Sunday, July 10, 2016

Motion Sickness

Summer travels bring a lot of questions about motion sickness, also known as car sickness, sea sickness, and air sickness.

Whether it's the threat of a long car trip, concern about flying, or anticipated problems on a cruise, there are many kids who suffer from motion sickness. Kids 2 - 12 years are the most likely to suffer from motion sickness. It's less common in teens and adults and very rare in infants and toddlers. It is more common in women and people with migraines.

Photo by Greg L via Wikimedia


Motion sickness is thought to be triggered when the inner ear senses motion but the eyes don't. These mixed signals coming into the brain can cause nausea, dizziness, vomiting, paleness and cold sweats. Motion sickness often happens on ships and boats, but it also can affect kids when they travel in planes, buses and cars. Motion sickness is often worst if there is a bumpy or curvy ride. It can also be triggered by strong smells, which is why avoiding gas stations (if possible) can help prevent it. Sometimes trying to read a book or watching a movie during travel can trigger motion sickness. In both children and adults, playing computer games can sometimes lead to motion sickness.

Some general tips to avoid motion sickness:

  • Look out the window during travel. Don't watch other moving objects (such as cars) -- watch the horizon. Teens and adults can benefit from sitting in the front seat. Younger children (12 and under) are safer in the back seat. 
  • Avoid strong smells, such as those at the gas station, if possible. 
  • Eat small amounts of high protein, non-greasy foods during travel. Spicy and fatty foods can exacerbate symptoms. Crackers can help.
  • Sleep. Or at least close eyes. 
  • Take deep, controlled breaths.
  • Use a headrest to prevent head movement.
  • In a plane: sit over the wing and recline when possible.
  • On a ship: stay on deck where you can see the horizon as much as possible. Avoid the bow and stern.
  • Take breaks for fresh air and a short walk if possible.
  • Some people believe that opening the car window for fresh air helps, but close windows if the air quality is poor or irritates the rider.
  • No smoking or e-cigarette use in the car. Ever. Even when no one is in the car with the driver. The compounds left behind can be dangerous to children.
  • Avoid reading books or playing video games when traveling. Movies are tolerated more often than reading, but if they are not tolerated, stop them.
  • Be aware that some medicines increase the risk of motion sickness. Avoid these if possible. A full list is included in the link, but those more commonly used in children and teens are ibuprofen, some antibiotics, some antidepressants, and hormones (birth control pills). 


Medicines for motion sickness:


All medicines have side effects, but many of the ones that seem to help motion sickness can have significant side effects, so risks and benefits must be considered. Note that none of these medicines is approved under 2 years of age, but motion sickness is uncommon in infants and toddlers.

If you decide upon a medicine, be sure to keep it out of reach of children to avoid overdose. Remember that during travel childproofing is more difficult!

In case of suspected overdose, call your local poison control center at 1-800-222-1222. Put this number in all of your phones for easy access in times of emergency. 

If a person is not breathing or unconscious, first call 911 and initiate CPR.
  • Benadryl (diphenhydramine) is an over the counter antihistamine that can help some kids over 2 years of age with motion sickness. Follow the over the counter package directions for weight - based dose and give it 30 minutes before travel and before meals and at bedtime if needed. It can lead to excessive sleepiness - or hyperactivity in some kids, so be careful! If your child has never had benadryl, I recommend doing a test dose at home before travel to be sure they don't get wired or irritable on it. 
  • Dramamine (dimenhydrinate) can also help kids over age 2 and is available over the counter. It also should be started 30-60 minutes before traveling and every 4-6 hours (for 12 years and up) and every 6-8 hours (for children under 12 years) as needed. Side effects include drowsiness, dry mouth, blurry vision, thickened mucus in their airways, feeling excited or restless, and increased heart rate.
  • Dramamine Less Drowsy (meclizine) is also available over the counter and can help prevent motion sickness in children over 2 years of age. Meclizine comes as a regular and chewable tablet and a capsule. It should be taken 1 hour before you travel. Doses may be taken every 24 hours if needed. Side effects include drowsiness, dry mouth, and blurred vision.
  • Phenergan (promethazine) is sometimes prescribed for motion sickness. Some significant warnings exist for children, so see the attached link and talk to your doctor about the risks and benefits of this medication. The drug comes in suppository and tablet form. When promethazine is used to treat motion sickness, it is taken 30 to 60 minutes before travel and again after 8 to 12 hours if needed. On longer trips, promethazine is usually taken in the morning and before the evening meal on each day of travel. Side effects include dizziness, anxiety and drowsiness. It can slow or stop breathing in children.
  • Zofran (ondansetron) is a prescription medicine that is used to treat nausea and vomiting. See your doctor to discuss if this prescription is appropriate for your child for motion sickness.
  • Prochlorperazine is an antipsychotic that helps treat severe nausea and vomiting. It comes as tablets and suppositories. Prochlorperazine should not be used in children under 2 years old or who weigh less than 20 pounds. Prochlorperazine requires a prescription, and a full discussion of risks and benefits should be done with your doctor before taking this medicine. See the attached link for full list of potential side effects as well as other drug interactions. 
  • Metoclopramide has been used for treatment of motion sickness, but carries significant risks. Please see the attached link for details. 
  • A scopolamine patch can be considered for teens and adults but should not be used in kids under 12 years. Some experts discourage any use in all children due to significant side effects, which include sedation, blurred vision, disorientation and mouth dryness. See attached link for complete list of side effects. If it is used, the patch is placed behind the ear 4 hours before travel and left in place for up to 72 hours.

Alternative treatments:

  • Ginger has been shown to help prevent motion sickness, but the specific dose is not clear. Kids can drink ginger tea or ginger ale or suck on a ginger lollipop or lozenge - only if old enough to not choke. To make ginger tea: dissolve 1/8 - 1/4 teaspoon of powdered ginger in a cup of hot water or boil two slices of fresh ginger root (each about 1/8 of an inch thick) in one cup of water for about 10 minutes. Sweeten to taste, and offer small sips throughout the day.
  • Accupressure wristbands are sold in pharmacies and online, and though research is not conclusive, I have seen decent benefit from these. They fall into the "it won't hurt to try" category in my opinion. I don't know if it is the power of suggestion (placebo effect) or a real benefit, but I have seen several families rely upon these successfully.
  • If your child suffers from motion sickness often, there are some studies that support vestibular training. It will not work for your vacation next week, but can be considered for children who suffer to help long term. Have your child work with a physical therapist trained in vestibular training. 

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