Motion Sickness

Motion or car sickness is fairly common in children and adults. More kids appear to have the problem, therefore there is a chance your child may grow out of it. The problem appears to be more related to the speed of rotational force, the frequency of rotation direction change, and the speed of rotational direction change. In other words, the more body roll and jerking around in the car, the more sick your going to get. It is not known why some kids get it and others don’t.

If body roll and jerking are the cause, then we need to prevent that.

• Place the child as close to the middle of the car as possible. There is less effect of body roll here.

• Place the child high enough to be able to see outside and ask them to look far out the front of the car. Your brain has some adaptive reflexes that limit the effect of rotational forces on vision. Focusing on a distant object reduces the effect of rolling through these reflexes.

• Inflate the tires to the maximum recommended pressure. Under inflated tires make the ride smoother, but this increases body roll. Most tires have a range of pressure on them rather than a single number. Inflate the tire to the upper end of that range. You will also get better gas mileage.

• Increase the stiffness of your shocks if possible. On most cars, this is not a possibility. If you have adjustable shocks or suspension, adjust to the stiffest position to reduce roll.

• When driving on straight roads, drive as straight a line as possible and adjust the car’s direction slowly. Try to aim far down the road and hold course. If you adjust the direction frequently, you’re making the car roll frequently. You may not feel it in the driver’s seat, but the rest of the car can really be affected, especially in minivans.

• When driving through turns, try to take them like a race driver. That is, start slightly wide, slowly and steadily go into the turn taking the shortest route possible and end the turn slightly wide. Try to make the path you take one nice continuous curve rather than a series of small straight lines with abrupt corrections to stay in the curve.

There is an acupressure device marketed for sea and airsickness. I have not seen any medical studies demonstrating effectiveness. The traditional medicine theory is that they stimulant or block a flow of energy. The current medical theory has more to do with a counter irritant effect. Regardless of whether or how they work, they are safe. I am not aware of one of these devices being marketed or size specifically for children.

Most antihistamines have a mild anti-nausea effect. If your child normally takes an antihistamine and is not taking them now, try giving it before riding in the car. Most will take 30-45 minutes to work. If it works, then continue to use that medicine as needed. If it doesn’t work, or your child is already taking the antihistamine anyway, then we need to go to Dramamine (Dimenhydrinate). If you child is going to take Dramamine, then they cannot take most antihistamines with it, as it is a mild antihistamine. Check with the pharmacist to be safe. Dramamine should be given 30-60 minutes before driving or flying and will last from 3-6 hours.  You can give the medicine every 4 hours as needed. Some kids are slightly to moderately sedated with this medication and this is not necessarily a bad thing for a long car trip. Of course it is not a good idea to give it solely for this purpose. About 5% of kids are paradoxically excited or get hyper or jittery with the medication. For this reason, it is a good idea to give a test dose before using it for a trip.

                Below you will find a dosing chart for Dimenhydrinate (=Dramamine). Notice there are 2 tables. The first is a standard dosing chart based on weight for each preparation available. There are 3 liquid strengths, although 2 of them are actually the same strength just worded differently. There are also maximum total doses per day based on age. Since there are heavy young children and lighter older children, it is possible to dose right based on weight and exceed the maximum daily dose. To prevent this, first look at the standard dose per weight and then check and make sure you don’t exceed the maximum dose per day on the second chart. You really should not be giving the dose more than a few times per day anyway. If you give the dose once or twice per day for travel, that’s ok. If you wish to give the dose more than a few days in a row, you should discuss this with your physician.

Scopalamine patches have been used for years, but may not be used in pediatric patients. There are no other prescription medications used for motion sickness.

Copyright 2006 Joe Matusic, MD, FAAP, AME

 home