A Spoonful of Sugar

A recent report in the March/April 2010 edition of the journal Pediatric Dermatology reported the use of an oral sucrose solution for pain relief in infants who were undergoing steroid injections into vascular birthmarks called hemangiomas.


As a pediatric dermatologist, minimizing pain is extremely important to me. I choose painless treatment modalities whenever possible, and when a painful procedure is necessary I take whatever measures I can to make it as pleasant as possible for the patient. It has been suggested that this is especially important for infants, because pain control for early procedures affects how kids respond to pain when they are older. Oral sucrose solution is currently commonly used in neonatal intensive care units and for circumcisions, and is used by some pediatricians for immunizations.


This 24% solution of sucrose is administered 2 minutes prior to the procedure, either by placing it on the anterior tip of the tongue or by dipping a pacifier into the solution. How does sugar numb pain? Well, we aren’t exactly sure, but it may activate sites in the brain that decrease pain perception, or it may cause the release of chemicals which cause babies to have less feeling of pain.


In addition to hemangioma steroid injections, oral sucrose solution could be used by pediatric dermatologists for biopsies and laser treatments. One caveat: it is only useful for infants less than one year of age. For older children, I use topical anesthetics and distraction techniques such as a portable DVD player. For infants less than a year of age, however, oral sucrose solution may help an infant tolerate many dermatologic procedures… in a most delightful way!

Be a Savvy Sunscreen Shopper

Parents ask me every day, “Which sunscreen should I use for my child?” The short answer is, “Whichever one they will actually use!” Most sunscreens, as long as they provide UVA/UVB coverage and are applied appropriately, will provide reasonable protection from the sun. The five following scenarios can help you choose which sunscreen might be best for your kiddos.

1) For daily use:

It is never too early to start applying a facial moisturizer with sunscreen on a daily basis. Kids don’t tend to mind them either, because they are non-greasy and don’t have the smell of traditional sunscreens.

My picks: Eucerin Everyday Protection Face Lotion, Oil of Olay Complete Defense, Neutrogena Healthy Defense

2) For infants:

Until 1996, the American Academy of Pediatrics didn’t recommend that any sunscreens be applied to infants under 6 months of age. Physicians agree that the best strategy for infants is sun avoidance and sun-protective clothing, but it is now recommended that sunscreen be applied where an infant’s skin is not protected adequately by clothing. For infants I recommend choosing one without chemical sunscreen ingredients. Look for a sunscreen with ONLY zinc oxide and titanium dioxide. This used to be really hard to find until Neutrogena introduced a new one last year.

My pick: Neutrogena Pure & Free Baby SPF 65+

3) For kids with sensitive skin:

Chemical sunscreens can cause irritation in children with sensitive skin or skin conditions such as atopic dermatitis.  Look for a sunscreen with ONLY zinc oxide and titanium dioxide.

My picks: Neutrogena Pure & Free Baby, Blue Lizard

4) For kids with REALLY sensitive skin or “allergy” to a previously used sunscreen

Not only can the chemical sunscreens be irritating, but some people can be allergic to fragrance or preservatives in the cream itself. Choose a brand with ONLY zinc oxide and titanium dioxide PLUS no added dyes, fragrance, lanolin, parabens, and other preservatives.

My pick: Vanicream Sensitive Skin Sunscreen

5) None of the above apply to you or your kids? Have fun with it!

Sunscreen comes in all kinds of formulations, including sprays (good for wiggly kids), sticks (great to carry in a pocket, purse, or diaper bag), and wipes.  Coppertone even makes a spray which goes on purple then disappears. (Coppertone Kids Colorblock SPF 40)

Disclaimer: I have absolutely no financial interest in any of these companies, by the way (just a sincere interest in getting kids to use sunscreen early & always).  Happy summer!