Ph.D. candidate in Applied Developmental Psychology and Special Education at the University of North Carolina at Chapel Hill’s School of Education
About the author: Sarah Pedonti, M.Ed., is a Ph.D. candidate in Applied Developmental Psychology and Special Education at the University of North Carolina at Chapel Hill’s School of Education. Her research focuses on early reading and language interventions for young children with or at risk for developmental language disorders. She has worked in varied settings serving young children with disabilities, including Early Head Start, Head Start, North Carolina Pre-K (co-located within a Title I Engineering Magnet Elementary School), NC State’s Engineering Place Summer Programs, and the Office of Head Start’s National Center on Early Childhood, Development, Teaching, & Learning (NCECDTL)
Outdoor learning is important for helping young children with and without disabilities to regulate attention (Szczytko et al., 2018) and improve learning engagement (Norwood et al., 2019) and contributes positively to foundational STEM skills such as spatial working memory (e.g. remembering the position of cards during a game of memory; Schutte et al., 2015). Yet, there may be hurdles to safe participation in outdoor learning for some children with disabilities, including sensory hypersensitivities which may cause difficulty with safety precautions such as sunscreen.
Sunscreen use is important: one in five U.S. citizens will be diagnosed with skin cancer in their lifetime (Guy et al., 2015). Although children are at low risk for developing skin cancer in childhood, sun safety behaviors in childhood can prevent the overexposure to UV rays which are responsible for skin cancers in later adulthood (Autier et al., 1994a,b). A childhood history of severe sunburn significantly raises one’s lifetime chance of developing skin cancer (Iannacone et al., 2012; US Department of Health & Human Services, 2014). Some children with disabilities may be particularly at risk for severe sunburn due to genetic skin conditions such as ichthyosis or Ehler-Danos syndrome, or due to developmental disabilities such as autism (Kanellis, 2020). Some children with autism and other developmental disabilities may display sensory hypersensitivity (Baranak et al., 2007) to “light” tactile experiences like sunscreen application (Baranek & Berkson, 1994; Quinde-Zlibut et al., 2020). Sensory (e.g., autism) or physiological (e.g., icthyosis or similar dermatological disorders with acutely sensitive skin) difficulties associated with sunscreen application can make outdoor summer activity difficult for families. Following are several recommendations for supporting sun safety and helping children with disabilities benefit from outdoor play and to understand the scientific rationale for sun protection:
Universal:
- Limit outdoor time to morning and late afternoon hours outside peak sun exposure when possible.
- Reapply every 90-120 minutes- even “waterproof” sunscreens need reapplication, and will need so even more frequently if you’re in the water (FDA, 2019)
- Seek the shade! Use a sun-tent or umbrella at the beach, and use playgrounds that have shady spaces under trees or sun sails.
- Don’t forget the hat! 13% of all skin cancers occur on the scalp. (Prodinger et al., 2018)
Individualized:
- Experiment with different textures of sunscreen- spray on, mineral/zinc stick, and lotions may be tolerated differently by children with different profiles of sensory sensitivity.
- Foreshadow how it will feel - “This may feel cold and sticky, but I’ll try to warm it up with my hands first!”. A fun song or video can familiarize your child. Familiar characters can help convey the idea: https://www.youtube.com/watch?v=z1eZpnH2sUU or https://pbskids.org/video/sid-science-kid/1568872756 or https://youtu.be/9CRH2oOuUD0?t=1001
- Apply lotion gradually – make it a game or solicit your child’s help to lotion different body parts. See who can do a leg the fastest!
- Consider a social story to help children who have sensory l hypersensitivity understand the need for sunscreen: https://www.skcin.org/downloads/georgeTheSunSafeSuperstar.pdf (Clifford, 2012)
- Schools and child care programs can consider using a free sun safety curriculum developed by researchers at the MD Anderson Cancer Center, the Sunbeatables: https://letsgo.catch.org/bundles/sun-safety (Tripp et al., 2009)
- For children who can’t tolerate sunscreen for physiological or sensory reasons, explore UV-protective clothing like rashguards, jammers, hooded sunshirts, and wetsuits.
- Use visual cues to help children apply sunscreen: https://starautismsupport.com/sites/default/files/FITS%20-%20Group%20-%20Life%20Skills%20-%20Sunscreen%20Application%20Practice.pdf
Most of all, have FUN! Outdoor learning supports children with disabilities to learn, participate with their peers, and benefit cognitively from STEM experiences that occur outdoors. Sun safety precautions can protect children from future risk of skin cancer while encouraging their present-day learning!
References
Autier, P., Doré, J. ‐F, Schifflers, E., Cesarini, J. ‐P, Bollaerts, A., Koelmel, K. F., Gefeller, O., Liabeuf, A., Lejeune, F., Lienard, D., Joarlette, M., Chemaly, P., & Kleeberg, U. R. (1995). Melanoma and use of sunscreens: An EORTC case‐control study in Germany, Belgium and France. International Journal of Cancer, 61(6), 749–755. https://doi.org/10.1002/ijc.2910610602
Boyd, B. A., Baranek, G. T., Sideris, J., Poe, M. D., Watson, L. R., Patten, E., & Miller, H. (2010). Sensory features and repetitive behaviors in children with autism and developmental delays. Autism Research, 3(2), 78–87. https://doi.org/10.1002/aur.124
Baranek, G., Boyd, B., Poe, M., David, F., & Watson, L. (2007). Hyperresponsive sensory patterns in young children with autism, developmental delay, and typical development. American Journal on Mental Retardation, 112(4), 233–245. https://doi.org/10.1352/0895-8017(2007)112
Baranek, G. T., & Berkson, G. (1994). Tactile defensiveness in children with developmental disabilities: Responsiveness and habituation. Journal of Autism and Developmental Disorders, 24(4), 457–471. https://doi.org/10.1007/BF02172128
Food and Drug Administration (2019) Sunscreen: How to Protect your Skin. https://www.fda.gov/drugs/understanding-over-counter-medicines/sunscreen-how-help-protect-your-skin-sun#infants
Guy, G.P., Machlin S., Ekwueme, D.U., & Yabroff, K.R. (2015) Prevalence and costs of skin cancer treatment in the US, 2002–2006 and 2007–2011. American Journal of Preventative Medicine, 48(8) 183–7.
Iannacone, M. R., Wang, W., Stockwell, H. G., O’Rourke, K., Giuliano, A. R., Sondak, V. K., Messina, J. L., Roetzheim, R. G., Cherpelis, B. S., Fenske, N. A., & Rollison, D. E. (2012). Patterns and timing of sunlight exposure and risk of basal cell and squamous cell carcinomas of the skin - a case-control study. BMC Cancer, 12(1), 1–11. https://doi.org/10.1186/1471-2407-12-417
Kanellis, V. G. (2020). Barriers to sun safety in autism spectrum disorder. In Biophysical Reviews (Vol. 12, Issue 4, pp. 791–792). Springer. https://doi.org/10.1007/s12551-020-00732-2
Norwood, M.F., Lakhani, A., Fullagar, S., Maujean, A., Downes, M., Byrne, J., Stewart, A., Barber, B., Kendall, E., (2019). A narrative and systematic review of the behavioural, cognitive and emotional effects of passive nature exposure on young people: Evidence for prescribing change. Landscape and Urban Planning, 189, 71-79.
Prodinger, C. M., Koller, J., & Laimer, M. (2018). Scalp tumors. Journal Der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 16(6), 730–753. https://doi.org/10.1111/ddg.13546
Schutte, A. R., Torquati, J. C., & Beattie, H. L. (2017). Impact of Urban Nature on Executive Functioning in Early and Middle Childhood. Environment and Behavior, 49(1), 3–30. https://doi.org/10.1177/0013916515603095
Szczytko, R., Carrier, S.J., Stevenson, K.T., (2018). Impacts of outdoor environmental education on teacher reports of attention, behavior, and learning outcomes for students with emotional, cognitive, and behavioral disabilities. Frontiers in Psychology, 3
Tripp, M., Herrmann, N., Parcel, G., Chamberlain, R., & Gritz, E. (2000). Sun protection is fun! A skin cancer prevention program for preschools. Journal of School Health, 70(10), 395–401. https://doi.org/10.1111/josh.2000.70.issue-10
Quinde-Zlibut, J. M., Okitondo, C. D., Williams, Z. J., Weitlauf, A., Mash, L. E., Heflin, B. H., Woodward, N. D., & Cascio, C. J. (2020). Elevated thresholds for light touch in children with autism reflect more conservative perceptual decision-making rather than a sensory deficit. Frontiers in Human Neuroscience, 14, 122. https://doi.org/10.3389/fnhum.2020.00122
US Department of Health & Human Services. (2014) The Surgeon General’s Call to Action to Prevent Skin Cancer. Washington, DC: US Dept of Health and Human Services, Office of the Surgeon General.
Comments
You can apply sunscreen with a big makeup brush. My kids like this for the face because then I can be more careful around the eyes.