Medication Safety and Efficacy for Motion Sickness in Children

Important Safety Considerations

Children under 6 years of age should not use over-the-counter antihistamines for motion sickness due to potential toxicity and safety concerns, as recommended by the American Academy of Allergy, Asthma, and Immunology 1
The FDA advisory committees have recommended against using OTC cough and cold medications, including antihistamines, in children under 6 years due to safety concerns and reported fatalities, with a high strength of evidence 1
Between 1969 and 2006, there were 69 fatalities associated with three antihistamines in children under 6 years, with 41 reported in children under 2 years, highlighting the need for caution 1

For children who cannot take antihistamines, non-pharmacological approaches, such as distraction techniques, audio-visual entertainment, and relaxation methods, should be considered first, as suggested by the European Society of Nuclear Medicine 2

Second-generation antihistamines have been shown to be well-tolerated with a good safety profile in young children, though their efficacy for motion sickness is limited, according to the American Academy of Allergy, Asthma, and Immunology 1

Combining multiple motion sickness medications can lead to overdose errors and increased risk of adverse effects, as warned by the American Academy of Allergy, Asthma, and Immunology 1
Long-term use of vestibular suppressant medications can interfere with natural adaptation to motion and should be avoided, as advised by the American Academy of Pediatrics 3

The American Academy of Otolaryngology-Head and Neck Surgery suggests that antihistamines work by suppressing the central emetic center to relieve nausea and vomiting associated with motion sickness, with first-generation antihistamines preventing motion sickness symptoms in approximately 40% of susceptible individuals compared to 25% with placebo (moderate-certainty evidence) 4
The Centers for Disease Control and Prevention recommends avoiding the administration of aspirin or aspirin-containing products to children ≤18 years with nausea/vomiting due to the risk of Reye's syndrome 5, 6

The American Academy of Otolaryngology-Head and Neck Surgery advises against long-term use of vestibular suppressant medications, as they interfere with central compensation in peripheral vestibular conditions and prevent natural adaptation to motion 4

The American Academy of Pediatrics recommends watching for paradoxical behavioral disinhibition, especially in younger children, when using antihistamines for motion sickness 7

Close monitoring is necessary for sedation, which occurs in approximately 66% of patients on antihistamines, and for anticholinergic side effects including blurred vision and cognitive impairment, although the specific citation for this fact is not provided, a similar warning is given for antihistamine use in children 7

The American Gastroenterological Association recommends dimenhidrato, an antihistamine, for the prevention and treatment of nausea, vomiting, and motion sickness, as it acts by suppressing the central emetic center to relieve nausea and vomiting associated with motion sickness 8
The American College of Obstetricians and Gynecologists considers dimenhidrato a safe first-line pharmacologic antiemetic therapy if needed, for nausea and vomiting during pregnancy, with a strength of evidence considered high 9

The American College of Obstetricians and Gynecologists also recommends that antagonists of the H1 receptor, such as dimenhidrato, are considered safe for persistent nausea and vomiting of pregnancy refractory to non-pharmacologic therapy, with a strength of evidence considered moderate 9