Sun safety for babies: sunscreen, shade, UV and sunburn

A baby's skin is thin and burns easily, so sun protection starts from day one. For young babies that mostly means keeping them out of direct sun and using shade, clothing and a hat; sunscreen plays a smaller part, and advice on it for babies under 6 months differs between countries. As your baby grows into a toddler, add sunscreen, sunglasses and good habits. Check the UV index rather than the temperature, never cover a pram with a cloth, and know which signs after a day in the sun need a doctor.

When can babies go out in the sun?

Babies can go outside, but they need protecting from direct sun, especially when UV is high. The sources set slightly different age lines:

Cancer Council Australia says babies should be protected from UV from the day they're born, and that babies under 12 months should be kept away from direct sunlight when UV levels reach 3 or above. It says that when UV is below 3, a few minutes of direct sun is considered safe for babies, but for longer periods outside they should still be covered, wear a hat and be kept in the shade.

The NHS says babies under 6 months should be kept out of direct sunlight, and older babies should be kept out of the sun as much as possible, particularly between 11am and 3pm in summer. The AAP also says to keep babies under 6 months out of direct sunlight, in the shade of a tree, an umbrella or the stroller canopy, and to limit sun between 10am and 4pm.

What does the UV index mean for my baby?

The UV index tells you how strong the sun's ultraviolet (UV) rays are. The Royal Children's Hospital Melbourne (RCH) says your child needs sun protection whenever the UV index forecast is 3 or more, and that children can get sunburnt in as little as 10 minutes.

A few things catch parents out:

• You can't feel UV. The RCH says some hot days have low UV and some cold days have high UV, so check the forecast rather than the temperature. In Australia, the Bureau of Meteorology and Cancer Council's free SunSmart app show daily UV and sun protection times.
• Clouds don't block it. The AAP says up to 80% of UV rays can get through clouds, and that UV bounces back from water, sand, snow and concrete.
• Shade isn't complete. Cancer Council Australia says UV can be scattered or reflected, so use other protection in the shade too.
• Car windows let some through. Cancer Council says clear side windows block almost all UVB but only 21% of UVA, so consider window shades.
• Timing varies. The RCH says UV is usually strongest between 10am and 4pm, and in Victoria it usually reaches 3 or more from mid-August to the end of April; in other parts of Australia it's high all year.

Can babies wear sunscreen?

From 6 months, yes. Under 6 months, sources differ, so here is each position as stated:

How to use sunscreen once your baby is old enough:

1. Choose broad-spectrum. The RCH, NHS and AAP say to look for protection against both UVA and UVB. The AAP suggests zinc oxide or titanium dioxide for sensitive areas such as the nose, cheeks and ears.
2. Test it first. Cancer Council suggests trying a small amount on the inside of the forearm for a few days before using a new sunscreen all over. Stop using any sunscreen that causes a reaction, and ask your doctor.
3. Apply before going out. Cancer Council says 15 to 20 minutes before, the RCH says 20 minutes and the AAP says 15 to 30 minutes.
4. Use plenty and reapply. All four say to reapply every 2 hours, and sooner after swimming, sweating or towelling. For toddlers, the RCH says a two-year-old needs about two teaspoons for the whole body, and a five-year-old about three.
5. Mind the eyes. The AAP says to be careful around the eyes, and to wipe your baby's eyes and hands with a damp cloth if they rub sunscreen in.

The RCH says lotions and creams are best and to avoid aerosol sprays, because it's hard to apply enough. Sunscreen is never a reason to stay out longer; the AAP says it's for protection, not for extending time in the sun.

How do I dress my baby for the sun?

Clothing, a hat and shade do most of the work at every age.

• Clothing. Cancer Council Australia suggests cool, loose clothes and wraps in densely woven fabric that cover as much skin as possible. It says fabric rated at least UPF 15 gives good protection and UPF 50 excellent protection. The AAP suggests holding fabric up to the light: the less light that shines through, the better.
• Hats. Cancer Council suggests a broad-brimmed, bucket or legionnaire hat that shades the face, neck and ears, in a soft fabric that crumples when a young baby puts their head down. If the hat has a strap, it should have a safety snap, sit at the back of the head or be trimmed short so it isn't a choking hazard. The RCH says caps and visors don't give enough protection.
• Sunglasses. Cancer Council suggests close-fitting, wrap-around sunglasses labelled AS/NZS 1067:2016 if practical, and the RCH says to choose lens category 2, 3 or 4. The AAP suggests at least 99% UV protection. Toy or fashion sunglasses don't meet the standard.
• Feeds. Red Nose in Australia says babies need to drink more often in hot weather. Offer extra breastfeeds or formula, and see water for babies for when water fits in.

Darker skin still needs protecting. The RCH says melanin gives some protection but not complete protection, so children with darker skin still need clothing, a hat, sunscreen and shade.

How do I shade the pram without my baby overheating?

Shade the pram, but never close it in.

• Don't drape anything over it. Red Nose in Australia says never to cover the pram with a wrap, muslin or blanket, because even lightweight fabric can reduce airflow and trap heat. The Lullaby Trust says not to cover prams, buggies and travel systems with blankets, cloths or any cover that stops the air flowing, and the NHS says a blanket over the pram could lead to overheating.
• Use a clip-on sunshade or parasol. The Lullaby Trust's top tip is a clip-on sunshade or parasol, which shades your baby while letting air move and keeping them in view. The AAP suggests the stroller canopy.
• Find natural shade. Red Nose suggests trees or umbrellas and avoiding the hottest part of the day. Cancer Council Australia says shade should cast a dark shadow.
• Check your baby often. The Lullaby Trust says to feel the chest or the back of the neck, and Red Nose in Australia says to feel the tummy, which should feel warm. Cool hands and feet are normal.

Pregnancy, Birth and Baby, the Australian Government's parenting service, lists a dry cloth draped over a stroller or capsule as a cause of heat illness, although it describes a moist muslin with a fan blowing in as one way to shade. Because Red Nose, the Lullaby Trust and the NHS advise against any cover, we suggest the stricter advice.

If your baby falls asleep in the pram, Red Nose says to move them to a safe sleep space such as a cot as soon as you can, and never to leave them unattended. See naps on the go for safe sleep while you're out, and babies in hot weather for cars, sleep and feeds on hot days. Never leave your baby in a parked car, even briefly.

How do I treat sunburn in a baby or toddler?

Sunburn can be easy to miss at first. The AAP's sunburn guide says redness and pain start about 4 hours after sun exposure, peak at around 24 hours and start to improve after 48 hours. The RCH says lighter skin goes red, hot, swollen and itchy and may blister, while darker skin may not look red but can feel hot, itchy and sore, then flake, peel or darken.

The AAP says to call the doctor right away if a baby under 1 year gets sunburnt, and the NHS sunburn page lists a baby or young child with sunburn among reasons for an urgent GP appointment or a health advice line (Pregnancy, Birth and Baby on 1800 882 436 in Australia, NHS 111 in the UK, your pediatrician's after-hours line in the US). So for a baby, arrange a same-day check, and in the meantime:

1. Get out of the sun and keep your child out of it until the skin has healed.
2. Cool the skin gently with a damp cloth, cool compress or cool bath. The NHS says take care not to let a baby or young child get too cold.
3. Offer extra fluids. Extra breastfeeds or formula for babies, and water for older children, as the RCH and AAP suggest.
4. Leave blisters alone. The NHS and RCH say not to pop them.
5. Skip ice and petroleum jelly. The NHS and RCH say ice can damage the skin and petroleum jelly traps heat. Dress your child in loose clothing.
6. Ask before using creams or medicine. The AAP says to use medicated lotions only if your child's doctor says it's OK. For pain relief, check the age limits on the label and ask a pharmacist.

The NHS says sunburn usually gets better within 7 days, and the RCH says it can take a few days to a few weeks to heal, depending on how bad it is.

What are the signs of heat-related illness?

Sun and heat often go together. Babies heat up faster than adults and don't sweat as much, so check on them often on hot days. Pregnancy, Birth and Baby describes a range:

Red Nose adds unusual fussiness, listlessness or irritability, and pale, clammy skin that becomes hot and flushed. For heat exhaustion, Pregnancy, Birth and Baby suggests moving your baby somewhere cool, removing extra clothes, spraying them with lukewarm water and offering fluids, and taking them to a doctor without waiting. The RCH's sun safety sheet says a child with signs of heatstroke, such as a temperature of 38°C or more with a headache, nausea or vomiting, needs the emergency department. Our hot weather guide covers keeping cool, cars and sleep.

When should I get help for sunburn or heat?

Call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) now (or go straight to the nearest emergency department) if your baby or child, after time in the sun or heat:

• is floppy, much sleepier than usual, hard to wake or not responding normally, or has fainted or is too weak to stand
• is struggling to breathe or breathing very fast
• has a seizure
• has hot, dry skin, or pale or blotchy skin with cold hands and feet
• has had no wet nappy or wee for 12 hours, or has a sunken soft spot
• is vomiting and has a temperature of 38°C (100.4°F) or more, or has other signs of heatstroke
• is under 3 months and has a temperature of 38°C (100.4°F) or higher, or is 3 to 6 months old and has a temperature of 39°C (102.2°F) or higher

These come from Pregnancy, Birth and Baby, the RCH, the AAP and the NHS urgent-help guide. While you wait, Pregnancy, Birth and Baby suggests cooling your baby with a lukewarm bath or sponging, fanning them, and giving fluids only if they're awake and able to swallow.

Get medical help today (same-day GP, after-hours doctor or a health advice line (Pregnancy, Birth and Baby on 1800 882 436 in Australia, NHS 111 in the UK, your pediatrician's after-hours line in the US)) if your baby or child:

• is under 12 months and has any sunburn (the AAP says call right away; the NHS lists sunburn in a baby or young child for urgent advice)
• has blistered or swollen skin, large blisters or blisters on the face, or a lot of pain
• has sunburn and feels hot, cold or shivery, or is very tired or being sick
• seems weak, tired, thirsty, pale or sweaty after time in the heat (Pregnancy, Birth and Baby says to seek urgent care if they don't improve once cooled)
• is refusing feeds or feeding much less than usual, or has fewer wet nappies than usual
• has sunburn that looks infected, with spreading redness, pus or red streaks

Talk to your GP or child-health nurse if an itchy rash keeps appearing on sun-exposed skin, which the AAP suggests raising with your doctor, if a sunscreen seems to irritate your child's skin, or if you're unsure about vitamin D (see vitamin D for babies). If your child has swelling of the lips or tongue or trouble breathing after a new product, call your local emergency number (000 in Australia, 999 in the UK, 911 in the US).

If you're unsure which tier fits, call a health advice line (Pregnancy, Birth and Baby on 1800 882 436 in Australia, NHS 111 in the UK, your pediatrician's after-hours line in the US).