May 2008
Topic:  Spring Outdoors; remember Sunscreen and Insect Repellant,

Health Services Department:  Health and Safety Tips

Warm spring weather means flowers, green grass and a lot more time for outdoor play!  Along with all the fun, it is important to consider some possible risks as the children in your care are exposed to sun and insects. Children that develop sunburns from too much time in the sun increase their risk for developing skin cancer later in life. Insect bites from ticks, bees and mosquitoes bring many concerns and risks to children.  In addition to the local reaction of redness, swelling and itching, these types of bites can carry viruses and other serious illnesses. 

General Tips for Limiting exposure to the Sun without using Sunscreen

This material is adapted from the National Program for Playground Safety, NPPS.org and the California Child Care Health Program  www.ucsfchildcarehealth.org

1.  Encourage parents to bring wide brim hats that will provide shade to their face, neck and ears.

2.  Wear clothing that is loose fitting, yet full length and light in color, will minimize skin exposure to the sun without application of sunscreen.

3.  Provide areas of shelter/shade when children are engaged in outdoor activities. The best time to find large areas of shade is early in the morning or late in the afternoon. Teach children to identify and use good sources of shade.  Be sure to keep infants and small children in the shade when outdoors.

4.  Schedule outdoor activities before 10 am and after 3pm, to avoid the peak sun intensity hours, when UV light is strongest.  By avoiding sun exposure during peak hours, sun exposure may be reduced by as much as 60%.

5.  Create shade in your outdoor areas.  Permanent shade structures include porches,  picnic shelters, and fabric shade canopies.

The New York State Regulations

The regulations allow all child care providers to apply sunscreen and insect repellant in their centers if they follow the steps below: 

1.  The parent gives the program Written Parental Permission to apply the sunscreen. 

2.  The instructions the parent gives you to use the sunscreen or insect repellant match the instructions written on the sunscreen or insect repellant.

3.  The child care provider must document each time that they use the product on the child

4.  Parents are notified when their child has had the insect repellant or sunscreen  applied.

5. Storage:  sunscreen and insect repellant must be stored in an area that is clean and inaccessible to children.

Considerations in picking and applying Sunscreen

• Alcohol free, and paba free is preferred
• Apply broad spectrum SPF 15 or higher
• Apply only to areas of exposed skin, not the eyelids,
• Apply 30 minutes prior to going outside and every two hours while in the sun.
• For safety ensure that the child has no known allergies to sunscreen, and if they do have allergies, that the parent identifies the allergy, and possibly supplies an appropriate sunscreen for their child.
• Staff understands and can follow directions on the sunscreen printed on the product container.
• You have all required written permissions to apply the sunscreen.

Note: Children should wash hands when they come in from the playground so they don’t eat or rub eyes with sunscreen on their hands.

Insects

Limiting exposure to insects is much trickier than limiting exposure to the sun.  Wearing loose fitting, full length clothing will help to protect skin from exposure to insects.  Standing water and garbage tends to attract insects and mosquitos and should be avoided.  Outdoor play around wet areas should be avoided, as mosquitos will hatch eggs in standing water.

Choosing an Insect Repellant:

The Center for Disease Control recommends using a product that may contain any of the following: 

1.DEET,  Deet containing products must be chosen and applied very carefully.

Consider the age of the child.  DEET should NOT be used on children under 2 months of age, and Oil of Lemon Eucalyptus should only be used on children over three years old! 

Consider the time you will be outside:  It is best to use the lowest concentration of DEET.  The higher the concentration of DEET means that the product will last on the skin longer, not that it is more effective.  Use the lowest concentration for your situation. 

30% or less is the recommended concentration.

2. Picaridin, or

3. Oil of Lemon Eucalyptus (only for children over 3 years old.)

Applying Insect Repellant

The AAP and the EPA recommend the following precautions when using IR as reported by the California Childcare Health Program:

• Apply repellents only to exposed skin and or clothing. Do not use under clothing.
• Always apply according to directions on the label
• Never use on babies under 2 months of age
• Never apply near eyes, or mouth or hands, and sparingly around ears
• Never use repellents over cuts, wounds, or irritated skin.
• When using sprays, do not spray directly on face, spray on hands first and then apply to face.
• Do not allow children to handle the product. When using on children apply to your own hands first. Do not apply on children’s hands.
• Use just enough to cover exposed skin, heavy applications do not work better. If a thin film does not work, you can apply a bit more.
• After returning indoors, wash treated skin with soap and water. Also wash treated clothing before wearing again. (Check product label for further instructions.)
• If a child develops a rash, stop using the product, wash with mild soap and water and call poison control and the child’s parent for guidance

Frequently Asked Questions:

Does my staff need to be trained, or approved to administer medications in order to apply sunscreen or insect repellant?

All staff may apply sunscreen, insect repellant, and over the counter topical ointments without special training or approval.  All staff should be aware of the precautions and information provided in this tip.  In addition, staff must be aware that the directions the parent supplied must match the directions on the sunscreen or insect repellant in order to accept their written permission.  Staff should read and understand the label directions.

Can I store a big bottle of sunscreen or insect repellant to use on all the children in my program?

Yes, you may store a non child specific sunscreen or topically applied insect repellant on site.  You do NOT need a stock medication waiver.  You MUST have written permission from parent/guardian.  Your health care plan should describe how you will prevent the spread of infection while applying sunscreen and insect repellant.

Is there specific paperwork that I must use in order to get the written parental permission to give a child insect repellant or sunscreen?

The regulations require you to have parental/guardian permission. Some programs are choosing to use the NYS form Written Consent for Medication Administration. You may develop one of your own.  Parents must give permission for each type of over the counter topical ointment, sunscreen and insect repellant you are using in your program.

References:

California Childcare Health Program, www.ucsfchildcarehealth.orgInsect Repellant Health and Safety Notes;  Summer Safety Child Care Health Connections July-August 2003; Sunscreen/SunSmart information

Great Resources
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