Sunscreen can help prevent those painful episodes of childhood sunburn, a risk factor for skin cancer later in life. But although sunscreen is recommended for infants older than six months by everyone from the National Institutes of Health to the American Academy of Pediatrics, there's growing concern by advocacy groups, parents and some doctors that some of the chemicals in the products are endocrine disruptors and may pose risks to children.
The U.S. Food and Drug Administration, which drafted sunscreen safety standards in 1978, is expected to issue the final rules in October. But for the last three decades, "it has been a Wild West on the market," said Jane Houlihan, senior vice president of research for the advocacy group Environmental Working Group (ewg.org). "Parents need to be careful what they're using, as well as follow other sun-safety measures, including wearing protective clothing and sunglasses," she said.
What concerns Greene is that the tests evaluating oxybenzone have been done on healthy adults in the middle of life. "Permanent changes of puberty happen with one drop of sex hormones," he said. "We don't know the impact of kids and babies who get at least three times the concentration as adults."
But the data are preliminary. Moreover, "absorption alone isn't enough to justify any posture," said Dr. Michael Smith, director of pediatric dermatology at Children's Hospital at Vanderbilt University.
"We are very comfortable with zinc oxide and titanium dioxide agents," said Smith, chair of the AAP section on dermatology. He added that he's unaware of compelling data showing that parents need to be concerned about any ingredients in current FDA-approved sunscreens, including oxybenzone.
Still, zinc and titanium products have their own issues: They may contain nanoparticles that have limited safety studies, may be dangerous if inhaled and may pose a risk to the environment. (Regular sunscreen is generally made with microsize particles; nanoparticles are even smaller.) The FDA doesn't require the manufacturer to list nanoparticles on the label.
So far, the data show the use of nanoparticles on the skin is safe for adults; the EWG calls nano-scale zinc and titanium "a reasonable choice" in sunscreens.
But experts caution that there is little, if any, data on the potential impact on children's health. For that matter, "information on the safety — or lack thereof — of sunscreen chemicals is, to the best of my knowledge, very limited," said Dr. Philip J. Landrigan, director of the Children's Environmental Health Center at Mount Sinai School of Medicine in New York.
Zinc oxide and titanium dioxide-based sunscreens that do not contain nanoparticles are generally thicker and whiter than those that do. Avoid nano-sprays or powders altogether, especially near the face, because the particles can be inhaled into the lungs, said Dr. Alan Greene, author of "Raising Baby Green."
Once your baby is 6 months old, the American Academy of Pediatrics recommends products with a rating of SPF 30 or more with a broad-spectrum sunscreen, or one that protects against both ultraviolet A and B rays.
"Avoid products that combine bug repellent and sunscreen," said Dr. Michael Smith of Vanderbilt. Bug repellent isn't known to be safe for frequent application — but you do need to reapply sunscreen to avoid burn every 1 1/2 hours. And use enough: 3 teaspoons for an average toddler, 6 teaspoons for an 8-year-old, Smith said.