Shedding Light on the Shade: How Nurseries Protect Their Children from Ultraviolet Radiation

Abstract

Minimizing exposure to ultraviolet radiation (UVR) is strongly recommended as the most important primary prevention measure regarding skin cancer. The responsibility for adequate sun protection of young children lies with their parents and external caregivers. Since a high proportion of 3- to 6-year-old children in Germany attend nurseries, the practice of sun protection in this setting was assessed. A survey was conducted in 246 nurseries in southern Germany during spring and summer of 2014 and 2015. Shade coverage in the outdoor area of the nursery was assessed by study team members and UVR protective behavior of staff was assessed by an interview with the directors. On average, 52% of the entire outdoor area and 65% of the children’s outdoor play area were covered by shade, with a significant difference between nurseries of different sizes, pointing to a better shade coverage in larger nurseries. The daily outdoor stay was not regularly scheduled before or after peak sun intensity hours around noon to avoid intense UVR exposure. General sun protection rules were present in the majority of the nurseries and addressed predominantly wearing sunhats and applying sunscreen. Our findings show that current sun protection recommendations for children are only partially met in nurseries and indicate a lower level of sun protection in small institutions. Especially, avoidance of excessive exposure to UVR around noon and the importance of shade provision over play structures needs to be emphasized in future information campaigns.

Cluster Randomized Trial: Sun Protection Intervention ‘Clever in Sun and Shade for Preschools’—Effectiveness and Dissemination

“…Furthermore, the external validity may be limited by the drop-out. Childcare institutions often undergo a high staff turnover [20,87]. The impact of CLEVER may be restricted to staff members being present at the implementation of the intervention.…”

“…The dependence of preschool staff on parents to provide hats and clothes to protect children as well as the need for more parental contribution and sponsors to supply and finance sunscreen has been highlighted earlier [20,33]. In a German study, a majority of preschools (86%) had sun protection rules, while only a minority (18%) provided a written policy [87]. Guidelines concerning seeking shade and avoiding peak sun intensity hours were stated less often than wearing hats and applying sunscreen, while long-sleeved clothing and sunglasses were rarely or never mentioned [87].…”

“…In a German study, a majority of preschools (86%) had sun protection rules, while only a minority (18%) provided a written policy [87]. Guidelines concerning seeking shade and avoiding peak sun intensity hours were stated less often than wearing hats and applying sunscreen, while long-sleeved clothing and sunglasses were rarely or never mentioned [87]. However, recent studies in preschool and primary school settings in Australia show the potential impact of sun protection strategies on sun protection practices [85,88,89].…”

“…Constant change in staffing and leadership, but also in children and parents, has been described as a barrier to implementation [90]. Staff turnover in childcare centers is commonly high and therefore the long-term impact of skin cancer prevention programs is still unclear [87]. To enhance successful implementation, strategies that reinforce key behavioral messages and that are accessible for new staff are required [90].…”

“…To enhance successful implementation, strategies that reinforce key behavioral messages and that are accessible for new staff are required [90]. Besides repeated interventions, the development of a written sun protection policy is recommended, since it may secure the implementation with a high standard [87]. Further research on CLEVER may benefit from the adaption of the questionnaire according to these investigations, i.e., the comprehensive measurement of child-related sun protection practice criteria (hat-wearing practices, sunscreen practices, and protective clothing practices) as well as organizational-level sun protection practices (enforcement of policy, role modelling, education, shade provision, policy review and update, information for caregivers) [88].…”