Definition

• Red or blistered skin from too much sun
• The redness, pain and swelling starts at 4 hours
• It peaks at 24 hours, and starts to get better after 48 hours

Health Information

Symptoms

• Sunburns are sneaky. Many parents are surprised when their child gets a sunburn. Reason: There are no warning signs while the burn is occurring.
• Redness (sunburn) often is not seen until 4 hours after being in the sun. The pain and redness keep getting worse. They don’t peak for 24 to 36 hours.
• Pain and swelling start to get better after 3 days
• Then the sunburn often becomes itchy

Severity of Sunburn

• Most sunburn is a first-degree burn that 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.

Causes

• Direct sun exposure. Clouds don’t help. 70% of UV light still gets through on cloudy days.
• Reflected sun rays. From snow 80% is reflected, from sand 20%, from water only 5%.
• Tanning beds. A common cause in teens.

Prevention of Recurrent Sunburn

1. Sunscreens:
   • Use a sunscreen with an SPF of 15 or higher. Fair-skinned children need a sunscreen with an SPF of 30. This is especially true if your child has red or blond hair.
   • Put sunscreen on 30 minutes before exposure to the sun. This gives it time to get down into the skin. Give special attention to the areas most likely to become sunburned. Examples are the nose, ears, cheeks, and shoulders.
   • Put sunscreen back on every 3 to 4 hours. Apply often while swimming or if sweating a lot. A "waterproof" sunscreen stays on for about 30 minutes in water.
   • Most people use too little sunscreen. The average adult requires 1 ounce of sunscreen each time.
   • The best way to prevent skin cancer is to prevent sunburns.
2. Infants and Sunscreens:
   • The skin of infants is thinner than the skin of older children. It is more sensitive to the sun.
   • Sun avoidance is best for children under 6 months. Stay in the shade.
   • Sun avoidance or sun proof clothing is best for children 6 months to 3 years. That means clothes that fully cover the arms and legs. Also, have your child wear a hat with a brim.
   • When a sunscreen is needed, infants can use adult sunscreens. The FDA hasn’t approved their use under 6 months old. However, the AAP supports their use at this age. There are no reported harmful side effects from today’s sunscreens.
3. Protect Lips, Nose and Eyes:
   • To prevent sunburned lips, apply a lip coating that contains sunscreen.
   • If the nose or some other area has been burned often, use zinc oxide or titanium oxide ointment.
   • Protect your child’s eyes with good sunglasses. Reason: Prevent future cataracts.
4. Time of Day:
   • Avoid exposure to the sun during the hours of 10:00 AM to 3:00 PM. Reason: Sun’s rays most intense.
   • Caution: When overcast, over 70% of the sun’s rays still get through the clouds.

Care Advice

1. Overview:
   • Most sunburns do not blister.
   • Most blisters can be treated without needing to see a doctor.
   • Here is some care advice that should help.
2. Ibuprofen:
   • For pain relief, start ibuprofen (Motrin or Advil) as soon as you can.
   • Reason: If started within 6 hours, it can greatly limit the pain and swelling. Must give for 2 days.
   • Caution: Not approved for age under 6 months.
3. Steroid Cream:
   • Use 1% hydrocortisone cream as soon as possible. No prescription is needed.
   • Put it on 3 times per day.
   • Reason: If used early and continued for 2 days, it may reduce swelling and pain.
   • Use a moisturizing cream or aloe vera cream until you can get some.
   • Use creams only. Avoid ointments on red skin. Reason: They can block the sweat glands.
4. Cool Baths:
   • Use cool wet washcloths to the burned area. Do this several times a day. Reason: To reduce pain.
   • For larger sunburns, give cool baths for 10 minutes. Caution: Avoid any chill.
   • Do not use soap on the sunburn.
5. Extra Fluids:
   • Offer lots of extra water on the first day.
   • This helps to replace the fluids lost into the sunburn.
   • This will also help to prevent dehydration and dizziness.
6. Blisters:
   • Caution: Leave closed blisters alone. Reason: To prevent infection.
   • For broken blisters, trim off the dead skin. Use a fine scissors cleaned with rubbing alcohol.
7. Antibiotic Ointment:
   • For any large open blisters, use an antibiotic ointment. An example is Polysporin. No prescription is needed.
   • Remove it with warm water. Then, reapply it 2 times a day for 3 days.
8. What to Expect:
   • Pain stops after 2 or 3 days
   • Peeling starts on day 5–7

Call Your Doctor If

• Pain becomes severe
• Sunburn looks infected
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC