Drug of Choice for Motion Sickness in Children
Dimenhydrinate is the drug of choice for motion sickness in children due to its established efficacy and safety profile for pediatric use. 1
First-Line Medications
Antihistamines
Dimenhydrinate (Dramamine):
- FDA-approved for prevention and treatment of motion sickness 1
- Dosing by age:
- 2-5 years: 12.5-25 mg every 6-8 hours (max 75 mg/day)
- 6-12 years: 25-50 mg every 6-8 hours (max 150 mg/day)
12 years: 50-100 mg every 4-6 hours (max 400 mg/day)
- Should be administered 30-60 minutes before travel
Meclizine (Antivert):
- Alternative for children ≥12 years
- 25-50 mg once daily, 1 hour before travel
- Not FDA-approved for younger children
Evidence for Efficacy
Antihistamines are probably more effective than placebo at preventing motion sickness symptoms under natural conditions, with a prevention rate of 40% compared to 25% with placebo 2. First-generation antihistamines like dimenhydrinate have demonstrated effectiveness in preventing motion sickness in susceptible individuals 3.
A Cochrane review found moderate-certainty evidence supporting antihistamines for motion sickness prevention, though they may cause sedation more frequently than placebo 2.
Important Considerations
Timing of Administration
- Administer 30-60 minutes before anticipated motion exposure
- For longer trips, may need to redose according to duration of action
Side Effects
- Sedation: Most common side effect (66% with antihistamines vs 44% with placebo) 2
- Other potential side effects:
- Dry mouth
- Blurred vision (14% with antihistamines vs 12.5% with placebo) 2
- Mild cognitive impairment
Contraindications
- Children under 2 years (limited safety data)
- Known hypersensitivity to antihistamines
- Caution in children with:
- Narrow-angle glaucoma
- Bladder neck obstruction
- Seizure disorders
Non-Pharmacological Approaches
These should be used alongside medication for best results:
- Position child to minimize motion (middle of car, over wings in airplane)
- Have child look at the horizon or a fixed point
- Ensure adequate ventilation
- Avoid reading or screen time during travel
- Small, light meals before travel (avoid heavy, spicy, or fatty foods)
- Regular breaks during travel
Special Populations
Infants and Young Children
- Limited data on motion sickness in very young children, but it can occur even in infancy 4
- For children under 2 years, non-pharmacological measures are preferred
- Consider consulting a pediatrician before using medications in very young children
Children with Comorbidities
- Children with migraine disorders, vestibular impairment, or history of otitis media may be more susceptible to motion sickness 4
- These children may benefit from prophylactic treatment before travel
Ineffective Treatments
- Ondansetron: Not effective for motion sickness prevention despite its antiemetic properties 3, 5
- Non-sedating antihistamines: Less effective than first-generation antihistamines 3
- Ginger root: Insufficient evidence for effectiveness in motion sickness 3
Summary
Dimenhydrinate is the most appropriate first-line medication for motion sickness in children, administered 30-60 minutes before travel at age-appropriate doses. Combine with non-pharmacological strategies for optimal prevention. Be aware of potential sedation as the main side effect.