Prevention and treatment of motion sickness in children

Motion sickness is a normal and transient response to unfamiliar or unnatural motion stimuli. The most common form of motion sickness in children appears to be car or bus sickness (travel sickness), and that produced by amusement park rides. An explanation for the causation and pathogenesis of motion sickness is provided by the neural mismatch and sensory rearrangement theory. This hypothesises that symptoms and signs of motion sickness are the result of a CNS response to unnatural motion stimuli transmitted to the vestibular nuclei, the archicerebellum, and to other brainstem, autonomic and hypothalamic areas. There are very few studies of motion sickness in children, and no controlled studies of its pharmacological treatment in the paediatric population. It is generally agreed that infants are highly resistant to motion sickness and do not require pharmacological treatment. Susceptibility then increases with age, peaking at around 10 to 12 years. If the nonpharmacological measures designed to reduce neural sensory mismatch are insufficient to ameliorate motion sickness, the use of pharmacological treatment is advised. All agents that have some central or peripheral vestibular suppressant effect, acting on relevant areas before motion impulses reach the vomiting centre, will be effective in the prevention or active treatment of motion sickness. As motion sickness is a form of vertigo, it is not surprising that all anti-motion sickness drugs are considered antivertigo drugs. Antihistamines are the only drugs recommended for children. Cinnarizine, cyclizine, dimenhydrinate and promethazine, taken before departure, are all effective in the prevention of motion sickness. Rectal or parenteral administration are recommended for active treatment when signs of motion sickness have already appeared. The development of new anti-motion sickness and antivertigo agents, based on recent neurochemical data, seems to be a promising field of investigation. Any such investigation should include controlled studies in children.