Should You Pull Over? Kids and Motion Sickness

For some people, just hearing about this scenario is enough: you are in the back seat of a car on a windy mountain road. You are reading a dull novel as the temperature of the car becomes oppressively hot. Soon, the weaving of the curves starts to get to you and…WHAM-O! Motion sickness. It ain’t much fun. While not lethal, it presents a management and expeditionary challenge to parents, child passengers, and cleaners of upholstery. So, what is motion sickness exactly? How to prevent the little ones ralphing on your Big Summer Trip? Do let us delve.

Truth is, scientists and physicians aren’t exactly sure what happens neurologically when we become motion sick. We do know that motion sickness-whether due to travel on air, land, or sea-arises from complex interplay between specific areas of the brain and information we receive visually and proprioceptively* (Word Wealth moment: *this is where we perceive our body parts in space). Motion sickness doesn’t happen when you walk down the street; people cannot make themselves motion sick, even by jumping around. (I am sure parents of toddlers are grateful for this much).We also know that some individuals are far more vulnerable to the perils of motion sickness than others, with some being rendered nauseous just by thinking about it.

Normally, adults and children will unconsciously integrate visual information with feedback from their balance center, the vestibular system, located just behind the inner ear. The higher centers of the brain and the cerebellum then process this information to keep folks feeling well and walking upright. Interestingly, children and adults with severe visual impairments compensate for their lack of ocular input, and rely on their other senses…but they are no more or less apt to fall ill to motion sickness than other people when subject to the right stimuli.

Problems develop when these neurologic systems get conflicting information such as by gentle, low frequency movements or gyrations. (think back to that car on a winding road, or the rocking of a boat on sea swells). If the eyes tell a child that they are still (sitting in a carseat), but their vestibular systemis perceiving movement, the body’s balancing mechanisms tend to disorganize, and tickle the emetic centers of the brain (that’s the zip code for vomit control). If unhappy stimulation persists, a cascade of symptoms begins: nausea, pallor, increased salivation and burping may culminate in the proverbial tossing of the cookies. If you see this, it might be time to pick another row on the airplane.

Pushed hard enough, everyone can be made motion sick. Heck, experiments have shown even fish can become seasick. Interestingly, kids under two are resistant to motion sickness, a fact I celebrate as I cart my toddler to and from her sibs’ baseball and soccer games.

Motion sickness does become common after the age of two, and appears to peak in frequency around the age of 12. Gender studies of adults show women develop motion sickness more often than men. But both genders overcome the symptoms equally well if subject to sickening motion for a few days, per research on sea travelers, fighter pilots, and astronauts. However, that may provide little solace to the family whose kiddo yurks during every jaunt to the mall.

There are many ways for parents and drivers and sea captains work to dampen kids’ tendencies to become motion sick. Some really seem to work. Other times, it isn’t so clear.

Avoiding triggers. Some easy environmental controls can go a long way for keeping motion sickness at bay in older children. Potentially car- or seasick kids should avoid activities that involve looking at a fixed point inside the cabin of the car or boat. Reading, watching movies or playing cards or video games may generate that unhappy cross chatter between their visual centers and motion sensors. Best if illin’ kids sit by a window (and if old enough, up front) looking out and ahead. Cool air helps, so an open window or AC vents aimed at the face provide relief. For kids on boats, lying down may also lessen the feeling of malaise as well.

Diet and expectations. When anticipating a potentially difficult trip, simple food and good marketing help. In the former case, kids should avoid large meals, or rich, spicy, or greasy snacks that are harder to digest–or they may end up seeing them twice. Bland foods (bread or crackers) and small amounts of them are the smarter choice, as they are easier on the stomach.

In the latter instance, creating expectations that kids will do well on a trip becomes a self-fulfilling prophecy. In one study, cadets who were told that they would feel seasick were much more likely to be symptomatic on their voyage. Keep it positive!

Meds. Many medications are discussed for their use in children, but only a few are appropriate for younger ages, and/or seem to have any positive effect. Antihistamine medications, including Dramamine or Benadryl are used with some good results in children down to the age of two. These meds are over the counter, inexpensive, and taken easily by these age groups. The downside? They can be quite sedating.

I recall one childhood deepsea fishing trip where I caught my fish, took my Dramamine and woke up 2 hours later on the front deck fried to a crisp. Plan accordingly! Newer generation, ‘non-sedating’ antihistamines, such as Claritin or Zyrtec do not appear to be effective against motion sickness. Pity.

Scopolamine, an anti-nausea drug, can be used in children over 12 and up. Given as pills or in patches placed behind the ear, this prescription medication does work well for some people, for up to 72 hours. Some adults and children find scopolamine’s side effects, including dry mouth and some mild fatigue, to be annoying and less of a help.

There are a host of other medications for motion sickness that are used in the adult population, few of which might used in children. All of these medications, including promethazine, metaclopramide, benzodiazepines, and others are available only as a prescription. As in so many things, there is less pediatric data available as to their safety and effectiveness. I urge families that have exhausted the first lines of treatment (as above) to consult with their primary care doctor as to what may be most suitable for them.

Complementary and alternative therapies. Herbal remedies include benign, and potentially helpful options. Though studies offer some contradictory results, ginger may be effective, and can be given in a variety of forms, such as candy, brewed teas, or prepared capsules. Cookies and ginger ale are not found to be as effective. Peppermint’s essential oil has long been celebrated as a tonic for nausea, and may be given to children as hard candy (if old enough), and as mint tea.

Acupuncture (the placement of needles) or acupressure (gentle pressing with fingers or purchased bracelets) are safe and possibly effective against motion sickness when applied to a key point on the wrist. However, parents can skip the seasickness bands that send small electrical impulses to these areas, as they were not found to be any better than standard acupressure bands.

As in so many things, using relaxation techniques and deep breathing work safely and effectively for mind-body phenomena like motion sickness. Doing breathing exercises during a rough trip can offer distraction and a welcome focus, even for pre-schoolers. Magnets used for carsickness won’t hurt, mind you, but I don’t see them worth your time and effort.

React quickly and calmly. Alas, should all of your efforts be for naught, and should a little passenger riding in your sedan suffer an Extreme Emetic Event (EEE) by puking on your floormats, allow me to offer a few final suggestions.

First, while you overcome the awful smell, realize motion sick littluns feel miserable. Offer words of solace and reassurance, as blowing your stack helps little, and may make the situation worse. And, if you are driving, it may be best to pull over to avoid the chain reaction of a full-on puke-o-rama. On my deepsea trip from so long ago, the captain regaled us with a tale of one seasick kid who threw up on his grandfather. Thusly blessed, the grandfather yakked on the child, who returned fire. Apparently, this went on awhile. Best if it not happen in your car, no?

For further consideration on motion sickness prevention, management, and cleanup, I highly recommend this pithy blog on the subject. I found it insightful as it provides other worthwhile approaches to use on your next cross country trip, flight, or fishing expedition. However, if you are faint of heart and feel your gorge rising as you educate yourself on the topic, you might best sit up front, and look out the window, towards the horizon and breathe deeply. I bet you feel better already.

Happy trials!

Photo above by erikkay. Cartoon below by me.

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