Is Your Child Sick?

Advanced Pediatric Associates provides on-line health care advice to our patients via nationally recognized pediatric protocols provided by Pediatric Web and written by Barton Schmitt, M.D. ( Medical Director of the After-Hours Call Center at The Children's Hospital of Denver). If you are not a patient of Advanced Pediatric Associates, we recommend that you consult with your own physician regarding health concerns. This information is provided as a guide to our patients, but in no way replaces the advice given by our staff.

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Is this your child's symptom?

  • Red or blistered skin from too much sun
  • The redness, pain and swelling starts at 4 hours after being in the sun
  • It peaks at 24 hours, and starts to get better after 48 hours

If NOT, try one of these:

Severity of Sunburn

  • Most sunburn is a first-degree burn that turns the skin pink or red.
  • Prolonged sun exposure can cause blistering and a second-degree burn.
  • Sunburn never causes a third-degree burn or scarring.

Causes of Sunburn

  • Direct sun exposure. Warnings: Clouds don't help. 70% of UV light still gets through on cloudy days.
  • Reflected sun rays. From snow 80% is reflected, from sand 20%, from water only 5%.
  • Tanning lamp or sun lamp.
  • Tanning bed. A common cause in teens.

Ibuprofen to Reduce Pain and Other Symptoms

  • Sunburn is an inflammatory reaction of the skin.
  • Ibuprofen is a drug that can block this reaction. It can reduce the redness and swelling. But, it needs to be started early.
  • Sunburns are sneaky. Many parents are surprised when their child gets a sunburn. Reason: There are no warning signs while the burn is occurring.
  • Redness (sunburn) often is not seen until 4 hours after being in the sun. The pain and redness keep getting worse. They don't peak for 24 to 36 hours.
  • Lesson: If you think your child got too much sun, start ibuprofen then. Give it 3 times per day for 2 days. Don't wait for redness.

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When to Call for Sunburn

Call 911 Now

  • Passed out or too weak to stand
  • You think your child has a life-threatening emergency

Call Doctor Now or Go to ER

  • Fever over 104° F (40° C)
  • Can't look at lights because of eye pain
  • Fever and looks infected (spreading redness more than 48 hours after the sunburn)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Sunburn pain is severe and not better after using care advice
  • Large blisters (more than ½ inch or 12 mm)
  • Many small blisters
  • Blisters on the face
  • Swollen feet make it hard to walk
  • Looks infected (draining pus, red streaks, worse pain after day 2) and no fever
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Itchy rashes in sun-exposed skin occur many times
  • You have other questions or concerns

Self Care at Home

  • Mild sunburn

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Care Advice

Treating Mild Sunburn

  1. What You Should Know About Sunburns:
    • Most sunburns do not blister.
    • Most blisters can be treated without needing to see a doctor.
    • Here is some care advice that should help.
  2. Ibuprofen for Pain:
    • For pain relief, give an ibuprofen product (such as Advil). Start this as soon as you can.
    • Give every 6-8 hours.
    • Reason: If started within 6 hours, it can greatly limit the pain and swelling. Must give for 2 days.
    • Caution: Not approved for age under 6 months.
  3. Steroid Cream for Pain:
    • Use 1% hydrocortisone cream (such as Cortaid) as soon as possible. No prescription is needed.
    • Put it on 3 times per day.
    • If used early and continued for 2 days, it may reduce swelling and pain.
    • Use a moisturizing cream or aloe vera cream until you can get some.
    • Use creams only. Avoid putting ointments on red skin. Reason: They can block the sweat glands.
    • Burned skin can be very painful. Covering it with a cream can give great relief.
  4. Cool Baths for Pain:
    • Use cool wet washcloths to the burned area. Do this several times a day to reduce pain and burning.
    • For larger sunburns, give cool baths for 10 minutes. Caution: Avoid any chill. Can add 2 ounces (60 ml) baking soda per tub.
    • Do not use soap on the sunburn.
  5. Fluids - Offer More:
    • Offer extra water on the first day.
    • This helps to replace the fluids lost into the sunburn.
    • This will also help to prevent dehydration and dizziness.
  6. Blisters - Don't Open:
    • Caution: Leave closed blisters alone. Reason: To prevent infection.
    • For broken blisters, trim off the dead skin. Use a fine scissors cleaned with rubbing alcohol.
  7. Antibiotic Ointment for Open Blisters:
    • For any large open blisters, use an antibiotic ointment (such as Polysporin). No prescription is needed.
    • Remove it with warm water. Then, reapply it 2 times a day for 3 days.
  8. What to Expect:
    • Pain stops after 2 or 3 days.
    • Peeling occurs day 5-7.
  9. Call Your Doctor If:
    • Pain becomes severe
    • Sunburn looks infected
    • You think your child needs to be seen
    • Your child becomes worse

Preventing Sunburn

  1. Sunscreens:
    • Use a sunscreen with an SPF of 15 or higher. Fair-skinned children need a sunscreen with an SPF of 30. This is especially true if your child has red or blond hair.
    • Put sunscreen on 30 minutes before exposure to the sun. This gives it time to get down into the skin. Give special attention to the areas most likely to become sunburned. Examples are the nose, ears, cheeks, and shoulders.
    • Put sunscreen back on every 3 to 4 hours. Apply often while swimming or if sweating a lot. A "waterproof" sunscreen stays on for about 30 minutes in water.
    • Most people use too little sunscreen. The average adult requires 1 ounce (30 ml) of sunscreen at a time.
    • The best way to prevent skin cancer is to prevent sunburns.
  2. Infants and Sunscreens:
    • The skin of infants is thinner than the skin of older children. It is more sensitive to the sun.
    • Sun avoidance is best for children under 6 months. Stay in the shade.
    • Sun avoidance or sun proof clothing are best for children 6 months to 3 years. That means clothes that fully cover the arms and legs. Also, have your child wear a hat with a brim.
    • When a sunscreen is needed, infants can use adult sunscreens. The FDA hasn't approved their use under 6 months old. However, the AAP supports their use at this age. There are no reported harmful side effects from today's sunscreens.
  3. Protect Lips, Nose and Eyes:
    • To prevent sunburned lips, apply a lip coating that contains sunscreen.
    • If the nose or some other area has been burned often, protect it completely. Use zinc oxide or titanium oxide ointment.
    • Protect your child's eyes from the sun's rays and cataracts with good sunglasses.
  4. High-Risk Children:
    • Some children are at higher risk for sunburn. If your child has red or blond hair, he is at higher risk. Fair-skinned children and children who never tan are also at higher risk.
    • These children need to use a sunscreen even for brief exposures.
    • They should avoid sun exposure whenever possible.
  5. High-Risk Time of Day:
    • Avoid exposure to the sun during the hours of 11:00 AM to 3:00 PM. This is when the sun's rays are most intense.
    • Caution: When overcast, over 70% of the sun's rays still get through the clouds.

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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Copyright 1994-2017 Schmitt Pediatric Guidelines LLC. All rights reserved.

Sunburn - Face

This individual has a first degree sunburn on the face. The skin is red and painful. There is no blistering.

Sunburn can be prevented by wearing a hat (best) or by applying a sunscreen lotion with a SPF of 15 or higher.

First Aid - Heat Exhaustion
  • Move the victim to a cool shady area. If possible, move into an air-conditioned place.
  • The victim should lie down. Elevate the feet.
  • Undress victim (except for underwear) so the body surface can give off heat.
  • Sponge the entire body surface continuously with cool water. Fan the victim to increase evaporation.
  • Give as much cold water or sports drink (e.g., Gatorade, Powerade) as the victim can tolerate. An adult or teen with heat exhaustion should drink 2-3 cups (480-720 ml) of liquids right away to replace what was lost. Then the adult or teen should drink approximately 1 cup (240 ml) every 15 minutes for the next 1-2 hours.

Disclaimer:  If you are not a patient of Advanced Pediatric Associates, we recommend that you consult with your own physician regarding health concerns. This information is provided as a guide to our patients, but in no way replaces the advice given by our staff. Occasionally, advice given by our providers or nurse line may vary slightly from that offered by Pediatric Web and its contributors. If you are unsure of any issue regarding your child's health, please call our Patient Care Line at (303) 699-6200. 

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