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AAP Issues Guidelines on Limiting Sun Exposure in Children Sun Exposure Not Enough to Correct Vitamin D Deficiency

From Medscape Medical News
AAP Issues Guidelines on Limiting Sun Exposure in Children

Laurie Barclay, MD

February 28, 2011 — The American Academy of Pediatrics (AAP) has issued guidelines on limiting sun exposure in children and supporting legislation to prohibit salon tanning by minors, according to a policy statement entitled “Ultraviolet Radiation: A Hazard to Children and Adolescents.”

The new recommendations and an accompanying technical document are reported online February 28 and published in the March issue of Pediatrics.

“Ultraviolet radiation (UVR) causes the 3 major forms of skin cancer: basal cell carcinoma; squamous cell carcinoma; and cutaneous malignant melanoma,” write Sophie J. Balk, MD, former chairperson, AAP Committee on Environmental Health, and colleagues.
“Public awareness of the risk is not optimal, overall compliance with sun protection is inconsistent, and melanoma rates continue to rise. The risk of skin cancer increases when people overexpose themselves to sun and intentionally expose themselves to artificial sources of UVR.”

Despite these risks, sunburn continues to be prevalent, and teenagers as well as adults continue to make frequent visits to tanning parlors. Therefore, the policy statement suggests that pediatricians offer advice about UVR exposure during health supervision visits and at other appropriate times.

Recommendations
Specific recommendations for pediatricians include the following:

* Health-supervision practices should include advice about UVR exposure, such as avoiding sunburn and suntan, wearing clothing and hats with brims, using sunglasses, and applying sunscreen. If possible, outdoor activities should be scheduled to limit exposure to peak-intensity midday sun (10 AM to 4 PM).
* When a child or adolescent might sunburn, he or she should use sunscreen to reduce the known risks for sun exposure and sunburn, including the increased risk for skin cancer. Sunscreen with a sun-protection factor (SPF) of at least 15 should be applied every 2 hours and after swimming, sweating, or drying off with a towel. People may prefer avoiding sunscreens containing oxybenzone, as these may have weak estrogenic effects when absorbed through the skin.
* Although all children need counseling about UVR exposure, this is particularly true for children at high risk for the development of skin cancer, including those with light skin, nevi, and/or freckling; and/or a family history of melanoma.
* Skin cancer prevention is a lifelong effort, and beginning in infancy, at least 1 health maintenance visit per year should include advice about UVR exposure. All children are at risk for adverse effects of UVR exposure on the eyes and immune system, although not all children sunburn. Especially appropriate times for counseling about UVR exposure include during the spring and summer in northern states, before anticipated sunny vacations, and during visits for sunburns.
* Because outdoor physical activity should be strongly encouraged, this should be promoted in a sun-safe manner.
* Sun-protection practices tend to wane in early childhood. Beginning at age 9 or 10 years, it may be helpful for pediatricians to discuss sun protection with children, together with parents, to encourage joint responsibility for the child’s sun protection.
* Infants younger than 6 months should be kept out of direct sunlight and covered with protective clothing and hats. When sun avoidance is impossible, parents may apply sunscreen only on exposed areas. Absorption of sunscreen ingredients may be higher in preterm infants.
* Pediatricians should become familiar with chemical photosensitizing agents. People using these oral or topical agents should limit sun exposure and avoid all UVA from artificial sources. When sun exposure is inevitable, they should wear fully protective clothing and high SPF sunscreen that also blocks UVA wavelengths.
* Breast-fed and formula-fed infants and other children should receive vitamin D supplementation in accordance with guidelines, for a total intake of at least 400 IU of vitamin D daily. Children at risk for hypovitaminosis D may need laboratory testing of 25-hydroxyvitamin D concentration.
* Deliberate UVR exposure to artificial sources and overexposure to sun with the goal of increasing vitamin D concentrations or for other reasons should be avoided.
* Pediatricians should advocate for adoption of sun-protective policies (eg, shaded playgrounds, outdoor time before 10 AM, and allowing hats at schools and child care facilities).
* Pediatricians should support and advocate for legislation banning use of tanning parlors by children younger than 18 years.

Benefits of Limiting Exposure to UVR

The AAP, the World Health Organization, the American Medical Association, and the American Academy of Dermatology all support legislation prohibiting access to tanning salons or use of artificial tanning devices by children younger than 18 years.

“Skin cancer is a major public health problem; more than 2 million new cases are diagnosed in the United States each year,” write Dr. Balk and coauthors of the accompanying technical report. “Approximately 25% of sun exposure occurs before 18 years of age. The risk of skin cancer is increased when people overexpose themselves to sun and intentionally expose themselves to artificial sources of UVR.”

In addition to describing new evidence on the association of exposure to sun and artificial sources of UVR with skin cancer and other health risks, the report also highlights sun-protection methods, vitamin D, community skin cancer–prevention efforts, and the pediatrician’s role in preventing skin cancer.

This report describes the interrelationship between sun exposure and vitamin D status, and the requirement of adequate vitamin D for bone health and for various other health conditions. Sunlight exposure is needed for cutaneous vitamin D production, but the efficiency of this production is complicated by many factors.

“Ensuring vitamin D adequacy while promoting sun-protection strategies, therefore, requires renewed attention to evaluating the adequacy of dietary and supplemental vitamin D,” the report authors write. “Daily intake of 400 IU of vitamin D will prevent vitamin D deficiency rickets in infants. The vitamin D supplementation amounts necessary to support optimal health in older children and adolescents are less clear.”

Pediatrics. Published online February 28, 2011.
http://www.medscape.com/viewarticle/738074?src=mp&spon=9

Lp (še vedno) Tanč; Pediater je odvetnik otroka. Vedno se vpraša: "Ali je to in to za otroka dobro?" ne glede na interese, mnenja, prepričanja drugih.Everything will be OK in the end. If it`s not OK, it´s not the end yet. In seveda: UPORABLJAJTE ISKALNIK!!!!!!!!!!!!!!!!!!!!!!!!! ISKALNIK JE ZAKON!!!

Sun Exposure Not Enough to Correct Vitamin D Deficiency

Medscape Medical News from the:
American Academy of Dermatology (AAD) 70th Annual Meeting
Kate Johnson

March 17, 2012 (San Diego, California) — “The ‘epidemic’ in vitamin D deficiency is clearly not from too little sun exposure,” and dermatologists can be confident in insisting that their patients continue their sun protection efforts, said Richard Gallo, MD, PhD, here at the American Academy of Dermatology (AAD) 70th Annual Meeting.

“Clearly solar exposure is an influence — there is no doubt about that — but you cannot predictably say that a certain amount of exposure will normalize vitamin D deficiency,” said Dr. Gallo, chief of dermatology and professor of medicine and pediatrics at the University of California, San Diego, in an interview with Medscape Medical News.

Speaking to an overcapacity audience at the meeting’s “Hot Topics” symposium, Dr. Gallo, who was involved in the 2010 Institute of Medicine’s (IOM’s) consensus report on updated dietary vitamin D intake recommendations, said that although “sunlight is a very reliable source of vitamin D, nutritional sources are clearly required and are, of course, much safer.”

He said although there is strong evidence that vitamin D is “absolutely necessary” for bone health, other potential health benefits such as protection from cardiovascular events, cancer, and infection are, as yet, unproven.

Although some physicians advocate universal screening for vitamin D deficiency or insufficiency, Dr. Gallo said there is no evidence to support this approach, and there is a lack of consensus on the definition of these conditions.

The IOM report recommends that patients should have serum vitamin D levels above 20 ng/mL, but the American Endocrine Society sets this level at 30 ng/mL, Dr. Gallo said.

There is evidence to support screening in high-risk individuals, he added, and noted that this is an extensive list including all dark-skinned, pregnant or lactating, elderly, and obese individuals, as well as those with malabsorption syndromes, rickets, osteomalacia, osteoporosis, chronic kidney disease, granulomatous disorders and lymphomas, and patients receiving chronic antifungal therapy.

“This is a pretty broad spectrum of individuals, and it’s kind of left up to the individual practitioner right now to use their common sense regarding who should be screened and who shouldn’t,” Dr. Gallo noted. Physicians who do find a deficiency on screening should consider checking parathyroid hormone, which can sometimes have a compensatory rise, he said.

“An elevated parathyroid hormone paired with low vitamin D and potentially low calcium could be high risk for bone disease. So those kinds of individuals on the severe [low] end you might be best to refer to an endocrinologist,” he said in the interview.

“For individuals on the borderline, at 15 ng/mL (and a lot of individuals are there) a simple thing to do is to just suggest a vitamin supplement and rescreen them perhaps 3 to 6 months later.”

Winter blood tests will naturally reflect lower levels than in the summer, he added.

Dr. Gallo have disclosed no relevant financial relationships.

American Academy of Dermatology (AAD) 70th Annual Meeting: Presented March 16, 2012

Lp (še vedno) Tanč; Pediater je odvetnik otroka. Vedno se vpraša: "Ali je to in to za otroka dobro?" ne glede na interese, mnenja, prepričanja drugih.Everything will be OK in the end. If it`s not OK, it´s not the end yet. In seveda: UPORABLJAJTE ISKALNIK!!!!!!!!!!!!!!!!!!!!!!!!! ISKALNIK JE ZAKON!!!

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