Motion sickness
Motion or car sickness in kids is annoying AF - and it can make you feel pretty helpless as a parent.
Here’s an overview. We’re going to go over WHY it happens, how you can tell if your child has it, and how to be prepared. I’m also going to discuss what evidence-based methods we have to prevent it.
What is motion sickness?
Motion sickness occurs when the sensation the body is experiencing does not match the sensory input coming from the eyes, ears, etc. Weirdly enough, it does not require actual motion — just the perception of motion.
Part of how our brain figures out what is going on in the world around us is by integrating sensory input from a range of sources — what we see, what we hear, how our bodies are moving, and more.
When there’s a discrepancy that doesn’t make sense (eg your body feels like it is moving but your brain isn’t getting visual sensory input consistent with that) then that can generate symptoms of motion sickness.
Think about reading your iPhone in the car: your eyes and body are not sensing motion, but the vestibular/balance system in the ears senses motion. This discrepancy disorients the body and creates that sensation.
Anyone can get motion sickness.
Although some people are more susceptible to motion sickness than others, it can actually be induced in everyone with the right triggers. Certain types of travel are also more likely to cause it (being on a boat is a particular culprit).
Risk Factors
Hormones: Women in general are more likely to suffer from motion sickness than men, and there seems to be increased susceptibility during pregnancy, or if a person is menstruating or on oral contraceptives.
Migraines: chronic migraine sufferers are more susceptible to motion sickness.
Genetics: there are certain genetic variants that have been found to be associated with motion sickness susceptibility (PMID: 25628336)
Age? The prevailing opinion is that young children cannot get motion sickness, especially under age 2y. I don’t agree with this. It is certainly more challenging to assess in young infants, but we have a tendency to under-treat children who are too young to communicate. I have often wondered whether those babies who “have always hated being in the car” may be experiencing some degree of motion sickness.
Symptoms
The symptoms of motion sickness are often insidious, and can vary from person to person. They can include:
Nausea and vomiting (these are the most common)
Headaches
Dizziness
Sweating, salivating
Drowsiness
A general feeling of being “off” — which can become quite severe. Some people experience shortness of breath, tingling in their arms and legs, and even a feeling of impending doom.
How is it diagnosed?
Motion sickness tends to be a clinical diagnosis based on history, symptoms, and family history.
What do I do if my child vomits?
First, and most importantly, don’t panic. Recognize that these symptoms are not under their control, and may be scary for them.
Be reassuring
Let your child lie down with their eyes shut in a cool, well-ventilated area.
Sometimes a cool compress on the forehead or the back of the neck, or a few sips of a cool liquid can be soothing.
Give them a barf bag or bucket in case they need to throw up again.
If you’re able to take a break during travel, do so! Use your motion sickness kit to clean the car, change clothes, and reset.
Dr Playforth’s recommendations for a motion sickness car kit:
If your child is prone to motion sickness, it’s worth having a car prep kit ready to go. Here are some things worth including:
Bucket or empty containers (such as those from large yogurts) or barf bags (some are linked on my medicine cabinet faves).
Absorbent pads (eg puppy pads) to help with clean up. I admit that I once used a clean diaper because we didn’t have pads in the car. Don’t be like me!
A roll of paper towels
Extra plastic bags for soiled items
Wipes, hand sanitizer, and old towels.
Change of clothes
Air freshener
Medications only if recommended by your pediatrician.
The Pediatrician Mom Tip: Never use windex or other cleaning products on a car seat. These products can compromise the integrity of the car seat. If you need to clean your child’s seat, check out the manufacturer’s cleaning instructions.
Medications
Environmental modification and prevention are the best ways to intervene for most children (see below). Unfortunately, the medication options for children aren’t great - the options that exist are sedating and have significant side effects. The decision to use a medication should be made in conjunction with your pediatrician because you will need to weigh risks vs benefits carefully.
Dramamine (Dimenhydrinate): This is a sedating antihistamine that has been approved in the US for children over 2 years old. It is not widely recommended because of the side effects, but there are circumstances where the pros may outweigh the cons. I recommend discussing it with your pediatrician if your child has ongoing debilitating symptoms of motion sickness. For some children, Benadryl (Diphenhydramine) can also be used, but again the side effects make it a non-ideal choice except in some specific circumstances. Unfortunately, non-sedating antihistamines have not been shown to have much impact on symptoms.
Scopolamine patches can have serious side effects such as blurry vision, dry mouth, confusion, and sedation. They are not shown to be more effective than antihistamines, and should not be used without a thorough discussion of pros and cons with your pediatrician.
The Pediatrician Mom Tip: Always dispose of scopolamine patches in the trash and out of reach of children and pets.
Prevention
Worrying about your child vomiting can really ramp up anxiety if you’re preparing to travel. Here are some practical (and evidence-based) tips to try the next time you travel, so that hopefully you can have a memorable trip for entirely positive reasons!
Positioning: When you’re in a car, you want visual sensory input to match the sensory input of how your body is moving. Looking straight out of the front window, rather than a side window, will do this (PMID: 10629944, 23713212, 11439716) Ways to achieve this:
Switch to the middle seat
Place shades or covers over the side windows
Use motion sickness glasses (I need to flag that I’ve not used these personally and cannot vouch for them).
Sometimes being rear-facing can particularly exacerbate this issue. However, I do not recommend turning a child from rear to forward-facing prematurely — if they don’t meet the criteria, it is still safest for them to face the back. Remember, safety trumps everything.
Activities: For a similar reason, you want to have your child avoid reading or staring at a screen when the car is in motion. Because this can make for a very long boring journey, try to be prepared ahead of time: talk to your child about why you’re implementing this rule, and make sure you have plenty of alternative forms of entertainment. Some options include:
Music
Podcasts
Audiobooks
Car games
Ginger pretreatment before travel: We know that Ginger can help prevent symptoms of motion sickness, although the mechanism remains unclear (PMID: 12576305). It has also been shown to be helpful for tummy bugs and for pregnancy-related nausea, so it is definitely a great natural option to keep in mind.
Add a small amount of grated fresh ginger, or ginger paste, to warm water with honey (only in kids >1y)
Ginger chews or lollipops (be aware that these can be choking hazards and should only be used for children > 4 years and never in the car!)
Whichever method you use, remember ginger is potent: start low, and go slow.
NOTE: Ginger ale doesn’t have actually contain much ginger
Ventilation & Cooling: When a person experiences motion sickness they often feel flushed, hot, sweaty. We don’t know exactly why this happens, but that cluster of symptoms is a physiological indicator that the body is trying to cool itself down. Helping the body cool down can help your child feel better — and keeping the environment cool and well-ventilated can really help prevent symptoms.
Run the AC in the car.
Make sure you have cool compresses available that can be used for the forehead or back of neck.
Wrist acupressure: This is the basis for sea-bands or other wrist bands. The evidence here is mixed. Some data shows it can help especially at the P6 pressure point (wrist), other evidence is equivocal. This is a tough study to do in a randomized controlled way, so it can be hard to rule out placebo effects — but because it is a relatively harmless intervention, it is reasonable to try! (PMID: 17484344, 7575310, 14693623, 11452572)
Meals: Heavy, greasy or spicy food can be harder to digest. On the other hand, some data shows increased susceptibility to motion sickness when a person has an empty stomach — so plan for a happy medium: choose a light, bland snack (crackers, nuts for older children) beforehand, ideally 30-60 mins before travel.
Take breaks: Many children who are prone to motion sickness do fine on shorter car journeys but feel sick on long trips. Breaking up your travel where possible - even just short breaks to stretch and get fresh air - can make a huge difference.
Mind over matter: Believe it or not, evidence shows that there is a mindfulness piece to preventing motion sickness episodes. If a person believes they won’t have symptoms, they are less likely to experience them (PMID: 7592232). This is a useful thing to keep in mind when you talk about it with your child.
