1. In the child care setting…
Sun Safety
In the child care setting…
In 2008, the Sun Safe Nova Scotia coalition in partnership with Community Services, Early Childhood Development Services conducted an assessment of sun safety practices within Nova Scotia’s licensed child care centres and family home day care agencies.
While child care staff were aware of the importance of sun safety and incorporated many sun safety practices into their routines, they also identified barriers to sun safety practice. These included the need for credible information on various sun safety topics including sunscreen, shade and vitamin D.
In response this presentation has been developed to provide child care staff with the information needed to support them in the adoption of good sun safety practice.
In addition a “how to” guide Play it Sun Safe – Guidelines and Best Practice for Sun Safety in Nova Scotia’s Child Care Centres was developed to support the adoption of sun safety practice as well as a series of fact sheets that can be used by child care centre staff or with parents and guardians as the need arises.

2. Overview Skin cancer facts Skin cancer risk factors Reducing the risk
Sun Safety in the child care setting
Today’s presentation will provide you with an understanding of over exposure to the sun as one of the risk factors for developing skin cancer, with a focus on supporting sun safety in child care centres. The presentation will also highlight ways to reduce these risks.

3. Expected Incidence Rates...Canada 2014
Melanoma
Non- Melanoma
6,500
76,100
Skin cancer is the most commonly occurring cancer in Canada, it accounts for nearly 1/3 of newly diagnosed cancers…
But before we can understand how to reduce our risk, it’s necessary to understand what the real risks are. Over exposure to the Ultra Violet rays (UV Rays) from the sun are linked to three types of skin cancer:
1. Melanoma – occurs least often but can spread quickly and can result in death. It is a highly dangerous form of skin cancer that if left untreated will invade into the skin and spread through the blood stream or the lymphatic system to other parts of the body.
And…
There are two forms of skin cancer – often referred to together as Non-Melanoma skin cancer. These are:
2. Basal Cell Skin Cancer – is the most common form of skin cancer in Canada. It is the least dangerous form of skin cancer but does require treatment since it will continue to grow and invade and destroy surrounding skin tissue.
3. Squamous Cell Skin Cancer – Is the second most common form of skin cancer in Canada and must be treated because it may continue to grow in size, damaging surrounding tissue and may spread to other areas of the body.
While melanoma skin cancer is considered the most serious and life threatening form of skin cancer, the very high incidence of non-melanoma skin cancer makes it a significant health priority as well.
Reference:
Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian Cancer Statistics 2014.
Toronto, ON: Canadian Cancer Society; 2014.
Canadian Dermatology Association – website – information on melanoma, basal cell and squamous cell skin cancer accessed on 04/16/09 – URL

4. The Effects of Over Exposure to the Sun…
Skin Cancer
Premature aging of the skin
Damage to the eyes
Weakening of the immune system
In addition to putting us at risk for skin cancer, over exposure to the UV rays of the sun can cause other serious health effects such as:
*Premature aging of the skin… when skin ages early, becomes wrinkled, sagging or has a leathery look.
*Damage to the eyes- Not only can the sun cause sensitivities to light but UVA radiation can damage the cornea and cause cataracts.
*Weakening of the immune system- UV radiation lowers the body’s ability to fight against bacteria and viruses. This effect is called immunosuppression.
UV rays emitted from the sun can cause damage to our skin but also to other parts of our body. Its important to remember that the damage from the sun is cumulative, it adds up. While the redness from a sunburn may fade within a few days, the damage remains.

5. Ultraviolet Radiation (UV Rays)
Two types of ultraviolet radiation
UVA
UVB
UV rays are strongest
between April - September
between 11a.m. and 4p.m.
So we know what overexposure to UV rays can do. But what exactly are UV Rays?
Understanding ultraviolet radiation (UV rays) from the sun is important to help make decisions about sun safety practices.
There are two types of UV rays from the sun that reach the earth and can penetrate our skin. Because we can’t see UV rays it’s easy to forget that they are present and are a risk. UVA and UVB rays are strongest in Nova Scotia between April and September. UVA rays are a longer wavelength. This means that they can penetrate deeper into our skin damaging underlying tissue and their strength is consistent throughout the day. UVB rays are a shorter wavelength which results in them being less intense in the morning and later in the day. UVB rays are responsible for reddening (burning) of the skin. The UVB rays are strongest between 11a.m. and 4 p.m. which is why limiting sun exposure during this time of day is encouraged.
While heavy cloud can reduce the amount of UV radiation reaching us it’s important to remember that up to 80% of UV rays can pass through cloud cover…the lighter the cloud cover, the more UV rays get through.
Also UV rays are reflected off of water, sand, cement and even snow.
Altitude is also a factor where UV is concerned. The higher we are the more UV reaches us. Skiers for example should always use sun protection on exposed skin. Even though skiing typically falls outside of peak UV months, the high altitude and significant UV reflected off of the snow increases the risk for sun damage.

6. Personal Risk Factors Light coloured skin/eyes/hair
Work/play/exercise frequently in the sun
Have had blistering or frequent sunburns as a child
Have a family history of skin cancer
While protection from over exposure to the suns UV Rays is important for everyone, some people have a higher risk of sunburn, sun damage and of skin cancer.
People that have light coloured hair, eyes and skin, who tend to burn easily and rarely tan are most at risk for sun damage. Individuals that work or play outside year round are also more at risk.
Both the pattern and amount of sun exposure influence the development of skin cancer. Continuous patterns of sun exposure (ie. people who have a job that requires them to be out of doors) are related to an increased risk of Squamous Cell Cancers. Intermittent or intense sun exposure that may result in a sunburn is implicated in the development of Basal Cell Cancer and Melanoma.
Many believe that having darker skin prevents sun damage from occurring. This is not true. While the risk of skin cancer is lower for those with darker skin, it can still occur and premature aging, eye damage and weakening of the immune system remains the same regardless of skin colour. Sun protection is important for everyone.
Reference: Key Sun Safety Messages, 2008, Alberta Cancer Board.

7. Children in the Sun
56% of Atlantic Canadian children spend 2 hours in the sun.
35% of these children are between the ages of 1-5.
35% of children aged 1-5
and 34% children aged of 6-12
always or often seek shade.
In the fall of 2006 a national study of Canadian knowledge, attitude and behaviour on sun safety was conducted. The study found that:
*56% of Atlantic Canadian children had spent at least 2 hours in the sun between 11:00 a.m. and 4:00 p.m. on a typical summer day that summer.
*35% of these children were between the ages of 1 and 5 years.
Among Atlantic Canadian children in the sun for at least 30 minutes between 11 a.m. and 4 p.m., 35% of children aged 1-5 and 34% of those aged 6-12 always or often sought shade.
Reference:
National Sun Safety, Knowledge Attitude and Behaviour of Canadians survey,2006 – Atlantic level data.

8. What the evidence shows…
Adequate sun protection can reduce our risks…..PREVENTABLE
Exposure in childhood- key determinant.
80% of lifetime exposure happens before 18.
Unlike some cancers where the cause is unknown, sun exposure is the main environmental cause of skin cancer. The UV radiation from the sun is a known carcinogen – meaning that it causes cancer – skin cancer. The most significant preventable risk factor for developing skin cancer is exposure to the sun’s UV rays.
Over exposure to sunlight in childhood is a key determinant of skin cancer risks in adulthood. Reducing overexposure and protecting against severe or multiple sunburns in childhood may reduce the risk of skin cancer in adulthood.
Much of our lifetime sun exposure occurs when we are children and youth with upwards of 80% of our lifetime exposure happening before the age of 18 years – making protective practices during these early years very important.

9. “Six Sun Safety Steps” For Everyone…
Limit time in the midday sun
Seek shade
Wear protective clothing
Apply sunscreen
Put on a hat
Wear sunglasses
Sun safety is about protecting ourselves and those in our care from the harmful effects of the suns UV rays.
With spring comes the warmer weather and more outdoor time.
This increases our exposure to UV rays. Being sun safe does not mean avoiding the outdoors - sun safe means taking the necessary precautions to enjoy the outdoors while minimizing the risk of sunburn and sun damage.
The suns rays are strongest between 11a.m. and 4p.m.. When the UV index is high (6 or 7) limiting outdoor time is recommended. Planning outdoor activities in shaded areas in addition to wearing protective clothing, hats, use of sunscreen and sunglasses protect the skin and eyes from overexposure to the UV rays from the sun.

10. For Childcare Staff… Practice sun safe behaviours
Encourage sun safety behaviours
Educate others about sun safety
Incorporate sun safety into daily procedures/routines
It is important to know about and to put sun safety into practice. All Staff and volunteers working in child care settings are encouraged to practice sun safety. Providing training sessions on sun safety can help with awareness and adoption of these practices.
Educating parents about sun safety and informing them that sun safety is practiced in the child care setting is important. Parents will also need information with respect to applying sunscreen and dressing their child with clothing that comfortably covers the skin and a hat that shades the face, ears and back of the neck.
Staff are in a terrific position to be strong sun safety role models for the children in their care. Teaching by example is an important way to educate children about sun safety. Such practices also reduce the risk of sun damage to child care staff.
By incorporating sun safety into a centre’s daily procedures and/or routines, it becomes a normal part of every day. Just as head counts are routine before leaving on an outing, hat counts ensure every head and neck are protected.

11. UV Index UV INDEX Category Sun Protection Actions 0-2 Low
Minimal protection
3-5
Moderate
Cover up.
6-7
High
Protection required. Reduce time in sun.
8-10
Very high
Take full precautions. Avoid sun between 11-4
11+
Extreme
Take full precautions. Avoid sun between 11-4.
The UV Index is a helpful tool to determine the level of protection needed on any given day. Developed in Canada, the UV Index is now used around the world to standardize UV radiation reports.
The UV Index provides recommended protection for UV from low to extreme ratings. Once the UV index is 3 or moderate, protection is needed. When the UV index is 3 or higher it is reported on the weather network and on radio stations. It is a good habit to check the UV index each day. The Weather Network provides an on-line searchable UV Index report covering most areas of Nova Scotia. By doing an online search for UV Report: Canadian UV Index Nova Scotia you can quickly check the UV Forecast for your area (i.e The information includes a UV reading for the day and indicates the time of day when the UV index will be at its maximum.

12. Shade An element of a comprehensive approach.
Seek shade between 11AM and 4PM
Sources of shade
Creating shade
Shade is part of a comprehensive sun safety approach. Planning activities in the shade is an effective way of reducing overexposure to the sun. When the UV index is high and particularly between the hours of 11 a.m. and 4 p.m. limiting time in the sun is recommended. Balancing this recommendation with the importance of active play and outdoor time may be difficult. Planning outdoor activities in well shaded areas can help.
There are several sources of shade that are available. Trees are a great source of natural shade. Some trees offer a natural canopy that shades a large area underneath. Other types of trees such as evergreens don’t provide a canopy of shade, but can still provide some shade. Buildings themselves can also provide shade.
If natural shade is not an option consider built or constructed sources such as canopies, tents, shade sails, umbrellas, and gazebos.
Creating your own shade is an option too. Positioning a well planned structure can give shade to any area. When developing your own shade consider the materials you will be using and the location. As the sun moves throughout the day – the shade also shifts.
Conducting a shade audit is a great way to assess the shade available or the kind needed. A shade audit tool has been developed to assist child care administration and staff to complete a shade audit of their facility or of frequently used parks and playgrounds. (
Shaded areas can be used for many different activities at a child care centre. Snack time, picnic lunch, table top activities, water play and story time all lend themselves well to shade planning.
Shade is part of a comprehensive approach and should be used in conjunction with other sun protection measures.

13. Sunscreen Protects against UVA/UVB- Broad Spectrum Approach SPF 30
Waterproof
Non irritating/ hypoallergenic
Use before ‘best before’ date
Includes zinc oxide or titanium dioxide
Canadian Dermatology Assoc.
When choosing a sunscreen check to see that it offers both UVA and UVB protection, This is sometimes referred to as “broad spectrum” protection. SPF (Sun Protection Factor) recommendations may vary a little bit from one organization to another. Use of a sunscreen with a minimum SPF 15 or 30 for those spending long periods outdoors is the most common recommendation. A SPF of 15 blocks 93% of UVB radiation and an SPF of 30 blocks 97% of UVB radiation.
A recent research review conducted by the Alberta Cancer Board (2008) on key sun safety messages notes the need for a greater focus on high SPF sunscreen (30+). This recommendation comes from research findings that increased SPF offers better protection against sunburns and has shown to be effective at protecting against both sunburn and immunosuppression.
The application of adequate amounts of sunscreen product is important to ensure that the full protection listed on the label is provided. It has been shown that most people use about half of the amount actually needed to give them the protection factor listed on the sunscreen bottle.
Ensure the sunscreen is waterproof and is non irritating.
Sunscreen products lose their effectiveness over time. Check the “best before” date when purchasing a sunscreen product or using a product that you have had for awhile.
Many sunscreen products must be applied 20 – 30 minutes before going outdoors. This is to allow the product to become fully effective. An exception to this is sunscreen that contains zinc oxide and titanium dioxide. These are physical blockers that reflect UV rays. They do not require absorption time which may be helpful in the child care setting where many children require sunscreen application.
CDA stands for the Canadian Dermatology Association - When a sunscreen has the CDA logo on it, it means it has met the CDA standards. If a sunscreen does not carry this logo it means it has not been assessed or applied to be assessed. It does not necessarily mean that the sunscreen is a poor choice. If you are going to choose a sunscreen product without a CDA logo make sure it meets the above criteria.
Reference: Key Sun Safety Messages Research Review, Alberta Cancer Board, 2008

14. Sunscreen Q & A Under 12 months of age? Over 12 months of age?
What SPF should children use?
“Child friendly” sunscreen?
Vitamin D concerns?
Sunscreen does have a place in sun protection. There are parts of the body that cannot easily be covered by clothing – like the hands or face and sunscreen can protect these areas. It is key to remember that sunscreen is not intended to be the first line of defense against UV exposure. It is intended to supplement other sun safety practices including covering up with clothing, planning activities in shaded areas, wearing wide-brimmed hats and limiting time in the sun during peak UV times. For children older than 12 months sunscreen can safely be used in this way.
Infants’ skin is extremely sensitive to the sun. As a result, children under 12 months of age should not be directly exposed to the sun. Shade, use of protective clothing and wide-brimmed hats in addition to use of sunscreen on skin not otherwise protected by clothing and hats is advised.
Again, sunscreen use should not be the first line of protection with infants, but may be safely used in small quantities in conjunction with hats, clothing and shade to protect exposed skin.
The Canadian Dermatology Association advises the use of a minimum SPF of 30 for infants and children.
Some sunscreen products are labelled “child friendly”. The primary difference with these products is that they are designed to appeal to the younger market with use of packaging, design or colour. It is not necessary to purchase products designed specifically for children to provide appropriate sunscreen protection.
The vitamin D issue has received a lot of attention over the past few years. We get vitamin D from foods including salmon, milk and eggs. Our bodies also make vitamin D when our skin is exposed to sunlight.
The amount of sunlight needed to make enough vitamin D varies from person to person. Our ability to produce vitamin D in this way is influenced by the amount of ultraviolet B (UVB) rays present in our environment, which are in turn affected by latitude, season, and time of day.
If using sunlight as a source of vitamin D, skin needs only to be exposed to the sun for a short time and should not be allowed to turn red. Vitamin D produced from sun exposure reaches a maximum after 10 to 20 minutes, depending on age, time of day, UV levels and skin tone. After that, no extra vitamin D is stored. Brief exposure in this way can raise vitamin D levels.
But, as outlined above, over-exposure to the sun carries risks. For most people, small periods of sun exposure and eating vitamin D-rich foods provides enough vitamin D throughout the year without long-term damage to the skin.
References:
Canadian Dermatology Association – website – Sun Protection for Babies – accessed on-line 4/21/09
Canadian Dermatology Association – website – Sun Protection for Children & Teenages – accessed on-line 4/21/09
Alberta Cancer Board – website – Vitamin D: Commonly Asked Questions – accessed on-line 4/21/09

15. Protective Clothing All clothing acts as a physical barrier
Design/fabrics/colour make a difference
Tight weaves and darker colours.
Specially treated clothing-UPF
Effective sun protection includes wearing clothing to protect the skin…clothing acts as a physical barrier, blocking UV rays.
Choosing clothing that covers as much skin as possible is optimal. Remember that:
Clothing with a tighter weave allows less UV rays to penetrate through the clothing.
Darker colours absorb more of the UV rays than lighter clothing- a green shirt offers a UPF (Ultraviolet Protection Factor) of 10 while a white offers a UPF of 7.
Choosing lightweight material is important in the summer. Clothing that allows ventilation and keeps you cool such as cotton or linen works well.
The condition of the clothing also matters. Stretched clothing allows more UV rays to pass through and a wet garment loses up to 50% of its protective ability.
Some clothing is marketed now as offering an ultraviolet protection factor rating - labeled as a UPF. While this can be helpful, it may be more difficult to find and can be more expensive.

16. Hats Wide brimmed hats Bucket hats Legionnaire style hats
90% of skin cancers occur on parts of the body that are chronically exposed to the sun….such as our face, necks, ears…..choosing a wide brimmed hat that covers the back of the neck, the nose and full face will offer the best protection.
While baseball hats and visors may provide some shade to the eyes and face - they do not offer complete protection…and do not cover the whole face, ears or the back of the neck…that is why a wide brimmed hat such as a bucket hat is strongly recommended. Another style of hat called the legionnaire-style hat has fabric attached to the back of the hat that covers the neck.

17. Sun Safety and the Child Care Setting.
Incorporating standards of sun safety practice into your child care centre is important.
Educate staff and parents
Educate children
Incorporate into routines
Role model sun safety
The Play it Sun Safe – Guidelines and Best Practice for Sun Safety in Nova Scotia’s Child Care Centres is a tool that has been developed by Sun Safe Nova Scotia, in collaboration with Early Childhood Development Services, N.S. Department of Community Services, to support the implementation of sun safety in child care centres across the province.
Play it Sun Safe provides direction:
for the development and adoption of guidelines
for the education of staff and parents (with tools such as this presentation and fact sheets)
for the education of children in the centre
And for Board Members who may help to develop policies or guidelines
It also provides direction on how to provide supports to developed guidelines:
Things like incorporating guidelines into routines and ensuring that staff role model sun safety.
(Refer to Play it Sun Safe – Guidelines and Best Practice for Sun Safety in Nova Scotia’s Child Care Centres).

18. More Information Canadian Cancer Society www.cancer.ca
Canadian Dermatology Association
Health Canada
For additional information on skin cancer prevention and sun safety check out these websites.

19. Thank You www.cancercare.ns.ca/childcare
For electronic copies of the fact sheets, shade audit or this powerpoint presentation go to Cancer Care Nova Scotia’s website at