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Motion Sickness

Posted in: How to Keep Your Kids Happy (and safe), Tips & Tricks

Motion sickness is thought to happen because your brain can’t reconcile differing inputs from your visual, vestibular, and proprioceptive systems – where your eyes tell your brain that you are moving, but the proprioceptors in your skin tell your brain that you are sitting still. Unfortunately, the default when you can’t reconcile these inputs is to feel nauseated. Ask any adult who gets motion sick while riding in a car (and is obviously riding forward-facing) there is no magic cure for preventing motion sickness. However, there are ways you can make it so that your child is less likely to feel sick – and their car seat easier to clean if they do vomit.

Nausea may be the first recognized symptom of motion sickness - but the nausea is almost always preceded by other subtle symptoms such as a sensation of fullness in the stomach area, malaise, drowsiness, and irritability.

Looking out the side windows is the last thing you want to do if you are prone to motion sickness. Trust me - I can ruin an entire car trip by just 30 seconds of looking out the side windows. Why? Things appear to be moving much faster when you look out the side windows, compared to when you look out the front or back window - and the faster things tend to appear to be moving, the more the brain gets mixed signals about whether you are sitting still or moving fast. This is something to keep in mind if you have a child who gets motion sick that you aren't asking them to play games where they are looking for things they can only see out the side windows.

For most kids, a view of the horizon line will make them feel less sick.

For rear-facing kids, this means a view out the back window. So try and sit the child more upright, remove the vehicle head rest (if possible), and select a car seat that sits higher up if possible (the Clek Foonf sits the highest and gives the best view out the back). However, we know of some rear-facing kids who do better when sitting lower and more reclined (they likely don't see much out the rear window or the side windows). It is hard to predict what one child may prefer.

2 Diono's RF in Honda Odyssey and me in centerFor forward-facing kids (and adults), the center of the back seat is the best spot in the back seat, since it gives the least obstructed view out the front window. You can see in the photo here that I sit in the middle seat when I rides in the back, because I can look out the front window and feel less sick.

For minivans & SUVs, keep motion sick kids in the 2nd row - as the 3rd row is bumpier and will make them feel sicker.

In our decades of experience, we have found that turning a child forward-facing typically doesn't do much to change the motion sickness, but it ALWAYS decreases the child's safety. 

If forward-facing were a cure for motion sickness, then no adults would get motion sick in a car. As an adult who still gets horribly motion sick - even when sitting in the front seat - how I wish that forward-facing cured motion sickness!

For most kids who get sick, activities that require them to look down - like books, movies, or games - will make them feel sick.

Music

Music - but especially musicals where there is a storyline for an older child to follow - is great for kids of all ages.

Audiobooks

Audiobooks are a great option for older pre-schoolers and school age kids.

Podcasts

There are also a growing number of podcasts created for kids. CommonSenseMedia has some helpful suggestions on navigating podcasts for children along with some recommendations to get you started. KidsListen is an app that aggregates podcasts geared towards kids - and continues to add new episodes and podcasts. 

Games

If you are going to play games that require looking out the window (like I-spy or license plate games) make sure the child is only looking out the front or rear windows, not the side windows since the side windows will make them feel sicker.

For obvious reasons, it is best to avoid feeding a child who is prone to motion sickness while they are riding in a car. Just as feeling really full can make you more prone to vomit, so too can being really hungry. Therefore, if you can, try and have the child eat a snack before the car ride so they aren't hungry and aren't super full.

Some recommend eating ginger to prevent motion sickness - however a search of the literature shows that there is no evidence that ginger is effective in preventing or treating motion sickness. But, if your child likes ginger there likely isn't much of a downside to having them eat ginger in the car.

Sleep is the magic pill for motion sickness - as it is the only time you are guaranteed to not feel sick. Therefore, we suggest trying (whenever possible) to travel during nap time or at bedtime.

Drowsy driving is real and it is very risky. Therefore, make sure when traveling at bedtime that the adult who is driving is wide awake as drowsy driving puts not only the driver at risk but everyone else in the car and those sharing the road. If there are 2 adults in the car, it is ideal for the adults to trade off every few hours so that each gets a chance to nap while the other is driving. 

Could an undiagnosed eye problem be the cause of your child's motion sickness?

If your child has motion sickness, they most likely do NOT have a problem with their eyes as it is extremely UNcommon for motion sickness to be related to eye pathology in children.  
 
Pediatric Ophthalmologists recommend the following:
  • All children should have annual vision screening done at the pediatrician, in the community (ie Elks or Lions) or at school. This is especially important in the setting of motion sickness.
  • If there is any concern for abnormal eye movement, alignment or poor vision, then a child should be referred to pediatric ophthalmology (not an optometrist).
Again, if your child has motion sickness, they most likely do NOT have a problem with their eyes. Amblyopia, strabismus, and refractive error are common eye problems in children that can lead to problems seeing clearly. Nystagmus is uncommon in children, but perhaps more likely to be related to motion sickness. 
 
Strabismus: Strabismus is any misalignment of the eyes.  Crossing (esotropia), outward deviation (exotropia) or vertical misalignments (hypertropia) are the most common forms.
 
Amblyopia: Amblyopia is decreased vision in one or both eyes due to abnormal early childhood development of vision.  This can be due to strabismus, focusing issues or obstruction of vision (ei cataract, droopy eyelid).
 
Refractive Error:  The eye works much like a camera.  If the image is not in focus when it gets to the retina (the "film") of the eye, there is a refractive error.  Near-sightedness (myopia), far-sightedness (hyperopia) and astigmatism are common refractive errors.
 
Nystagmus: Nystagmus is involuntary shaking of the eyes. 
 

www.AAPOS.org is an excellent resource for those concerned about their children's eyes.

Note: "Behavioral Vision Therapy", which is touted as a cure for many problems, is not scientifically proven--especially for reading issues, learning disabilities and motion sickness.

Medicines work best when given before travel - as they won't work as well, or at all, once the child already feels sick.

Scopolamine

The most effective medicine for the prevention of motion sickness is Scopolamine - typically administered as a patch that is applied several hours before travel. However, Scopolamine is typically not recommended for kids under 10 years of age. The most common side effects are a very dry mouth and dilated pupils (hard to read, sensitive to light - like when you get your eyes dilated at the eye doctor).

1st Generation Anti-Histamines

Although sedating, these medicines can be effective at preventing motion sickness.

Moderately Effective: Promethazine (Phenergan), Cinnarizine

Least Effective: Meclizine (Antivert), Diphenhydramine (Benadryl), Dimenhydrinate (Dramamine), Cyclizine (Marezine)

Before giving your child medicine, please discuss with your pediatrician.

Non-sedating antihistamines (Claritin, Zyrtec), Ondansetron (Zofran), and ginger root are not effective in the prevention and treatment of motion sickness.

You can read more about what is and is not effective for motion sickness in this review article here.

A recent study of adults with nausea in an Emergency Room found that sniffing rubbing alcohol pads was just as effective as Zofran (the anti-nausea medication Ondansetron) at reducing nausea. On average the patients rated their nausea as 5 out of 10 (1 being very little nausea, 10 being the worst) before treatment and 2 out of 10 after sniffing the alcohol or being given the Zofran. It is not known if alcohol can help with motion sickness - but its worth a try since alcohol pads are cheap (get them at your local CVS, Rite Aid, etc) and easy to keep handy. Just make sure the child doesn't try to eat or suck the pad.

Accupressure bands worn on the wrist - like Seabands which come in children's sizes - may help some kids & adults. We've heard from quite a few parents who swear by these. Bigger kids & adults can also try PSIbands.

Below are the 2 most important features to look for in your next car to reduce the chance of your child feeling sick:

Functional 2nd Row Center Seat

Since a forward-facing child will feel best riding in the center seat, you'll want to make sure to get a vehicle that has a center seat in the 2nd row. This mean's you'll want to avoid captain's chairs in the 2nd row as you'll lose out on the best seat in the house (2nd row center).

But... just because the vehicle has a center seat, doesn't mean you'll be able to put your motion-sick child there. Surprisingly, the center seat of many vehicles is too narrow to accommodate a forward-facing car seat - and many are too narrow to even accommodate the narrowest backless booster. In our family vehicle buying guide we'll tell you whether a narrow backless booster fits in the center of the vehicle - if it doesn't, you'll want to pass on this vehicle as there won't be any way for a forward-facing child to ride in the center seat. We'll also tell you how wide the center seat is and whether the seat belt buckles are flexible or rigid - the wider the center seat, and the more flexible buckles there are, the greater your chance of fitting a forward-facing car seat or high back booster in the center. We'll also tell you if there is a head restraint in the center seat - as if there isn't, you can't put a child in a backless booster or an older child/adult there as they are at risk for severe whiplash. If there is a head restraint, we'll let you know if it is removable - as some head restraints protrude and interfere with the proper fit of forward-facing car seats and high back boosters, but you can get around this issue if the head restraint is removable. 

Adaptive Cruise Control with Stop and Go

https://youtu.be/hefNqVVEn-w

The video above shows a Volkswagen Golf with Adaptive Cruise Control with Stop & Go (for traffic jams).

Adaptive Cruise Control (ACC) is available on a growing number of newer cars (starting around 2014) and is one of the early steps towards autonomous driving. Just like regular cruise control, with ACC you set the speed you want to maintain. The difference is that with ACC you also set your following distance - basically telling the car how aggressive of a driver you want it to be. ACC not only maintains your set speed, but if traffic in front of you slows down ACC will slow your car down to maintain your desired following distance. Once the ACC detects that there is sufficient following distance, your car will accelerate to go back up your desired speed. 

Those who get motion sick will be the first to tell you that some drivers make them feel much sicker than others - particularly due to how the driver accelerates and brakes. ACC is the most gentle driver of all - as the car can accelerate and brake much smoother than a human can. And a gentle ride is a ride where you are less likely to feel sick. 

All car manufacturers' ACC works a little differently. Many versions of ACC only work at set speeds above 25-35mph. This means that many will NOT work for driving around town. Many versions also shut off when the car goes below a certain speed - meaning that if you are on the highway and find yourself in stop and go traffic, the ACC won't work. However, some versions have ACC with Stop and Go - which means that the ACC will continue to work even in the worst highway traffic jam where you are sometimes at a complete standstill.

Ever felt like losing your lunch in stop and go traffic - with all the constant lurching forward and back as the driver speeds up and slows down every few seconds? We can't get you out of a traffic jam, but ACC with Stop and Go can decrease the lurching your body experiences in stop and go traffic because the car is a much smoother driver than a human. ACC with Stop and Go can be a godsend for those who get motion sick. 

Our Family Vehicle Buying Guide includes a column that says whether the vehicle's ACC does Stop and Go or not

Click here to learn more about Adaptive Cruise Control. 

Make sure to keep the car on the cooler side. Don't overdress your child as overheating will make your child more likely to feel sick. 

When choosing your child's car seat, try and avoid black as black will absorb heat and make the child hotter than lighter colors. Fabrics that feel like they will easily wipe down are also likely to make the child sweat more than some of the other car seat fabrics.

An evaporative cooling towel is an inexpensive and easy way of keeping a child cool. The Frogg Toggs Chilly Pad cooling towel costs about $10 and does a great job. Just wet the towel and it will feel cool for an hour or more. Even though the towel is wet, it won't make the child or the car seat all wet.

Many vehicles have no vents for the back seat and as a result very poor airflow in back. A Noggle is a great solution. It uses dryer vent tubing (that they cover in fabric so it isn't hideous) that connects to one of the air vents in the front seat and brings the cold air from the A/C directly to the child in back. You can either hang the Noggle from one of the handles on the roof of the car, or allow the child to hold it so they can better control the air blowing on them.  

2-year-old rear-facing using Noggle to stay cool


Because cleaning vomit out of car seats - particularly the straps - is a parenting nightmare, we suggest having your prone-to-puking child wear a bib/smock OVER the straps to keep the car seat and themselves nice and clean should the grossness happen. AFTER your child is buckled snug, put the bib/smock on them... then if the gross stuff happens, the gross part only gets on the bib.

The Neat N' Cozy (what we affectionately call a "puking poncho") is made of soft terry cloth, cleans easily in the washing machine, and is comfortable for kids to wear even on long car trips. The Neat N' Cozy snaps around the child's neck and has a snap up pocket to help catch any vomit that might try to run down. Many families tell us how indispensable these have become in their travel with a motion sick child - letting them know that the child and car seat will stay clean even if the child vomits - as all they have to do is roll it up, unsnap it, and throw it in the washing machine. 

The Bumkins Super-Sized SuperBib is under $10 and should do the trick nicely - and has a small pouch that may help catch some of the vomit that tries to run down.  

Another full-coverage bib is the Bib-On. We'd suggest using it without the sleeves (they are detachable) to keep your child cooler in the car. 

How to Clean a Car Seat

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