Montgomery County schools require a doctor's note for children to use sunscreen. Howard County requires a note from parents, and the lotion must be stored in the nurse's office. Anne Arundel students, by contrast, may carry and apply sunscreen with impunity.
A bill pending in the Maryland legislature, however, would require school health officers to make sure students are allowed to wear sunscreen when they go outdoors on sunny days, a right that is not universally recognized in schools, according to cancer prevention advocates.
The American Cancer Society asked Del. Anne Healey (D-Prince George's) to draft the legislation after a survey of the 24 Maryland school systems in fall 2003. The survey, conducted by the Coalition for Skin Cancer Prevention in Maryland, found a jumble of inconsistent policies toward sunscreen, a product that many school systems treat as if it were an over-the-counter medicine.
Four school systems require a doctor's order for students to apply sunscreen. Eleven require at least a parent's note. Eight systems require students to leave the product with the school health officer. Rules can vary from school to school within each system.
"Children should be able to bring sunscreen with them like they bring ChapStick," said Roberta Herbst, project coordinator of the statewide coalition.
The quest to enshrine sunscreen in state law began when a PTA president from Harford County reported to the statewide group that students at some schools were being told they could not wear sunscreen, according to Herbst. The parent's account and others prompted a bill in the Maryland House of Delegates.
The legislation has since been folded into a broader bill that defines the responsibilities of school health officers. House Bill 549 won approval Wednesday and awaits consideration in the Senate.
Nursing directors in Maryland's larger school systems say they hear few complaints from parents about sunscreen restrictions. Most systems place sunscreen in a category with lotions, food supplements and cough drops: Neither medicine nor food, they are deemed items that could make a child sick or cause an allergic reaction if used the wrong way.
"We wouldn't want them to be sharing them with other kids who might have a hypersensitivity," said Donna Heller, health services manager for Howard County schools. "Even with hand and body lotions, we require a note from the parents."
Montgomery County schools treat sunscreen as an over-the-counter medicine. A student must bring in a doctor's note to apply it, and only older students are allowed to carry it with them at school.
"If you had a very young kid, and they put it in their eyes, it could hurt them," said Judith Covich, Montgomery's director of health and student services.
Interest in sun protection at school has risen alongside the growing consensus that sun exposure in childhood increases risk of skin cancer in later life. In California, for example, laws that went into effect in 2002 and 2003 gave students the right to wear sunscreen, hats and sun-protective clothing at school.
Maryland's skin cancer coalition lobbied for the publication of sun-protection guidelines, issued in 2001 by several state agencies, that recommend schools develop a policy for students to use the sunscreen they bring to school. But when the cancer society surveyed the school systems two years later, several said they were not aware of the guidelines.
"All I'm asking is for schools to follow the guidelines that are established by professionals," said Healey, who sponsored the bill.
The sunscreen bill became a part of House Bill 549, which requires school systems to designate a health services coordinator to ensure consistent health care in the schools. Healey, sponsor of both bills, said schools in Maryland have inconsistent rules that sometimes thwart students in need of prescription medications. A third bill, approved by the House, would require schools to give students access to their asthma medication.
The problem, Healey said, is that not all schools and school systems have properly trained health officers, and whatever the system rules, individual schools often vary in their approach to medicine and skin products.
"Their focus and their background and all their training is in pedagogy," Healey said. "They don't have an expertise in health care."