Roller coaster, boat rides and car trips are not much fun for some kids. Bouncing up and down, unexpected twists and turns, and sudden changes in position can cause an uneasy feeling in the stomach, cold sweats, dizziness, nausea and vomiting. These symptoms can quickly put a damper on family fun. Understanding what causes motion sickness and learning how to manage the condition will help the joy return to your family excursions.
Overstimulation and Confusion
There are many theories about what causes motion sickness. The chemical changes and nerve activities in the brain and spinal cord are very complex. The most common explanation is that the inner ear, which helps to control balance, is stimulated too much if there is a lot of motion. It also can happen when the brain seems to be getting confusing messages from its motion sensors in the eyes, ears and nerve endings in the muscles, bones and joints. These sensors are responsible for telling the body where it is in space when walking, sitting or lying down. While sitting in a car the brain thinks the body is still; however, the car is moving and the brain, eyes and ears are experiencing things in motion. This disconnect causes motion sickness.
What is it like to have motion sickness? The first symptom is referred to as stomach awareness or the uncomfortable feeling in the stomach that something is wrong. Children who cannot describe this queasiness generally become pale and restless, have more saliva, start yawning and may cry. In older kids, other early symptoms include cold sweats, nausea and loss of appetite. These symptoms are often, but not always, followed by vomiting, which is usually very mild. However, if vomiting is severe, you should monitor your child for signs of dehydration (vomiting all fluids given, no urine output in six to eight hours, increasing dizziness) and get emergency medical care, if necessary.
Motion sickness is very common and can happen during rides in a car or on an airplane, boat, train or roller coaster. It can even occur when watching something in motion — while playing handheld video games, seeing movies taken with a shaky camera or looking at a slide being moved under the microscope. Motion sickness is more common in girls and people with migraines, during the menstrual period, and is most bothersome to kids 2 to 12 years old. Although these factors cannot be controlled, it can help parents to know that kids who are fatigued, overfed and unable to see the outside tend to struggle with motion sickness. Fear, anxiety and exposure to tobacco fumes, exhaust, carbon monoxide and strong fragrances can worsen motion sickness. It’s important to identify what might cause motion sickness in your child.
Fortunately, there are several non-medicinal ways to try to prevent motion sickness. Children who tend to get motion sickness should:
* Be able to see outside (use a car seat, stay on the upper deck of a boat).
* Look at a stable reference point forward. The horizon is a great visual fixation from a car or boat.
* Avoid unnecessary head movements; wear sunglasses.
* Avoid reading, playing video games or doing puzzles while riding.
* Sit in the center of the car, train or boat.
* Sit in a window seat close to the wing of a plane.
* Have access to airflow. Use the fan on an airplane; open car windows.
* Avoid exposure to smoke or perfume.
* Eat a small meal before a trip. Avoid fatty, greasy and fried foods.
* Be encouraged to talk, sing or listen to music or books on tape while riding.
Some over-the-counter medications can prevent or treat motion sickness. Antihistamines that can make kids sleepy are the only medications available for use in younger children. A provider might recommend dimenhydrinate or diphenhydramine for children two to six years old. For kids over the age of six, the sedating antihistamines cyclizine or meclizine can be used, All of these antihistamines can cause dry mouth, dizziness and a headache. Antihistamines such as loratidine, cetirizine and fexofenadine are not helpful in preventing or treating motion sickness.
For children over the age of 12, prescription scopolamine in patch form is thought to be the most effective medication for preventing the nausea associated with motion sickness. If vomiting is already happening, scopolamine will not help. It can also cause dry mouth. The anti-nausea medication ondasetron does not help to prevent motion sickness.
Other non-medical strategies can be effective in preventing the symptoms of motion sickness. Powdered ginger root, which can be used at any age, has been shown to delay the onset and severity of nausea. Acupressure wristbands are available in most pharmacies and sundry stores and are safe for all ages. When placed correctly on each wrist, the bands provide acupressure in an area that helps prevent nausea. Note that wristbands can cause carpal tunnel if used for an excessive amount of time. Wristbands are commonly used, even though there is not much research to support their effectiveness in motion sickness.
Children who get motion sickness have little or no control over it. Astute parents and kids can learn to recognize triggers and symptoms of this malady and use preventative strategies and medications to make travel more pleasant.
Ann Petersen-Smith, PhD, APRN, CPNP-PC, CPNP-AC, is working in the Pediatric Call Center at the Children’s Hospital Colorado. She has had he honor of teaching and mentoring many PNP students during the last quarter century. She also does consultant work that includes writing, editing, teaching online programs, and committee work for the Society of Pediatric Nurses and the Colorado State Board of Psychologist Examiners.