Patient Presentation
A 9-year-old female came to clinic for her health maintenance examination.
Her mother said that they would be travelling by airplane soon for a family vacation, and that in the past her daughter has had severe nausea with the airplane ride but no emesis, ataxia or headache.
The nausea resolved within a couple of hours, and the patient states that it is better if she can sleep. Her mother says that she looks pale during these episodes but does not sweat. The patient also says she is getting more nauseous during car rides since the family purchased a van.
She says it is is more difficult for her to look out the front window of the van. The patient does not have nausea with any other activities but she says she doesn’t like to go on the merry-go-round or swing on swings in general.
She has tried diphenhydramine (Benadryl®) in the past for long car trips which has helped her to sleep.
The past medical history, family history, and review of systems are normal.
The pertinent physical exam reveals a healthy female with normal growth parameters and neurological examination.
The diagnosis of motion sickness was made. The family was advised to try to position the patient in the car so she can look out the window into the distance. For long car rides and airplane rides, they were advised to try the diphenhydramine as it has been effective in the past. An alternative was to use dimenhydrinate (Dramamine®).
The physician also recommended that the patient try to avoid being too cold or hot as these could also irritate the patient and possible increase the nausea. Also small frequent amounts to eat such as nibbling on crackers could also possibly help.
Although the physician was unaware if they were effective in studies, he suggested trying ginger as this has been used by sailors for many years and also pressure point wrist bands that are put on acupuncture locations.
Discussion
Motion sickness is a common problem for many children. Young child often present with ataxia, but older children often have nausea and/or vomitting.
Additional symptoms include pallor, vertigo and sweats.
It is theoretically caused by problems integrating the body’s sensory systems, such as the visual and the vestibular pathways, which causes problems with the vestibular-cerebellar pathways and a resultant feeling of dizziness (i.e. lightheadedness), true vertigo (i.e. surrounding or self-spinning) and other symptoms as noted.
Learning Point
Treatment for motion sickness can be multifaceted.
Antihistamines such as dimenhydrinate can be helpful and work by preventing histamine response in sensory nerve endings and blood vessels. Another commonly used antihistamine is diphenhydramine. Meclizine (Antivert®) does not have a pediatric dosage for children under age 12 and is not recommended.
Anticholinergics work by central suppression of the vestibular-cerebellar pathways. Scopolamine is not recommended for children less than 12 years because of increased side effects and lack of clinical data.
Antidopaminergics are also not recommended because of the high incidence of extrapyramidal symptoms.
Studies have found that short-term use of ginger can be helpful for pregnancy-related nausea and emesis, but the studies are mixed on if it is helpful for nausea caused by motion sickness, surgery or chemotherapy.
How acupuncture or acupressure works is unknown but it may work by regulating the nervous system and neurochemistry, and therefore potentially could help with nausea. There is some data to support acupressure as an effective anti-nausea therapy.
Other treatments such as avoiding an activity (e.g. not riding on a merry-go-round), or trying to decrease the sensory input (e.g. sleeping through a car ride, or looking into the distance during a car ride to stabilize the visual input) may be helpful.
Questions for Further Discussion
1. What other complementary and alternative therapies are potentially beneficial for motion sickness?
2. How is migraine headache related to motion sickness?
Related Cases
- Disease
- Symptom/Presentation
- Age
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Information prescriptions for patients can be found at MEDLINEplus for these topics: Motion Sickness and Alternative Medicine
and at Pediatric Common Questions, Quick Answers for this topic: Motion Sickness
To view current news articles on this topic check Google News.
National Center for Complementary and Alternative Medicine. Acupuncture. Available from the Internet at: http://nccam.nih.gov/health/acupuncture/ (rev. 12/2004, cited 7/13/06).
National Center for Complementary and Alternative Medicine. Ginger. Available from the Internet at: http://nccam.nih.gov/health/ginger/index.htm (rev. 5/2006, cited 7/13/06).
Friedman M, Hamid M. Dizziness, Vertigo and Imbalance. eMedicine.
Available from the Internet at http://www.emedicine.com/neuro/topic693.htm (rev. 5/30/2006, cited 7/13/2006).
Stauffer WM, Konop RJ, Kamat D. Traveling with Infants and Young Children Part I: Anticipatory Guidance: Travel Preparation and Preventive Health Advice. J. Travel Med, 2001;8:254-259.
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effecively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
5. Patients and their families are counseled and educated.
8. Health care services aimed at preventing health problems or maintaining health are provided.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
24. Cost-effective health care and resource allocation that does not compromise quality of care is practiced.
Author
Donna M. D’Alessandro, MD
Associate Professor of Pediatrics, Children’s Hospital of Iowa
Date
July 31, 2006
Pediatric Education 