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Should no hat no play still be the rule in winter?

A new position statement about the ideal amount of sun exposure has just been released. What has changed and how does it impact on students?

The dangers of sun-exposure are drilled into Australian children as soon as they’re old enough to walk. Slip Slop Slap. No Hat, No Play. It’s a well-known refrain that school children from across the country take for granted. Sunburn is bad. The sun can cause skin cancer.

Less well-known are the benefits of sun exposure.

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“Vitamin D production is not the only benefit of sun exposure. If it was, we would potentially recommend that everybody avoid the sun and take a vitamin D supplement,” says Professor Rachel Neale. “Vitamin D is very important for maintaining healthy bones. It also appears to play a role in other health outcomes, such as infection and autoimmune disease.”

Professor Neale is an epidemiologist and principal research fellow at the QIMR Berghofer Medical Research Institute with a long-standing interest in skin cancer prevention. More recently, she has developed an interest in the role of vitamin D and in how to balance the harms and benefits of sun exposure, leading the Health Working Group of a United Nations Environment Program panel that focuses on the impacts of ultraviolet radiation on humans and ecosystems.

“My current research focuses on the effect of sunscreen on vitamin D production, and what happens in the skin when we expose it to low doses of UV radiation delivered at a low intensity. The results of this research could lead to change in recommendations in the future,” explains Professor Neale.

A new position statement about sun exposure advice

A new position statement has just been released, providing sun exposure advice that explicitly recognises the differing needs of Australia’s diverse population, taking account of differences in location, skin colour, and other risk factors.

“Our recommendations are based on the principle that the sun has benefits in addition to vitamin D production so, for some people, a small amount of sun exposure is likely to be beneficial.”

However, the recommendations focus only on adults, with no specific mention of children. How should schools use the new information about sun exposure? Do children require more or less time in the direct sun for the same benefits?

“It is very difficult to comment on this,” admits Professor Neale “because there has been virtually no research in children to know whether their skin produces vitamin D at the same rate, or whether they experience the same benefits. In light of children’s susceptibility to sunburn and the risks of skin cancer associated with childhood sun exposure, the focus on children should be on sun protection. We would not advise any children deliberately expose their skin to the sun to make vitamin D.”

Advice for children

Professor Neale explains that while there has been no research focussing specifically on the effects of sun exposure in children, there are very clear recommendations.

“We do advise that sunscreen should be applied as part of the usual daily routine on all days when the UV index is forecast to reach 3 or more (even if only during a small part of the day). This type of routine application may not be needed for children with very deeply pigmented skin (i.e., dark brown or black) although if they are outdoors for more than a couple of hours (e.g., at a sports carnival) they should still protect their skin.”

It’s imperative that despite the relaxing of rules around hat-wearing in secondary schools, high school students are still encouraged to take precautions.

“I strongly believe that hats should be enforced in secondary schools. But we need to go further than that. We need to also have long-sleeved swim shirts required if swimming outdoors, and long-sleeved tops or sun sleeves should be enforced when children are playing sport outdoors when the UV index is 3 or more. And sunscreen should be freely available in schools.” Professor Neale

No Hat No Play All Year Round?

Professor Neale says the ‘no hat no play policy’ should apply on all days when the UV index is forecast to reach 3 or more.

In the northern parts of Australia such as Queensland and the Northern Territory, that is all year. However, in southern states such as Tasmania and Victoria, there can be a few months of the year where the UVI does not get to 3, so the No Hat No Play policy would not need to be enforced in winter. “Having said that,” admits Professor Neale “it may be easier if it is just routine throughout the year.”

Professor Neale reminds us that being physically active outdoors has benefits. “There is good evidence that time outdoors reduces the risk of becoming short-sighted,” she adds. “However, we need to ensure that children are protected when they are outdoors. Sunscreen is great but is not sufficient protection, so we need to focus more on protective clothing in school environments.”

Shannon Meyerkort

Shannon Meyerkort is a freelance writer and the author of "Brilliant Minds: 30 Dyslexic Heroes Who Changed our World", now available in all good bookstores.

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