What are the recommended medications for motion sickness in children?

Medications for Motion Sickness in Children

For children with motion sickness, dimenhydrinate and diphenhydramine are the recommended first-line medications for those over 6 years of age, while children under 6 years should generally avoid antihistamine medications due to safety concerns. 1, 2

First-Line Medication Options

• Dimenhydrinate is FDA-approved for prevention and treatment of nausea, vomiting, and vertigo associated with motion sickness in children over 6 years of age 1
• For children 6-12 years: diphenhydramine 10 mL (25 mg) every 4-6 hours, not exceeding 6 doses in 24 hours 2
• For children over 12 years: diphenhydramine 10-20 mL (25-50 mg) every 4-6 hours, not exceeding 6 doses in 24 hours 2
• Dimenhydrinate dosing for children: 1.25 mg/kg of body weight or 37.5 mg/m² of body surface area administered four times daily, not exceeding 300 mg daily 1

Important Safety Considerations

• Children under 6 years of age should not use over-the-counter antihistamines for motion sickness due to potential toxicity and safety concerns 3
• FDA advisory committees have recommended against using OTC cough and cold medications (including antihistamines) in children under 6 years due to safety concerns and reported fatalities 3
• Between 1969 and 2006, there were 69 fatalities associated with three antihistamines in children under 6 years, with 41 reported in children under 2 years 3

Alternative Options for Children

• For children who cannot take antihistamines, non-pharmacological approaches should be considered first 4
• Ginger has antinausea properties that act directly on the stomach rather than the central nervous system, making it potentially safer for children 4
• Distraction techniques, audio-visual entertainment, and relaxation methods are highly effective in reducing anxiety and improving cooperation in children 3

Special Considerations

• Antihistamines are likely to cause sedation (66% vs. 44% with placebo), which may be beneficial for long journeys but problematic when alertness is required 5
• Second-generation antihistamines (cetirizine, desloratadine, fexofenadine, levocetirizine, and loratadine) have been shown to be well-tolerated with a good safety profile in young children, though their efficacy for motion sickness is limited 3
• For severe cases where pharmacological intervention is necessary in children over 6 years, meclizine at 12.5-25 mg can be considered 6, 7

Prevention Strategies

• Position the child in the most stable part of the vehicle (middle seat, front seat for cars if age-appropriate) 8
• Encourage the child to watch the true visual horizon when possible 8
• Minimize exposure to other sources of physical, mental, and emotional discomfort during travel 8
• Slow, intermittent exposure to motion can help reduce symptoms through habituation 8, 9

Common Pitfalls to Avoid

• Long-term use of vestibular suppressant medications can interfere with natural adaptation to motion and should be avoided 6
• Medications primarily treat symptoms rather than addressing the underlying sensory conflict 6
• Combining multiple motion sickness medications can lead to overdose errors and increased risk of adverse effects 3
• Medications should be administered before travel begins rather than after symptoms develop for maximum effectiveness 10