Technical Report—Ultraviolet Radiation: A Hazard to Children and Adolescents

Sunlight sustains life on earth. Sunlight is essential for vitamin D synthesis in the skin. The sun’s ultraviolet rays can be hazardous, however, because excessive exposure causes skin cancer and other adverse health effects. Skin cancer is amajor public health problem;more than 2 million new cases are diagnosed in the United States each year. Ultraviolet radiation (UVR) causes the 3 major forms of skin cancer: basal cell carcinoma; squamous cell carcinoma; and cutaneous malignant melanoma. Exposure to UVR from sunlight and artificial sources early in life elevates the risk of developing skin cancer. 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. Public awareness of the risk is not optimal, compliance with sun protection is inconsistent, and skin-cancer rates continue to rise in all age groups including the younger population. People continue to sunburn, and teenagers and adults are frequent visitors to tanning parlors. Sun exposure and vitamin D status are intertwined. Adequate vitamin D is needed for bone health in children and adults. In addition, there is accumulating information suggesting a beneficial influence of vitamin D on various health conditions. Cutaneous vitamin D production requires sunlight, and many factors complicate the efficiency of vitamin D production that results from sunlight exposure. Ensuring vitamin D adequacy while promoting sun-protection strategies, therefore, requires renewed attention to evaluating the adequacy of dietary and supplemental vitamin D. 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. This report updates information on the relationship of sun exposure to skin cancer and other adverse health effects, the relationship of exposure to artificial sources of UVR and skin cancer, sun-protection methods, vitamin D, community skincancer–prevention efforts, and the pediatrician’s role in preventing skin cancer. In addition to pediatricians’ efforts, a sustained public health effort is needed to change attitudes and behaviors regarding UVR exposure. Pediatrics 2011;127:e791–e817 BACKGROUND Sunlight sustains life on earth. The sun provides warmth, is needed for photosynthesis, drives biorhythms, and promotes feelings of well-being, and sunlight is essential for vitamin D synthesis in skin. Sophie J. Balk, MD, and the COUNCIL ON ENVIRONMENTAL HEALTH and SECTION ON DERMATOLOGY