80% of respondents' children exposed to skin bleaching products were under 2 years old
Aesthetic preferences trumped knowledge of health risks, responses indicated
A significant proportion of under 5s in Nigeria may be being exposed to skin lightning products, if the results of a semi-urban community survey are indicative, suggests research published in the open access journal BMJ Open.
Most (80%) of the respondents' children exposed to skin bleaching products were under 2 years old, and despite good knowledge of the health risks of the practice, these were trumped by aesthetic preferences for lighter skin tones, the survey responses show.
The cosmetic use of skin lightening products has become increasingly common globally, with very high rates among women of reproductive age in Africa, note the researchers. And while the practice used to be associated only with poverty, youth, and female sex, this is now no longer the case, they add.
Of particular concern is the increasing trend of mothers using skin lightening creams on their young children who are especially vulnerable to the side effects of these products, explain the researchers.
This is because of their higher ratio of body surface area to weight, which increases systemic exposure, and their thinner and more permeable skin, which heightens the risk of absorption, they add.
And skin lightening products often contain endocrine system disruptors, such as liquorice, resveratrol, steroids, as well as heavy metals, such as mercury, they point out.
To better understand the prevalence and motives for the practice and inform policy to safeguard children's health, the researchers surveyed 369 mothers with at least one child under 5 in Ile-Ife, Osun State, Southwestern Nigeria.
The mothers were all attending community immunisation and infant welfare clinics in three government-owned primary healthcare centres.
The questions aimed to find out how many of them used skin lightening creams, soaps, or lotions on their young children and to explore their knowledge, attitudes, and perceptions of the pros and cons of these products.
Potentially influential factors, such as age, marital status, religion, income, occupation, cultural beliefs, educational attainment, personal skin colour and use of skin lightening creams, perceived social factors, and access to media were all taken into account.
The average age of the mothers was 30, and nearly all had attained at least secondary level education. Most (87%; 320) reported low household income. Between them, they had 792 children, ranging in age from 1 to 59 months.
Around 1 in 5 (19.5%;72) of the mothers said they used skin lightening creams on their children. Of these, 90% (65) applied the products routinely; the rest used them intermittently.
Infants and young children were the primary recipients. Over three quarters (81%; 58) of those exposed to these products were under 2 years old, with just over half (51.5%; 37) 6 months or younger.
Children under 2 were twice as likely to be the recipients of skin lightening attempts as older children.
The most frequently used agents were hydroquinone-based creams (60%; 43), followed by powerful topical steroid creams (29%; 21).
Three quarters (76.5%; 55) of the mothers who used skin lightening products on their children self-identified as light skinned, and a similar proportion (75%; 54) expressed a preference for lighter complexions.
Most of these mothers (89%; 64) said they had used skin lightening creams on their own skin. But only just over half of them (56%; 40) perceived lighter skin as conferring social or economic advantages over darker skin tones.
The most frequently cited reasons for the use of skin lightening products were to improve the child's complexion (61%; 50) and to preserve or maintain what was described as the child's natural skin colour (79%; 65).
Less than half (43%; 31) of the mothers cited specific perceived benefits of skin lightening, including the treatment of blemishes (8%; 6), enhancement of beauty (19.5%;14), or prevention of darkening from sun exposure (6%; 4).
Almost all the respondents (97%) were aware of the health risks associated with these products, and most (81%;58) of those using them on their children were aware of at least one serious systemic side effect associated with use.
One in three, (34%; 24) acknowledged the potential presence of toxic substances in some of these formulations. But they were around 4 times less likely to acknowledge specific dangers or identify complications than those who didn't use these products.
"The observed disconnect between awareness of risks, recognition of specific danger and skin lightening practices indicates that social expectations and perceived advantages can outweigh safety concerns," note the researchers.
Mothers who had used skin lightening creams on themselves were 15 times more likely to use them on their own children than those who didn't report personal use, while perceiving light skin as more attractive or socially advantageous nearly doubled the odds of early childhood exposure.
And having a family member who practised skin lightening was also associated with a doubling in the likelihood of using one of these products on a child.
This is an observational study and, as such, can't establish cause. And the researchers acknowledge that relying on survey data risks recall bias and possible under reporting through fear of judgment. And they only included mothers' perspectives, precluding the potentially influential views of other caregivers or household members.
But they point out: "Beyond physical health implications, these practices also transmit colourist ideals, positioning lighter skin as a marker of beauty, self-worth, and social acceptance."
They add: "Such early internalisation may adversely affect self-concept and identity, reinforcing intergenerational cycles of dissatisfaction with natural skin tone, stigma, and harmful cosmetic norms that persist across the life course."
And they conclude: "The dual risk of toxic exposure and early internalisation of colourist ideals from childhood skin-lightening carry profound public health implications. While risk awareness may contribute to reducing the practice, cognitive dissonance may undermine its impact.
"Addressing this requires policy measures that go beyond individual risk education to challenge cultural narratives and normative pressures, alongside stronger regulatory oversight to ensure accurate labelling and restrict hazardous formulations.
"Culturally sensitive strategies, such as integrating skin health education into maternal child health services, leveraging immunisation visits, and engaging trusted community leaders, may offer effective avenues for change."
