Cheryl Martin (Host): This is Children's Health Checkup, where we answer parents' most common questions about raising healthy and happy kids. I'm Cheryl Martin. Children can get motion sickness more often than you think. Here to offer tips for detecting the signs of motion sickness, remedies, and prevention is Dr. Linda Phan, a pediatrician at Children's Health Primary Care Mansfield. Dr. Phan, thanks for coming on.

Dr Linda Phan: Thank you so much, Cheryl. Happy to be here.

Host: So, what causes motion sickness in kids and why are some more prone to it than others?

Dr Linda Phan: The motion sickness in kids, it's caused by a sensory mismatch. It's a mismatch between what your eyes see and what your inner ear feels. So, the brain gets these conflicting signals, and it triggers a lot of the symptoms that we associate with motion sickness like nausea, dizziness, sweating, yawning, and so forth.

There are going to be some kids who are more prone to it than others. They say that about half of the kids get motion sick while the other half doesn't. And if your parents grew up being very motion sick in car rides or cruises, then you're more likely to also be motion sick too. So, there's a genetic component to it.

Host: What would you say are the most common signs of motion sickness in children, especially in younger kids who may not be able to describe what they're feeling?

Dr Linda Phan: The common signs of motion sickness include nausea, feeling dizzy, sweating. In little kids, you may see them looking pale. So, that's a really big one. Sometimes they just get quiet, or the opposite, they get very fussy and clingy. You may notice some yawning, some drooling, or them just looking a little bit off. Cold sweats is another kind of giveaway.

Host: And is there a typical age that motion sickness starts?

Dr Linda Phan: The age in which motion sickness starts is between two and it tends to stop after age 12. Interestingly, children under the age of two, they don't get motion sick.

Host: So, do most children eventually outgrow it?

Dr Linda Phan: Yes. So, most kids do outgrow it. What happens is that the brain eventually learns to sort out the mixed signals from both the eyes and the inner ear. And there are some adults that still carry it with them into adulthood, but they get a milder version of it. So for most parents, they can just be patient. It's just a phase. And usually, most kids will outgrow it

Host: That's good news. What can parents do before a trip to help prevent motion sickness?

Dr Linda Phan: So, what parents can do before a trip to prevent motion sickness is think first where the child is sitting. For children under the age of 12, they have to sit in the back. For children who still continue to be motion sick after age 12, at 13 and up, they can sit in the front. So, the front seat passenger side is probably the best choice. But under the age of 13, sitting in the back middle seat is going to be ideal.

You can also have them not read any books, stay away from the screens. Usually with the eyes fixed on the screens or books, that confuses the brain because the inner ear feels like you're moving, and so that usually is what triggers the motion sickness.

Having children be well rested before a trip. Some parents will time the trip during a nap, becasue cause sleeping can also diminish any of the motion sickness that would arise. Giving kids a light snack would be helpful. Not a heavy meal, but a light snack that maybe perhaps is protein-rich. Interestingly, A light snack with some protein before you go, research has shown that protein does a better job than even eating carbs at settling down the stomach. Maybe small sips of water would be helpful.

Having fresh air will be essential. So having the inside of the car be nice and cool. Fresh air is ideal, but if it's not ideal, then just cool air. And then, avoiding any heavy perfumes or heavy smells would be helpful.

Host: And going back, you mentioned the middle seat is best. Why is that?

Dr Linda Phan: It allows the children to be able to lift their heads and look straight ahead onto the horizon. Being able to match what the kids are seeing and what they're feeling as they're moving aligns everything so that there's not as much conflict in the brain that would cause the motion sickness symptoms that we usually experience with the kids.

Host: Those are great prep tips. So, if a child starts feeling sick during travel, what are some strategies that can help relieve symptoms in the moment? Anything else?

Dr Linda Phan: Yes. If your child starts feeling sick during the trip, there are some things that you can do to help. The best single thing that you can do is stop the car. Even if it's a five-minute break at Buc-ee's or at a rest stop, the fresh air can really reset things. And that having your child look far away at the horizon if you can't stop right away is very helpful. It helps the eyes and the inner ear get back into sync. Opening up the window some, letting some cool air flow, having them look up rather than down onto their iPad or books. Closing eyes is very helpful too, so that way there's less confusion between the eyes and the inner ear.

Another neat trick is to have them take very slow, steady breaths. It's not just a calming thing. But actually, the controlled breath activates a reflex that helps suppresses the urge to vomit. And music and audiobook is fine. But having them stop reading and turning off the screens is also very helpful.

Host: Now, are there any medications or remedies that are safe and effective for children with motion sickness?

Dr Linda Phan: There are medications and remedies that are safe for kids that parents may try. But first and foremost, we should always try the behavioral stuff first, such as looking outside at the horizon, the seating position, getting fresh air. Those are always your first line of defense.

But if you really need something, some common things that parents may use includes a medicine that they can find in their cabinet. It's good old Benadryl, diphenhydramine. There is a little warning with the Benadryl, though. For most kids, it makes them sleepy, which may be helpful. But in some kids, they get this paradoxical reaction where they get a little bit more hyper and upset. So, having a test run before a big trip would be helpful.

And other options that's over-the-counter includes dramamine and meclizine. And if your child is under the age of six, I would strongly recommend that parents contact their doctor for safe dosing and clearance to use the medicine.

Now, there is one medicine that older teenagers and adults may use. It's prescription-only. And those are the scopolamine patches, and those are the ones that adults will sometimes use. They'll place it behind the ear. They're not safe for kids, because there's an association with hallucinations and confusion in kids. But that's something to maybe consider, if you're an older teenager.

There are some natural remedies as well, and ginger gets a lot of attention. The studies don't necessarily show that they're super great for motion sickness, and some of the evidence is a little bit mixed, but it doesn't hurt. And so if parents want to do some ginger chews or if they like to use some ginger ale, they can certainly do that. And there are those acupressure wristbands, and studies show that they're not really any better than placebo. But if the kids feel better having it on, and the parents feel like it's helpful, there's no harm in using it. You just need to make sure that the bands that you buy would fit those little wrists.

Host: You mention light snacks with protein. Are there certain foods, in addition to that, drinks or activities that can make motion sickness either better or certain foods, activities? You've mentioned some that would make it worse.

Dr Linda Phan: There are foods, drinks, and activities that can make it better and can make it worse. And so, we can start with what makes it worse. So, think big, greasy, heavy meals before a car ride, that's definitely a recipe for trouble. Same things with sugary foods and drinks. And with reading a book, watching screens, either tablet or laptop or a small handheld video game, that can be one of the bigger triggers out there. Strong smells like heavy perfumes or the strong odor that comes from certain foods, that can really push a queasy kid over the edge. A hot, stuffy car with the windows up is definitely not your friend.

What actually does help is a light snack and some protein. So, think maybe cheese and crackers, a small sandwich, maybe nuts if they're old enough and if they're not allergic to it. Small sips of water to stay hydrated, cool fresh air, cracking down the windows, if that's easy to do. And my favorite is just listening to music and podcasts. Rather than having your eyes fixed on a book, being able to just listen to an audiobook is also very nice. So, no watching videos or reading books. And that way, all eyes can be on the windows looking at the horizon.

The sweet spot for parents is don't let them travel hungry. Don't stuff them either. Light protein-rich rich snack is probably going to be your best bet.

Host: So when should parents talk to their child's doctor about motion sickness?

Dr Linda Phan: First, I do want to emphasize that motion sickness is a really common thing in childhood. And most kids, it is completely normal and harmless. But a parent should contact the doctor about motion sickness in a few situations. So if the motion sickness is really severe and it's really preventing your family from being able to do an activity like short car rides, and your child still gets sick, if it looks like your child has dizziness and nausea and they're not in a moving car, that's going to be a different situation. That's probably worth looking into. If they get a lot of headaches, migraines, there's actually a connection between migraines and motion sickness, there's a higher rate of motion sickness in those who suffer from migraine headaches. If there's been a lot of ear infections, hearing changes, any delays in motor development, it could point to maybe like an inner ear problem.

So, very rarely, though, motion sickness would overlap something that would be of more concern. But if it seems like it's out of the ordinary, then a parent should really reach out to their pediatrician so they can discuss more and their good doctor can do a full examination.

Host: That's good to know. Dr. Linda Phan, thanks so much for educating parents on motion sickness in kids. Extremely helpful. Thank you.

Dr Linda Phan: You're very welcome. This was fun to do. Thank you very much.

Host: Now, if you're in North Texas, Children's Health Pediatric Primary Care offers trusted care close to home from newborn checkups to care for common illnesses and more. You can find a location near you at childrens.com/primarycare.

Thank you for listening to Children's Health Checkup. If you found this podcast helpful, please rate and review it or share the episode, and please follow Children's Health on your social channels.