’s possible, apply the sunscreen thirty minutes before going out into the sun, since it takes that long to be absorbed into the skin. (If you can’t manage that, however, applying it right before going out is far better than not applying it at all.) Spread the sunscreen generously and be careful not to miss any exposed skin (including the back of the neck, an area often overlooked). Be careful, too, not to get the sunscreen into your toddler’s eyes (there are no-tears formulas available for kids whose eyes are extra-sensitive). Since wind and water both thin out protection, reapply every hour or so if it’s windy, if your toddler is sweating a lot, or if he or she has been splashing in a pool or running under a sprinkler. You can reapply it less often—every two hours or so—if you’re using a waterproof product (read the label for recommendations). But keep in mind that even a waterproof sunscreen can be rubbed off by a lot of towel drying and will need to be reapplied more often under such conditions.

For extra protection on extra-vulnerable areas (nose, cheeks, and the tops of your toddler’s ears) you might want to dab on a little zinc oxide or titanium dioxide. These sun
blocks
, which actually let
no
UV rays through, are opaque and not exactly attractive to wear, but offer the strongest protection available. Some blocks come in toddler-pleasing neon colors, and are packaged like lip balm for easy appliction. A few sunscreens feature one or the other of these sun-blocking products in their formulations.

Lips need sun protection, too. Make applying a children’s sunscreen lip balm (which should be lick-proof) before going out in the sun as routine as applying sunscreen. Not only will lip balm protect your toddler’s lips from the sun, it may also prevent a reactivation of a herpes simplex virus infection in the form of a cold sore or fever blister (see page 494). And it will also shield your toddler’s lips from wind and cold in the winter, reducing chapping.

Make The Toddler Diet a habit.
What does diet have to do with sun protection? Actually, according to recent studies, possibly a lot. It seems that a diet high in beta-carotene (as is The Toddler Diet; see page 506) may ward off the ravages of the sun by reducing the detrimental effects of UVA rays.

Once in a while, what looks like chapped skin is actually eczema or another skin condition that needs medical attention. If your toddler’s skin is scaly, itchy, blistered, or oozing, check with the doctor.

The most common skin rashes in toddlers include:

Diaper Rash.
What is it?
A rash or irritation anywhere in the diaper area.
Who is susceptible?
Babies and toddlers in diapers. Children taking antibiotics are particularly vulnerable to yeast, or fungal, infections.
Signs and symptoms:
These vary, depending on the cause (see chart, facing page); in boys, a diaper rash may appear as a sore on the end of the penis.
Causes:
Again, see the chart on the facing page.
Transmission:
Chafing dermatitis, or simple diaper rash, is not contagious. Diaper rash that is caused by a micro-organism can sometimes spread to other parts of the body if conditions are favorable (for example, yeast infections, which thrive on moisture and warmth, can take hold in skin that is already irritated). When conditions are right and precautions aren’t taken, such infections may also be spread from child to child.
Treatment:
For simple chafing dermatitis:
1.
Reduce moisture in the diaper area. Change your child’s diaper as soon as you know it is wet. As always,
pat
the bottom dry after washing it. Applying cornstarch may help to reduce moisture, and spreading a thick layer of diaper rash ointment can protect the skin from the next flood of urine (ask your child’s doctor for a recommendation). This protection is especially important if you use cloth diapers and won’t be able to change the next wet one immediately.
2.
Increase exposure to air. Allow your toddler to wander about the house bare-bottomed (but only in areas of the house where cleaning up an “accident” will be easy). Keep a potty close by at such times, just in case. If your toddler usually wears waterproof pants with cloth diapers, leave the overpants off whenever feasible. And don’t cover the skin with ointment when you are exposing your toddler’s bottom to the air—the air can’t get through the ointment any more than moisture can.
3.
Minimize exposure to irritants. Change wet and soiled diapers immediately. Skip the wipes and use only warm water and
cotton balls or soft paper towels for clean-up when changing diapers. Use plain soap (page 465) on your toddler’s bottom no more than once a day. Adding a colloidal oatmeal bath product (such as Aveeno) to the bath water may be soothing, especially for a boy with a diaper rash on his penis.
4.
Switch diapers. Different children react differently to different diapers. Though diaper rash is slightly less common with disposables, some children do better with cloth diapers; some children do better with one type of disposable than another. If a diaper rash persists in spite of the above measures, try a change of diaper. If you home-launder diapers, rinse them with half a cup of vinegar or a special diaper rinse.
5.
For intractable diaper rash in a toddler who shows the signs of being ready for toilet learning, take the steps recommended in Chapter Nineteen to help the learning along.
Do not use:
Boric acid (which is toxic if ingested and is not safe to keep around the home with a toddler); talcum powder or a product containing talc (which, if inhaled, can cause respiratory problems); or medications for other family members, whether prescribed or bought over-the-counter (some ingredients in combination products can cause allergic skin reactions). Call your child’s doctor so that the condition can be diagnosed and a topical medication to deal with it prescribed if the diaper rash: gets worse, is painful, or spreads beyond the diaper area; develops blisters, sores, crusts, boils, or pustules or a sore at the end of the penis; doesn’t clear in three or four days; or if
unexplained fever develops. (Be sure to ask how long the medication should take to work. Once treatment has begun, call the doctor back if the condition doesn’t get better in the specified time, or if it gets worse.) Call immediately if your child seems very sick or if large blisters (1 inch or more across) develop.
Prevention:
Keep the diaper area clean and dry (applying cornstarch may help to reduce moisture); don’t wait too long between changes of wet diapers and change soiled diapers immediately; avoid giving your toddler foods that seem to irritate (in some children, certain acidic foods, such as citrus, produce irritating stool); and avoid soaps and wipes that seem to irritate. Be sure to wash your hands thoroughly after changing the diaper of a child with an infectious diaper rash, and be sure the same sanitary precautions are taken by your child’s other caregivers both at home and preschool.