What is the best treatment for a 12-year-old child with travel sickness?

Treatment of Travel Sickness (Motion Sickness) in a 12-Year-Old Child

Scopolamine transdermal patch is the first-line medication for preventing motion sickness in a 12-year-old child, applied at least 4 hours before travel, with first-generation antihistamines (such as dimenhydrinate or diphenhydramine) as effective alternatives if scopolamine is not available or tolerated. 1, 2

Pharmacologic Treatment Algorithm

First-Line: Scopolamine Transdermal System

• Apply one scopolamine 1 mg/3 days transdermal patch to a hairless area behind one ear at least 4 hours before the anticipated motion exposure 1, 2
• The patch can remain in place for up to 3 days if continuous protection is needed 1
• After applying the patch, the child must wash their hands thoroughly with soap and water immediately to prevent accidental eye contact with the medication 1
• Critical safety consideration: The patch should not be cut, and only one patch should be worn at any time 1

Second-Line: First-Generation Antihistamines

• First-generation antihistamines are effective for motion sickness prevention, though they cause sedation 2, 3
• These medications must be taken before departure to be effective 3
• Common options include dimenhydrinate or diphenhydramine (specific dosing should follow pediatric weight-based guidelines)

Medications That Do NOT Work

• Nonsedating antihistamines are NOT effective for motion sickness prevention or treatment 2
• Ondansetron is NOT effective for motion sickness 2
• Ginger root is NOT effective for motion sickness 2

Behavioral Strategies (Should Be Combined with Medication)

• Position the child in the most stable part of the vehicle: front seat of a car (if age-appropriate and safe), middle of a boat, or over the wing in an airplane 2
• Have the child watch the true visual horizon rather than looking down at books, screens, or other objects 2
• If possible, have the child lie down with eyes closed during travel 2
• Tilt the head into turns when the vehicle changes direction 2
• Minimize other sources of physical discomfort (hunger, heat, anxiety) 2

Important Caveats and Side Effects

Scopolamine Patch Warnings

• Most common side effects: dry mouth, dizziness, blurred vision, drowsiness, and disorientation 1
• Serious concern: If the patch contacts the eyes, it can cause temporary pupil dilation and severe blurred vision 1
• After removing the patch, wash both hands and the skin behind the ear thoroughly with soap and water 1
• Withdrawal symptoms can occur if the patch is used for several days then removed, including dizziness, nausea, vomiting, and confusion starting 24 hours or more after removal 1
• The used patch still contains active medication and must be folded in half (sticky sides together) and disposed of in household trash out of reach of children and pets 1

When to Avoid Scopolamine

• Do not use if the child has difficulties with stomach emptying, as this can worsen abdominal pain, nausea, or vomiting 1
• Avoid if there are concerns about urinary retention or narrow-angle glaucoma (standard anticholinergic contraindications)

Practical Implementation

• Early self-diagnosis is critical: Teach the child to recognize early symptoms (stomach awareness, malaise, drowsiness, irritability) that precede nausea 2
• Timing is everything: The scopolamine patch must be applied at least 4 hours before travel, not after symptoms begin 1, 2
• Gradual exposure helps: If possible, slow, intermittent exposure to motion can reduce symptoms over time 2
• The effectiveness of all motion sickness medications is limited, so combining pharmacologic and behavioral strategies provides the best outcome 3