Q: My daughter loves the water and swims like a fish but, no matter how much sunscreen I put on, I still see her skin getting slightly red and she is developing freckles. I’m worried about the damage to her skin but don’t want to deprive her of an activity that she loves. Can you recommend a really good strong sunscreen or any other measures I could take? Helen
A People are not exactly born with freckles, but can have a predisposed heredity to developing them. Sun exposure makes freckles more obvious, but an individual’s genetics will determine how many and how much sun exposure will reveal the freckles. Avoiding the sun will diminish freckles. This is why many freckled-faces disappear during the winter months when sunlight is scarce. You can avoid freckle development by keeping her out of the sun and generously applying and reapplying sunscreen every two hours to block ultraviolet rays.
All infants should be kept out of direct sun and be covered by protective clothing when possible. If sun exposure is inevitable, sunscreen should be applied to exposed areas (such as face, hands). Sunscreens have been deemed safe for infants older than six months. Choose a broad- spectrum sunscreen with an SPF 30. The protective ability of sunscreen is rated by its Sun Protection Factor (SPF) – the higher the SPF, the stronger the protection. Don’t be swayed by high SPF numbers alone, research has proven that SPF greater then 30 does very little to amplify protection. Sometimes it does the exact converse, it gives you as a parent an over-confidence about the protection provided and you forget to reapply every two hours, defeating the purpose altogether. Sunscreens labelled as ‘broad spectrum’ indicate that they have passed the test for protection against UVA. Spread sunscreen uniformly over all uncovered skin, including ears and lips, but avoid the eyelids.
To protect against both UVA and UVB rays, look for one of the following main ingredients on the label: avobenzone, titanium dioxide or zinc oxide. For the full effects, make sure that the titanium dioxide and zinc oxide are at least five per cent.
Avobenzone is a chemical created to absorb UVA rays. A main ingredient in most sunscreens on the market today, it can be absorbed into the skin.
Titanium dioxide and zinc oxide are natural mineral UV blockers. They are believed to cause less skin irritation because these ingredients stay on top of the skin, unlike the chemical ingredients which can be absorbed.
If your child gets a rash from sunscreen, look for one that is:
• Fragrance free
• PABA free
The FDA defines water resistant and waterproof sunscreens as:
• Water resistant: maintain their SPF rating for at least 40 minutes after water exposure.
• Waterproof: maintain their SPF rating for at least 80 minutes after water exposure.
Even if your kids are not going swimming, a water-resistant sunscreen is preferred for children.
If possible, avoid the sun between 10am and 2pm. It is best to plan indoor activities or seek shade under trees or umbrellas. One useful rule of thumb is that if your shadow is shorter than you, the sun is directly above and it is best to head for cover. Sun exposure is more intense closer to the equator, in the mountains and in the summer. The sun’s damaging rays are increased by reflection from water, white sand and snow.
Q: My little boy is coming up for two years old and is reaching all his developmental milestones but he is still not speaking. At what age should I start being worried? Rania
A Children who are regarded as late talkers are those who have fewer than 50 words at age two and use limited or no two- or three-word combinations, such as ‘more milk’.
Certain risk factors or signs of speech delays at age two suggest a child should receive early language intervention services. These signs include:
• Small vocabulary for age – fewer than 20 words
• Use of few verbs
• Difficulty comprehending simple language
• Limited vocalisations with few consonants
• Reduced or absent imitation
• Few communicative gestures (for example, shaking head for ‘no’)
• Chronic middle ear infections
• Family history of delayed speech, language or reading.
If you recognise any of the above in your son, contact your paediatrician. She or he will likely seek further evaluation, including a hearing test and a developmental assessment.
Although early intervention and speech therapy are necessary to help a child with speech delays, you can support a child’s speech by reading to him or her. Picture books are brilliant because they allow you to make a game of pointing and naming familiar objects.
If you have a question for Dr Jinan, please email firstname.lastname@example.org