travel vomiting medicine name for child

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Motion Sickness

Motion sickness happens when the movement you see is different from what your inner ear senses. This can cause dizziness, nausea, and vomiting. You can get motion sick in a car, or on a train, airplane, boat, or amusement park ride. Motion sickness can make traveling unpleasant, but there are strategies to prevent and treat it.

Preventing motion sickness without medicine

Avoiding situations that cause motion sickness is the best way to prevent it, but that is not always possible when you are traveling. The following strategies can help you avoid or lessen motion sickness.

Sit in the front of a car or bus.
Choose a window seat on flights and trains.
If possible, try lying down, shutting your eyes, sleeping, or looking at the horizon.
Stay hydrated by drinking water. Limit alcoholic and caffeinated beverages.
Eat small amounts of food frequently.
Avoid smoking. Even stopping for a short period of time helps.
Try and distract yourself with activities, such as listening to music.
Use flavored lozenges, such as ginger candy.

Using medicines for motion sickness

Medicines can be used to prevent or treat motion sickness, although many of them cause drowsiness. Talk to a healthcare professional to decide if you should take medicines for motion sickness. Commonly used medicines are diphenhydramine (Benadryl), dimenhydrinate (Dramamine), and scopolamine.

Special Consideration for Children

Motion sickness is more common in children ages 2 to 12 years old.

Some medicines used to prevent or treat motion sickness are not recommended for children. Talk to your healthcare professional about medicines and correct dosing of medicines for motion sickness for children. Only give the recommended dosage.

Although motion sickness medicines can make people sleepy, it can have the opposite effect for some children, causing them to be very active. Ask your doctor if you should give your child a test dose before traveling.

More Information

Motion Sickness in CDC Yellow Book

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ANDREW BRAINARD, MD, MPH, AND CHIP GRESHAM, MD

Am Fam Physician. 2014;90(1):41-46

Patient information : See related handout on motion sickness , written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Motion sickness is a common syndrome that occurs upon exposure to certain types of motion. It is thought to be caused by conflict between the vestibular, visual, and other proprioceptive systems. Although nausea is the hallmark symptom, it is often preceded by stomach awareness, malaise, drowsiness, and irritability. Early self-diagnosis should be emphasized, and patients should be counseled about behavioral and pharmacologic strategies to prevent motion sickness before traveling. Patients should learn to identify situations that will lead to motion sickness and minimize the amount of unpleasant motion they are exposed to by avoiding difficult conditions while traveling or by positioning themselves in the most stable part of the vehicle. Slow, intermittent exposure to the motion can reduce symptoms. Other behavioral strategies include watching the true visual horizon, steering the vehicle, tilting their head into turns, or lying down with their eyes closed. Patients should also attempt to reduce other sources of physical, mental, and emotional discomfort. Scopolamine is a first-line medication for prevention of motion sickness and should be administered transdermally several hours before the anticipated motion exposure. First-generation antihistamines, although sedating, are also effective. Nonsedating antihistamines, ondansetron, and ginger root are not effective in the prevention and treatment of motion sickness.

Motion sickness is a syndrome that occurs when a patient is exposed to certain types of motion and usually resolves soon after its cessation. It is a common response to motion stimuli during travel. Although nausea is a hallmark symptom, the syndrome includes symptoms ranging from vague malaise to completely incapacitating illness. These symptoms, which can affect the patient's recreation, employment, and personal safety, can occur within minutes of experiencing motion and can last for several hours after its cessation.

Nearly all persons will have symptoms in response to severe motion stimuli, and a history of motion sickness best predicts future symptoms. 1 Females, children two to 15 years of age, and persons with conditions associated with nausea (e.g., early pregnancy, migraines, vestibular syndromes) report increased susceptibility.

The pathogenesis of motion sickness is not clearly understood, but it is thought to be related to conflict between the vestibular, visual, and other proprioceptive systems. 2 Rotary, vertical, and low-frequency motions produce more symptoms than linear, horizontal, and high-frequency motions. 1

Clinical Presentation

Although nausea may be the first recognized symptom of motion sickness, it is almost always preceded by other subtle symptoms such as stomach awareness (i.e., a sensation of fullness in the epigastrium), malaise, drowsiness, and irritability. Failure to attribute early symptoms to motion sickness may lead to delays in diagnosis and treatment. Although mild symptoms are common, severely debilitating symptoms are rare 2 ( Table 1 1 , 2 ) .

Behavioral Interventions

Prevention of motion sickness is more effective than treating symptoms after they have occurred. Therefore, patients should learn to identify situations that may lead to motion sickness and be able to initiate behavioral strategies to prevent or minimize symptoms 1 , 2 ( Table 2 1 – 13 ) .

MINIMIZE VESTIBULAR MOTION

Patients should be advised to avoid traveling in difficult weather conditions. If they must travel, they should sit in the part of the vehicle with the least amount of rotational and vertical motion. 2 This is usually the lowest level in trains and buses, close to water level and in the center of boats, and over the wing on airplanes.

HABITUATE TO MOTION

With continuous exposure to motion, symptoms of motion sickness will usually subside in one to two days. Alternatively, slow, intermittent habituation to motion is an effective strategy to reduce symptoms. 1 For example, spending the first night aboard a boat in the marina, followed by a day acclimating in the harbor, is preferable to going straight into the open ocean.

SYNCHRONIZE THE VISUAL SYSTEM WITH THE MOTION

A small study found that focusing on the true horizon (skyline) minimized symptoms of motion sickness. 5 A survey of 3,256 bus passengers suggested that forward vision was helpful in reducing symptoms. 3 Another study indicated that forward vision in a car can reduce symptoms. 4

ACTIVELY SYNCHRONIZE THE BODY WITH THE MOTION

Actively steering the vehicle is an accepted strategy for reducing symptoms of motion sickness, although evidence is limited. 7 Additionally, a small study of automobile passengers found that actively tilting the head into turns was effective in preventing symptoms. 6 A survey of 260 cruise ship passengers supported the common advice to recline and passively stabilize themselves if they are unable to initiate active movements. 8

REDUCE OTHER SOURCES OF PHYSICAL, MENTAL, AND EMOTIONAL DISCOMFORT

Frequent consumption of light, soft, bland, low-fat, and low-acid food can minimize symptoms of motion sickness. 2 Treating gastritis is useful, 2 as is avoiding nausea-inducing stimuli (e.g., alcohol, noxious odors). Discussing symptoms with others can exacerbate the condition. Passengers should be well rested, well hydrated, well fed, and comfortable before beginning travel. Small studies have shown that cognitive behavior therapy, mindful breathing, and listening to music may also reduce symptoms of motion sickness. 9 , 10 , 13

Medications

Medications are most effective when taken prophylactically before traveling, or as soon as possible after the onset of symptoms 2 ( Table 3 1 , 2 , 14 – 23 ) . Medications are most effective when combined with behavioral strategies. To familiarize themselves with common side effects, patients should first take medications in a comfortable environment before using them for motion sickness during travel.

SCOPOLAMINE

Scopolamine, an anticholinergic, is a first-line option for preventing motion sickness in persons who wish to maintain wakefulness during travel. 2 , 20 , 24 A Cochrane review of 14 randomized controlled trials (RCTs) showed that scopolamine is effective for the prevention of motion sickness. 14 A more recent RCT of 76 naval crew members showed that transdermal scopolamine is more effective and has fewer side effects than the antihistamine cinnarizine (not available in the United States). 15 If the recommended dose of scopolamine does not adequately relieve symptoms, the dose may be doubled. Adding a second patch of transdermal scopolamine was well tolerated in a small RCT of 20 sailors. 25

ANTIHISTAMINES

First-generation antihistamines have been used to treat motion sickness since the 1940s. 1 They are generally recommended for patients who can tolerate their sedative effects. 2 , 20 Cyclizine (Marezine), dimenhydrinate, promethazine, and meclizine (Antivert) demonstrated effectiveness in small RCTs of varying quality. 16 – 19 Nonsedating antihistamines are not effective in preventing or treating motion sickness. 26

OTHER MEDICATIONS

Benzodiazepines are occasionally administered for severe symptoms of motion sickness and have been proven effective in a single small study. 27 The serotonin agonist rizatriptan (Maxalt) reduced motion sickness symptoms in a single RCT of 25 patients with recurrent migraines. 28 The serotonin antagonist ondansetron (Zofran) is ineffective for the prevention and treatment of motion sickness. 29 , 30

COMPLEMENTARY AND ALTERNATIVE THERAPIES

Although ginger root is often reported to prevent motion sickness, it had no statistically significant effects in an RCT of 80 naval cadets. 31 A single RCT of pregnant women showed that stimulation of the P6 acupressure point on the anterior wrist increased their tolerance of motion stimuli. 32 Controlled trials of behavioral, pharmacologic, or alternative therapies for motion sickness have demonstrated strong placebo effects. Therefore, treatments are likely to be most effective if the patient believes that they will work. 11 , 12

Data Sources : PubMed was searched using the MeSH headings motion sickness, ships, movement, space motion sickness, and travel. Additional searches were performed in Essential Evidence Plus, UpToDate, Medscape, and BMJ Clinical Evidence. Search dates: March 2012 through March 2014.

Golding JF. Motion sickness susceptibility. Auton Neurosci. 2006;129(1–2):67-76.

Shupak A, Gordon CR. Motion sickness: advances in pathogenesis, prediction, prevention, and treatment. Aviat Space Environ Med. 2006;77(12):1213-1223.

Turner M, Griffin MJ. Motion sickness in public road transport: the relative importance of motion, vision and individual differences. Br J Psychol. 1999;90(pt 4):519-530.

Griffin MJ, Newman MM. Visual field effects on motion sickness in cars. Aviat Space Environ Med. 2004;75(9):739-748.

Bos JE, MacKinnon SN, Patterson A. Motion sickness symptoms in a ship motion simulator: effects of inside, outside, and no view. Aviat Space Environ Med. 2005;76(12):1111-1118.

Wada T, Konno H, Fujisawa S, Doi S. Can passengers' active head tilt decrease the severity of carsickness? Effect of head tilt on severity of motion sickness in a lateral acceleration environment. Hum Factors. 2012;54(2):226-234.

Rolnick A, Lubow RE. Why is the driver rarely motion sick? The role of controllability in motion sickness. Ergonomics. 1991;34(7):867-879.

Gahlinger PM. Cabin location and the likelihood of motion sickness in cruise ship passengers. J Travel Med. 2000;7(3):120-124.

Dobie TG, May JG. The effectiveness of a motion sickness counselling programme. Br J Clin Psychol. 1995;34(pt 2):301-311.

Yen Pik Sang FD, Billar JP, Golding JF, Gresty MA. Behavioral methods of alleviating motion sickness: effectiveness of controlled breathing and a music audiotape. J Travel Med. 2003;10(2):108-111.

Horing B, Weimer K, Schrade D, et al. Reduction of motion sickness with an enhanced placebo instruction: an experimental study with healthy participants. Psychosom Med. 2013;75(5):497-504.

Eden D, Zuk Y. Seasickness as a self-fulfilling prophecy: raising self-efficacy to boost performance at sea. J Appl Psychol. 1995;80(5):628-635.

Denise P, Vouriot A, Normand H, Golding JF, Gresty MA. Effect of temporal relationship between respiration and body motion on motion sickness. Auton Neurosci. 2009;151(2):142-146.

Spinks A, Wasiak J. Scopolamine (hyoscine) for preventing and treating motion sickness. Cochrane Database Syst Rev. 2011;6:CD002851.

Gil A, Nachum Z, Tal D, Shupak A. A comparison of cinnarizine and transdermal scopolamine for the prevention of seasickness in naval crew: a double-blind, randomized, crossover study. Clin Neuropharmacol. 2012;35(1):37-39.

Estrada A, LeDuc PA, Curry IP, Phelps SE, Fuller DR. Airsickness prevention in helicopter passengers. Aviat Space Environ Med. 2007;78(4):408-413.

Brand JJ, Colquhoun WP, Gould AH, Perry WL. (—)-Hyoscine and cyclizine as motion sickness remedies. Br J Pharmacol Chemother. 1967;30(3):463-469.

Weinstein SE, Stern RM. Comparison of marezine and dramamine in preventing symptoms of motion sickness. Aviat Space Environ Med. 1997;68(10):890-894.

Paul MA, MacLellan M, Gray G. Motion-sickness medications for aircrew: impact on psychomotor performance. Aviat Space Environ Med. 2005;76(6):560-565.

Sherman CR. Motion sickness: review of causes and preventive strategies. J Travel Med. 2002;9(5):251-256.

Zajonc TP, Roland PS. Vertigo and motion sickness. Part II: pharmacologic treatment. Ear Nose Throat J. 2006;85(1):25-35.

Gordon CR, Shupak A. Prevention and treatment of motion sickness in children. CNS Drugs. 1999;12(5):369-381.

McDonald K, Trick L, Boyle J. Sedation and antihistamines: an update. Review of inter-drug differences using proportional impairment ratios. Hum Psychopharmacol. 2008;23(7):555-570.

Nachum Z, Shupak A, Gordon CR. Transdermal scopolamine for prevention of motion sickness: clinical pharmacokinetics and therapeutic applications. Clin Pharmacokinet. 2006;45(6):543-566.

Bar R, Gil A, Tal D. Safety of double-dose transdermal scopolamine. Pharmacotherapy. 2009;29(9):1082-1088.

Cheung BS, Heskin R, Hofer KD. Failure of cetirizine and fexofenadine to prevent motion sickness. Ann Pharmacother. 2003;37(2):173-177.

McClure JA, Lycett P, Baskerville JC. Diazepam as an anti-motion sickness drug. J Otolaryngol. 1982;11(4):253-259.

Furman JM, Marcus DA, Balaban CD. Rizatriptan reduces vestibular-induced motion sickness in migraineurs. J Headache Pain. 2011;12(1):81-88.

Muth ER, Elkins AN. High dose ondansetron for reducing motion sickness in highly susceptible subjects. Aviat Space Environ Med. 2007;78(7):686-692.

Hershkovitz D, Asna N, Shupak A, Kaminski G, Bar R, Tal D. Ondansetron for the prevention of seasickness in susceptible sailors: an evaluation at sea. Aviat Space Environ Med. 2009;80(7):643-646.

Grøntved A, Brask T, Kambskard J, Hentzer E. Ginger root against seasickness. A controlled trial on the open sea. Acta Otolaryngol. 1988;105(1–2):45-49.

Alkaissi A, Ledin T, Odkvist LM, Kalman S. P6 acupressure increases tolerance to nauseogenic motion stimulation in women at high risk for PONV. Can J Anaesth. 2005;52(7):703-709.

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Motion sickness

Travel sickness.

Peer reviewed by Dr Hayley Willacy, FRCGP Last updated by Dr Colin Tidy, MRCGP Last updated 16 Mar 2023

Meets Patient’s editorial guidelines

In this series: Health advice for travel abroad Travelling to remote locations Ears and flying Jet lag Altitude sickness

Motion sickness (travel sickness) is common, especially in children. It is caused by repeated unusual movements during travelling, which send strong (sometimes confusing) signals to the balance and position sensors in the brain.

What causes motion sickness, how long does motion sickness last, motion sickness symptoms, how to stop motion sickness, natural treatments for motion sickness, motion sickness medicines, what can a doctor prescribe for motion sickness, what should i do if i'm actually sick, what is mal de debarquement syndrome.

Continue reading below

Motion sickness is a normal response to repeated movements, such as going over bumps or around in a circle, send lots of messages to your brain. If you are inside a vehicle, particularly if you are focused on things that are inside the vehicle with you then the signals that your eyes send to the brain may tell it that your position is not changing, whilst your balance mechanisms say otherwise.

Your balance mechanisms in your inner ears sense different signals to those that your eyes are seeing which then sends your brain mixed, confusing messages. This confusion between messages then causes people to experience motion sickness.

Is motion sickness normal?

Motion sickness is a normal response that anyone can have when experiencing real or perceived motion. Although all people can develop motion sickness if exposed to sufficiently intense motion, some people are rarely affected while other people are more susceptible and have to deal with motion sickness very often.

Triggers for motion sickness

Motion sickness can also be triggered by anxiety or strong smells, such as food or petrol. Sometimes trying to read a book or a map can trigger motion sickness. Both in children and adults, playing computer games can sometimes cause motion sickness to occur.

Motion sickness is more common in children and also in women. Fortunately, many children grow out of having motion sickness. It is not known why some people develop motion sickness more than others. Symptoms can develop in cars, trains, planes and boats and on amusement park rides, etc.

Symptoms typically go when the journey is over; however, not always. In some people they last a few hours, or even days, after the journey ends.

There are various symptoms of motion sickness including::

Feeling sick (nausea and vomiting).

Sweating and cold sweats.

Increase in saliva.

Headaches .

Feeling cold and going pale.

Feeling weak.

Some general tips to avoid motion sickness include the following.

Prepare for your journey

Don't eat a heavy meal before travelling. Light, carbohydrate-based food like cereals an hour or two before you travel is best.

On long journeys, try breaking the journey to have some fresh air, drink some cold water and, if possible, take a short walk.

For more in-depth advice on travelling generally, see the separate leaflets called Health Advice for Travel Abroad , Travelling to Remote Locations , Ears and Flying (Aeroplane Ear) , Jet Lag and Altitude Sickness .

Plan where you sit

Keep motion to a minimum. For example, sit in the front seat of a car, over the wing of a plane, or on deck in the middle of a boat.

On a boat, stay on deck and avoid the cafeteria or sitting where your can smell the engines.

Breathe fresh air

Breathe fresh air if possible. For example, open a car window.

Avoid strong smells, particularly petrol and diesel fumes. This may mean closing the window and turning on the air conditioning, or avoiding the engine area in a boat.

Use your eyes and ears differently

Close your eyes (and keep them closed for the whole journey). This reduces 'positional' signals from your eyes to your brain and reduces the confusion.

Don't try to read.

Try listening to an audio book with your eyes closed. There is some evidence that distracting your brain with audio signals can reduce your sensitivity to the motion signals.

Try to sleep - this works mainly because your eyes are closed, but it is possible that your brain is able to ignore some motion signals when you are asleep.

Do not read or watch a film.

It is advisable not to watch moving objects such as waves or other cars. Don't look at things your brain expects to stay still, like a book inside the car. Instead, look ahead, a little above the horizon, at a fixed place.

If you are the driver you are less likely to feel motion sickness. This is probably because you are constantly focused on the road ahead and attuned to the movements that you expect the vehicle to make. If you are not, or can't be, the driver, sitting in the front and watching what the driver is watching can be helpful.

Treat your tummy gently

Avoid heavy meals and do not drink alcohol before and during travelling. It may also be worth avoiding spicy or fatty food.

Try to 'tame your tummy' with sips of a cold water or a sweet, fizzy drink. Cola or ginger ale are recommended.

Try alternative treatments

Sea-Bands® are acupressure bands that you wear on your wrists to put pressure on acupressure points that Chinese medicine suggests affects motion sickness. Some people find that they are effective.

Homeopathic medicines seem to help some people, and will not make you drowsy. The usual homeopathic remedy is called 'nux vom'. Follow the instructions on the packet.

All the techniques above which aim to prevent motion sickness will also help reduce it once it has begun. Other techniques, which are useful on their own to treat motion sickness but can also be used with medicines if required, are:

Breathe deeply and slowly and, while focusing on your breathing, listening to music. This has been proved to be effective in clinical trials.

Ginger - can improve motion sickness in some people (as a biscuit or sweet, or in a drink).

There are several motion sickness medicines available which can reduce, or prevent, symptoms of motion sickness. You can buy them from pharmacies or, in some cases, get them on prescription. They work by interfering with the nerve signals described above.

Medicines are best taken before the journey. They may still help even if you take them after symptoms have begun, although once you feel sick you won't absorb medicines from the stomach very well. So, at this point, tablets that you put against your gums, or skin patches, are more likely to be effective.

Hyoscine is usually the most effective medicine for motion sickness . It is also known as scopolamine. It works by preventing the confusing nerve messages going to your brain.

There are several brands of medicines which contain hyoscine - they also come in a soluble form for children. You should take a dose 30-60 minutes before a journey; the effect can last up to 72 hours. Hyoscine comes as a patch for people aged 10 years or over. (This is only available on prescription - see below.) Side-effects of hyoscine include dry mouth , drowsiness and blurred vision.

Side-effects of motion sickness medicines

Some medicines used for motion sickness may cause drowsiness. Some people are extremely sensitive to this and may find that they are so drowsy that they can't function properly at all. For others the effects may be milder but can still impair your reactions and alertness. It is therefore advisable not to drive and not to operate heavy machinery if you have taken them. In addition, some medicines may interfere with alcohol or other medication; your doctor or the pharmacist can advise you about this.

Antihistamines

Antihistamines can also be useful , although they are not quite as effective as hyoscine. However, they usually cause fewer side-effects. Several types of antihistamine are sold for motion sickness. All can cause drowsiness, although some are more prone to cause it than others; for example, promethazine , which may be of use for young children on long journeys, particularly tends to cause drowsiness. Older children or adults may prefer one that is less likely to cause drowsiness - for example, cinnarizine or cyclizine.

Remember, if you give children medicines which cause drowsiness they can sometimes be irritable when the medicines wear off.

See the separate article called How to manage motion sickness .

There are a number of anti-sickness medicines which can only be prescribed by your doctor. Not all of them always work well for motion sickness, and finding something that works may be a case of trial and error. All of them work best taken up to an hour before your journey, and work less well if used when you already feel sick. See also the separate leaflet called Nausea (Causes, Symptoms, and Treatment) for more detailed information about these medicines .

Hyoscine patch

Hyoscine, or scopolamine, patches are suitable for adults and for children over 10 years old. The medicine is absorbed through your skin, although this method of medicine delivery is slow so the patch works best if applied well before your journey.

You should stick the patch on to the skin behind the ear 5-6 hours before travelling (often this will mean late on the previous night) and remove it at the end of the journey.

Prochlorperazine

Prochlorperazine is a prescription-only medicine which works by changing the actions of the chemicals that control the tendency to be sick (vomit), in your brain. One form of prochlorperazine is Buccastem®, which is absorbed through your gums and does not need to be swallowed. Buccastem® tastes rather bitter but it can be effective for sickness when you are already feeling sick, as it doesn't have to be absorbed by the stomach.

Metoclopramide

Metoclopramide is a tablet used to speed up the emptying of your tummy. Slow emptying of the tummy is something that happens when you develop nausea and vomiting, so metoclopramide can help prevent this. It prevents nausea and vomiting quite effectively in some people. It can occasionally have unpleasant side-effects, particularly in children (in whom it is not recommended). Metoclopramide is often helpful for those who tend to have gastric reflux, those who have slow tummy emptying because of previous surgery, and those who have type 1 diabetes. Your GP will advise whether metoclopramide is suitable for you.

Domperidone

Domperidone , like metoclopramide, is sometimes used for sickness caused by slow tummy emptying. It is not usually recommended for motion sickness but is occasionally used if other treatments don't help. Domperidone is not a legal medicine in some countries, including the USA.

Ondansetron

Ondansetron is a powerful antisickness medicine which is most commonly used for sickness caused by chemotherapy, and occasionally used for morning sickness in pregnancy. It is not usually effective for motion sickness. This, and its relatively high cost means that it is not prescribed for motion sickness alone. However, for those undergoing chemotherapy, and for those who have morning sickness aggravated by travel, ondansetron may be helpful.

If you're actually sick you may find that this relieves your symptoms a little, although not always for very long. If you've been sick:

Try a cool flannel on your forehead, try to get fresh air on your face and do your best to find a way to rinse your mouth to get rid of the taste.

Don't drink anything for ten to twenty minutes (or it may come straight back), although (very) tiny sips of very cold water, coke or ginger ale may help.

After this, go back to taking all the prevention measures above.

Once you reach your destination you may continue to feel unwell. Sleep if you can, sip cold iced water, and - when you feel ready - try some small carbohydrate snacks. Avoid watching TV (more moving objects to watch!) until you feel a little better.

The sensation called 'mal de debarquement' (French for sickness on disembarking) refers to the sensation you sometimes get after travel on a boat, train or plane, when you feel for a while as though the ground is rocking beneath your feet. It is probably caused by the overstimulation of the balance organs during your journey. It usually lasts only an hour or two, but in some people it can last for several days, particularly after a long sea journey. It does not usually require any treatment.

Persistent mal de debarquement syndrome is an uncommon condition in which these symptoms may persist for months or years.

Dr Mary Lowth is an author or the original author of this leaflet.

Article History

The information on this page is written and peer reviewed by qualified clinicians.

Next review due: 14 Mar 2028

16 mar 2023 | latest version.

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Anti-Nausea/Vomiting Medications

Other names: Nausea; Stomach Upset; Upset Stomach; Vomiting

Medically reviewed by Carmen Pope, BPharm . Last updated on Dec 1, 2023.

Anti-nausea and anti-vomiting medications are also known as anti-emetics. These drugs work by targeting the vomiting center in the brain, blocking signaling pathways, or inhibiting stimulation of the GI tract, diaphragm, or abdominal muscles.

There are several types of anti-nausea and vomiting drugs, including:

Dopamine receptor antagonists, such as prochlorperazine or metoclopramide . These are common and often target dopamine to help prevent it from binding to areas in the brain that trigger nausea and vomiting
H1 antihistamines or antimuscarinics, such as diphenhydramine , meclizine , or dimenhydrinate . These are effective for nausea and vomiting secondary to motion sickness and vertigo
Serotonin (5-HT3) antagonists, such as ondansetron , granisetron , dolasetron , or palonosetron . These are effective at controlling nausea and vomiting that has already started and work by blocking the effects of serotonin, a substance commonly associated with nausea and vomiting. They may be given before chemo and then for a few days afterward
NK-1 receptor antagonists, such as aprepitant , rolapitant , and fosaprepitant . These help with delayed nausea and vomiting and work by blocking the effects of the NK-1 receptor, which is part of the vomiting reflex. They’re often given in combination with other anti-nausea medicines.
Some steroids, such as dexamethasone , may be given with other anti-emetics for severe or anticipated nausea or vomiting in certain patients.
Benzodiazepines, such as lorazepam or alprazolam may also be used to help reduce anticipatory nausea and vomiting or nausea and vomiting caused by anxiety by helping the person feel more calm and relaxed. They are often used in combination with other anti-nausea drugs.
Cannabinoids (eg, dronabinol , nabilone ) may be used to reduce nausea and vomiting caused by chemo when other anti-emetics don’t work. They can also be used to stimulate appetite.
Olanzapine may also be useful for some people at reducing nausea and vomiting, especially in combination with other anti-emetics, although it can cause drowsiness.

Many of these medications are also available in combination and can help with both acute and delayed nausea and vomiting.

Drugs used to treat Nausea/Vomiting

The medications listed below are related to or used in the treatment of this condition.

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Motion Sickness (37 drugs)
Nausea/Vomiting of Pregnancy (5 drugs)
Nausea/Vomiting, Chemotherapy Induced (36 drugs)
Nausea/Vomiting, Postoperative (12 drugs)
Nausea/Vomiting, Radiation Induced (2 drugs)

Alternative treatments for Nausea/Vomiting

The following products are considered to be alternative treatments or natural remedies for Nausea/Vomiting. Their efficacy may not have been scientifically tested to the same degree as the drugs listed in the table above. However, there may be historical, cultural or anecdotal evidence linking their use to the treatment of Nausea/Vomiting.

Dramamine Non Drowsy

Learn more about Nausea/Vomiting

Motion Sickness Drugs and Alcohol Interactions

Symptoms and treatments

Medicine.com guides (external).

Nausea and vomiting Guide

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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Anti-Nausea Medicine: What Products Should I Use?

What causes nausea, common anti-nausea medications for adults, anti-nausea medications for kids, anti-nausea medication in pregnancy.

Most Effective Anti-Nausea Medications

When to See a Healthcare Provider

Nausea is an uncomfortable or “queasy” feeling with or without the urge to vomit. How to treat nausea can be determined by its cause. Both over-the-counter (OTC) and prescription medications are available to help prevent or relieve queasiness. This article will discuss available medicines for nausea on the market and how to choose the right one for you.

Getty Images / m-gucci

Nausea is an uncomfortable or “queasy” feeling with or without the urge to vomit. There are many causes of nausea. A person can experience nausea due to many different signals sent to the brain and throughout the body, and knowing the cause can help decide the best treatment.

Potential causes of nausea may include, but are not limited to:

Motion sickness : Motion sickness occurs when your body gets confused by mixed signals from your eyes, ears, and body. It often occurs during travel in cars, planes, boats, or amusement park rides.
Pregnancy : Nausea or morning sickness is a common symptom early in pregnancy. While the cause of morning sickness is still unknown, it may be due to changes in hormones, blood pressure, or metabolism. It may also be due to the physical changes that happen during pregnancy.
Viral infection : Gastroenteritis or the stomach flu is a virus that attacks the intestines. In this case, nausea lets your body know that something is not right.
Medications : Several medications may cause nausea as a side effect. Two common drug groups that cause nausea are chemotherapy and general anesthesia . A healthcare provider may administer preventative anti-nausea medications for postoperative nausea and vomiting (PONV) or chemotherapy-induced nausea and vomiting (CINV).
Gastrointestinal disorders : Peptic ulcer disease and gastroparesis can also cause nausea.

OTC and prescription medications are available for the treatment and prevention of nausea.

OTC Medications

Antihistamines help you feel better by blocking histamine and the "vomiting center" (also called the chemoreceptor trigger zone ) in the brain. It also decreases electrical signals sent to the ear.

There are several OTC antihistamines available, including:

Dramamine ( dimenhydrinate )
Dramamine Less Drowsy or Bonine ( meclizine)
Benadryl ( diphenhydramine )

While certain antihistamines can be effective in preventing motion sickness, newer antihistamine agents, such as Zyrtec, have no effect on nausea.

Prescription Medications

Antihistamines

Phenergan (promethazine) is a prescription-only antihistamine that can prevent or control nausea related to anesthesia or surgery .

Anticholinergics

Transderm Scop (scopolamine) is an anticholinergic medicine that prevents nausea and vomiting. It is a removable patch that is applied to the skin.

Anticholinergics work by blocking the transmission of acetylcholine. Acetylcholine is a chemical messenger (neurotransmitter) that attaches to the surface and activates the vomiting center in the body.

Anticholinergics like scopolamine are effective for:

Motion sickness
Prevention of nausea caused by general anesthesia from a surgical procedure

Dopamine Antagonists

Dopamine antagonists work by blocking dopamine in the vomiting center in the brain, They also block serotonin at high doses.

Reglan (metoclopramide) is a dopamine antagonist that treats nausea and vomiting due to gastroesophageal reflux disease (GERD) or diabetic gastroparesis . It can also help manage CINV.

Dopamine receptor antagonists are effective for:

Prevention of chemotherapy-related nausea or vomiting
Prevention and treatment of nausea caused by general anesthesia from a surgical procedure
Gastroparesis

Selective Serotonin Receptor (5-HT3) Antagonists

5-HT3 antagonists work by blocking serotonin in the vagal nerve and in the vomiting center in the brain.

Medications available include:

Ondansetron
Sancuso (granisetron)
Palonosetron

5-HT3 antagonists are effective for:

Other Anti-Nausea Agents

Other agents used for nausea are corticosteroids such as dexamethasone and methylprednisolone, antipsychotic medications like olanzapine and prochlorperazine, and Emend (aprepitant).

Anti-nausea medications have a place in treatment for children, but it is best to speak to a healthcare provider before starting. Anti-nausea drugs have different age cut-offs, doses, and side effects, so it's critical that the medication is appropriate and safe for the child's specific age and health condition.

Motion Sickness

Anti-nausea medications and the recommended age cut-offs (see package label or speak to your healthcare provider or pharmacist for actual doses):

Dramamine for Kids: Used for kids 2 years and older
Benadryl: Used for kids 6 and older
Dramamine Less Drowsy: Used for kids 12 and older
Phenergan and scopolamine (prescription only)

Post-Operative Nausea and Vomiting (PONV)

Commonly prescribed medications for the prevention of PONV are:

Dexamethasone
Metoclopramide

These medications can also be used for nausea associated with chemotherapy.

Nausea during pregnancy, or morning sickness, is treated using different techniques to reduce the symptoms and to make pregnancy more comfortable. Morning sickness is different in every person.

Mild to Moderate Morning Sickness

You can try the following methods to help relieve motion sickness symptoms:

Lifestyle and diet changes : Eating bland foods and drinking plenty of water. Get enough rest and avoid exhaustion.
Acupressure and acupuncture : Applying pressure to specific points on the body (acupressure) or receiving acupuncture treatment may help some pregnant people.
Avoid triggers : Triggers can vary from person to person. Know those triggers, and avoid smells or situations that trigger nausea.
Vitamin B6 supplements : Studies suggest vitamin B6 may reduce nausea during pregnancy.

Severe or Chronic Morning Sickness

In severe cases of morning sickness, see your healthcare provider for medications safe in pregnancy. Commonly prescribed medications include:

Dimenhydrinate
Promethazine
Doxylamine/pyridoxine

Always talk to your healthcare provider before starting a new treatment during pregnancy.

Which Anti-Nausea Medications Are the Most Effective?

Every person has a threshold for nausea that can change frequently. The threshold can differ from person to person, making some people more likely to experience nausea than others.

The three major ways nausea occurs are through electrical signals sent to the ear (also called vestibular stimulation), signals sent from internal organs (also called visceral stimuli), and signals to the “vomiting center” in the brain (also called the chemoreceptor trigger zone).

Each of these mechanisms is associated with chemical messengers (neurotransmitters). Knowing these helps your healthcare provider pick the best medicine for use.

Vestibular stimulation : Histamine and acetylcholine
Visceral stimuli: Dopamine and serotonin
Chemoreceptor trigger : Dopamine, serotonin, and substance p (also called neurokinin-1)

Motion sickness is associated with an increase in histamine and acetylcholine. Therefore, common medications used for motion sickness are antihistamines and anticholinergics.

On the other hand, gastroenteritis and PONV are associated with more dopamine and serotonin. Common medications for gastroenteritis and PONV are dopamine receptor antagonists and selective serotonin antagonists.

Anticholinergics and antihistamines are equally effective at preventing nausea related to motion sickness.

Gastroenteritis

A review of several studies showed that ondansetron is most effective compared with other anti-nausea agents for reducing vomiting associated with gastroenteritis. It is important to drink plenty of fluids to avoid dehydration.

Post-Operative Nausea and Vomiting

First-line treatments for PONV are usually ondansetron or dexamethasone. Both are equally effective.

Ondansetron is used often because of its low cost and mild side effects. However, it may lengthen the QT interval and should be used with caution in some people.

Dexamethasone has the added benefit of pain control along with its anti-nausea effects.

Chemotherapy-induced Nausea and Vomiting (CINV)

Treatment is tailored for each individual by how likely a chemotherapy agent is to cause nausea and vomiting. The provider may change the medications based on the individual's response.

If the chemotherapy has a more than 90% likelihood of causing nausea and vomiting (high risk): Emend (aprepitant), ondansetron, dexamethasone, and Zyprexa (olanzapine) are used in combination.
If the chemotherapy has a 30% to 90% likelihood of causing nausea and vomiting (moderate risk): Aprepitant, ondansetron, and dexamethasone may be used in combination.
If the chemotherapy has a less than 30% likelihood of causing nausea and vomiting (low risk): Ondansetron may be used alone in some cases.

In mild cases, nausea should resolve on its own. The use of OTC medications can help prevent or treat nausea related to certain triggers, like motion sickness. In other cases, such as for nausea related to a medication or illness, you may need to get a prescription from a healthcare provider for the right treatment.

Call your healthcare provider if you are pregnant and have severe nausea and vomiting or persistent vomiting with significant weight loss. You may be experiencing a more severe form of nausea and vomiting known as hyperemesis gravidarum .

Nausea is a common and uncomfortable feeling. However, there are several OTC and prescription products available that are effective at preventing or treating nausea, depending on its cause.

If you know what's causing your nausea, ask your pharmacist or healthcare provider about which medicine will be most appropriate for you. You can also read the product labels for available OTC medicines to understand their uses better.

You should consult your provider if you're experiencing nausea with no known cause, as they can help you get to the root of what's causing it.

Frequently Asked Questions

Dramamine is the fastest OTC anti-nausea medication available. It takes 15 to 30 minutes to work.

Dimenhydrinate, promethazine, doxylamine/pyridoxine and ondansetron are considered safe in pregnancy.

Yes, in some cases, Pepto-Bismol may help with nausea. It works by slowing the movement of water and electrolytes in the bowel, lowers inflammation, and kills bad bugs that can cause diarrhea. A person may feel less nausea when their nausea is related to a stomach flu.

The author would like to recognize and thank Norma Ponce, PharmD, MHA for contributing to this article.

Singh P, Yoon SS, Kuo B. Nausea: a review of pathophysiology and therapeutics . Therap Adv Gastroenterol . 2016;9(1):98-112. doi:10.1177/1756283X15618131

Flake ZA, Scalley RD, Bailey AG. Practical selection of antiemetics . Am Fam Physician . 2004;69(5):1169-1174.

Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the management of postoperative nausea and vomiting . Anesth Analg . 2020;131(2):411-448. doi:10.1213/ANE.0000000000004833

DailyMed. Label: Phenergan- promethazine hcl tablet .

Food and Drug Administration. Transderm Scop label .

Athavale A, Athavale T, Roberts DM. Antiemetic drugs: what to prescribe and when. Aust Prescr . 2020;43(2):49-56. doi:10.18773/austprescr.2020.011

DailyMed. Label: Reglan- metoclopramide hydrochloride tablet .

Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L; American College of Gastroenterology. Clinical guideline: management of gastroparesis . Am J Gastroenterol . 2013;108(1):18-37; quiz 38. doi:10.1038/ajg.2012.373

DailyMed. Label: Ondansetron tablet, film coated .

Brown A. Motion Sickness . CDC Yellow Book 2023 .

DailyMed. Label: Dramamine for Kids- dimenhydrinate tablet, chewable .

DailyMed. Label: Dramamine Less Drowsy- meclizine hydrochloride tablet .

National Cancer Institute. Nausea and vomiting related to cancer treatment (PDQ)–health professional version .

Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 189: nausea and vomiting of pregnancy . Obstet Gynecol . 2018;131(1):e15-e30. doi:10.1097/AOG.0000000000002456

Sridharan K, Sivaramakrishnan G. Interventions for treating nausea and vomiting in pregnancy: a network meta-analysis and trial sequential analysis of randomized clinical trials . Expert Rev Clin Pharmacol . 2018;11(11):1143-1150. doi:10.1080/17512433.2018.1530108

Jayawardena R, Majeed S, Sooriyaarachchi P, Abeywarne U, Ranaweera P. The effects of pyridoxine (vitamin B6) supplementation in nausea and vomiting during pregnancy: a systematic review and meta-analysis . Arch Gynecol Obstet . 2023;308(4):1075-1084. doi:10.1007/s00404-023-06925-w

McParlin C, O'Donnell A, Robson SC, et al. Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review . JAMA . 2016;316(13):1392-1401. doi:10.1001/jama.2016.14337

Flake ZA, Linn BS, Hornecker JR. Practical selection of antiemetics in the ambulatory setting. Am Fam Physician . 2015;91(5):293-296.

Carter B, Fedorowicz Z. Antiemetic treatment for acute gastroenteritis in children: an updated Cochrane systematic review with meta-analysis and mixed treatment comparison in a Bayesian framework . BMJ Open . 2012;2(4):e000622. doi:10.1136/bmjopen-2011-000622

Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update . J Clin Oncol . 2017;35(28):3240-3261. doi:10.1200/JCO.2017.74.4789

Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: ASCO guideline update . J Clin Oncol . 2020;38(24):2782-2797. doi:10.1200/JCO.20.01296

PubChem. Dimenhydrinate .

Brum JM, Gibb RD, Ramsey DL, Balan G, Yacyshyn BR. Systematic review and meta-analyses assessment of the clinical efficacy of bismuth subsalicylate for prevention and treatment of infectious diarrhea . Dig Dis Sci . 2021;66(7):2323-2335. doi:10.1007/s10620-020-06509-7

Intermittent Fasting

Pre-Exposure Prophylaxis (PrEP)

Antiemetic medicines: otc relief for nausea and vomiting.

Last Updated August 2022 | This article was created by familydoctor.org editorial staff and reviewed by Leisa Bailey, MD

Over-the-counter (OTC) medicines are medicines you can buy without a prescription from your doctor. Medicines that treat nausea and vomiting are called antiemetics. Several OTC medicines are used as antiemetics. These include:

Bismuth subsalicylate (2 brand names: Kaopectate, Pepto-Bismol). This medicine may help treat some types of nausea and vomiting, such as from gastroenteritis (stomach flu). They are also used for upset stomachs and as an antidiarrheal (medicine to treat diarrhea).
Antihistamines . Certain types may help prevent nausea and vomiting caused by motion sickness. These include dimenhydrinate (brand name: Dramamine) and meclizine hydrochloride (brand name: Dramamine Less Drowsy).

Stomach viruses are easy to catch and can make you feel miserable. For mild cases, I recommend simple home treatment. Read More

by Dr. Shilpa Mehta

Path to improved health

How do antiemetic medicines work.

Bismuth subsalicylate works by protecting the stomach lining.

Antihistamines appear to dull the inner ear’s ability to sense motion. They block messages to the part of the brain that controls nausea and vomiting. This is why they work best if you take them before you start feeling motion sickness.

How do I safely take OTC antiemetic medicines?

Before you take an OTC antiemetic medicine, read the directions on the drug facts label. This will tell you how much medicine to take and how often to take it. If you have any questions, call your family doctor. Keep a record of which OTC medicines you’re using and when you take them. If you need to go to the doctor, take this list with you.

If you are pregnant, do not take any OTC antiemetic medicines without first contacting your doctor.

Follow these tips to make sure you are taking the right amount of medicine:

Take only the amount recommended on the medicine’s label. Don’t assume that more medicine will work better or quicker. Taking more than the recommended amount can be dangerous.
If you’re taking a prescription medicine, ask your doctor if it’s okay to also take an OTC antiemetic medicine.
Don’t use more than 1 kind of OTC antiemetic medicine at a time unless your doctor says it’s okay. They may have similar active ingredients. These could add up to be too much medicine.

How can I safely store OTC antiemetic medicines?

Store all medicines up and away, out of reach and sight of young children. Keep medicines in a cool, dry place. This will help prevent them from becoming less effective. Don’t store medicines in bathrooms or bathroom cabinets. These locations are often hot and humid.

Things to consider

Healthy adults usually don’t experience side effects from antiemetic medicines. Side effects can be a concern for older adults or people who have health problems.

The most common side effects of bismuth subsalicylate are:

Darkened stools or tongue
Constipation
Ringing sound in the ears (tinnitus)

These are short-term side effects.

Antihistamines may make you feel sleepy. This can affect your ability to drive or operate machines. It may be hard for you to think clearly. Alcohol can increase the drowsiness caused by antihistamines. They may also cause your mouth and eyes to feel dry.

Who shouldn’t take OTC antiemetic medicines?

Some people are allergic to aspirin or other salicylate medicines. They shouldn’t take bismuth subsalicylate. Don’t give bismuth subsalicylate to children 12 years of age or younger. Don’t give it to children or teenagers who may have the flu or chickenpox. This increases their risk for Reye syndrome. This is a serious illness that can lead to death.

Before taking an antihistamine, talk to your doctor if you have any of the following problems:

Trouble urinating (from an enlarged prostate gland)
Breathing problems, such as asthma, emphysema, or chronic bronchitis
Thyroid disease
Heart disease
High blood pressure

Can OTC antiemetic medicines cause problems with any other medicines I take?

Bismuth subsalicylate may affect how well some medicines work. It also may cause side effects if combined with other medicines. Ask your doctor before taking bismuth subsalicylate if you also take:

Blood-thinning medicines
Medicines for gout
Medicines for arthritis
Medicines for diabetes

Ask your doctor before taking bismuth subsalicylate if you take pain relievers or cold medicines. These medicines may contain aspirin, which is a salicylate. You may get too much salicylate if you take more than 1 of these medicines at a time.

Talk to your doctor before taking an antihistamine if you take sleeping pills, sedatives, or muscle relaxants. Many OTC cold and allergy medicines contain antihistamines. If you use more than 1 of these medicines, you may get more antihistamine than you intend.

Some prescription medicines have side effects similar to the side effects of antihistamines. These could include dry mouth and drowsiness. Talk with your doctor before taking these medicines at the same time.

Questions to ask your doctor

What kind of antiemetic medicine is best for me?
How does the medicine help my nausea?
How often can I take it?
Is there a limit on how many days I can take it?
What kinds of side effects should I look for?

Last Updated: August 10, 2022

This article was contributed by familydoctor.org editorial staff.

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

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Snotty Noses Happy Parents Raising Healthy Kids by Dr Orlena Kerek, Paediatrician

9 successful tips to avoid travel sickness in kids.

“My tummy aches!” complains Dante.

I turn and look at him, feeling queasy as I do so. He’s as pale as a sheet.

“Open the windows! Stop the car!” I cry.

Motion sickness runs in the family. I was always travel sick as a child. My middle son is also a frequent vomiter.

9 Successful Tips to Avoid Travel Sickness in Kids. Motion Sickness is just the worst, Here are some great tips to avoid car sickness in kids. Love the last one!

What Causes Travel or Motion Sickness?

The posh word is “kinetosis” but it’s the same as car sickness , sea sickness or air sickness .

Your body feels sick in response to being moved about too much.

There are many theories as to WHY exactly you should feel sick in response to movement (whether it is real movement or just perceived movement, such as when you go on a roller coster stimulator.)

Does your body think that it’s been poisoned and is hallucinating so vomits to get rid of the toxins? It’s a theory that no one has yet proven.

What we do know is that your vestibular system detects movement. Your inner ear has a system of little curvy fluid-filled canals, a bit like a 3D spirit level…you know those things carpenters put on a surface to see if they’re level.

The vestibular system sends signals to your brain that you’re moving and for some reason as yet unknown, your brain reacts by feeling sick.

In theory, if you can reduce those signals, you can reduce the feeling of motion sickness. If you can stop your brain thinking it’s moving, you should stop it from feeling sick.

Sometimes easier said than done.

Perceived Motion

I mentioned perceived motion such as when you’re in a roller coster stimulator. That feeling of whizzing by, can make car sickness in children worse. You know when you look out of the side window and see the world rushing by? Not great. Look out of the front and the world isn’t travelling so fast.

This effect is made worse by concentrating on something still inside the car, such as reading or watching a DVD, whilst you can still see the world whizzing past out of the corner of your eye. That corner of your eye, your peripheral vision, is a particularly sensitive visual area, so that you can see when you’re going to be pounced on. We notice things out of the corner of our eyes, even if we don’t really think about it.

Having personally suffered from motion sickness all my life and now helping my son, these are my best tips for avoiding it.

How to Avoid Motion Sickness.

Don’t read, write, watch TV or concentrate on things inside the car whilst you can see out of the window.
Closing your eyes sometimes helps (but not always)
Not too hot Don’t over dress them. Fresh cool air is great. (Open the windows when your kids start to complain.)
A position that allows you to see the front window is best. (Although I don’t like my children to sit in the middle seat as it’s less safe if you were to have an accident. It is easier to fly out of the front rather than hit the seat in front.)
Think about food . I personally find that car sickness is worse in the morning when I’m hungry and my tummy is empty. Strangely I find travelling after lunch with a full tummy much easier. Avoid lots of sweet sugar treats. Just stick to your healthy eating routine as normal.
Avoid strong smells in the car. (Ponky cheese and bananas are sure to trigger anyone’s car sickness.)
Have a bag ready , plus wipes, water and a change of clothes.
Neck . Personally I hate anything around my neck when I feel sick. I suspect it’s something to do with my gag reflex. Avoid polar neck jumpers, scarves and neck laces.
Be prepared to stop and get out of the car.
Sometimes you feel better after vomiting. The “let it all” approach!
Your car can make a difference. Some cars are better, or worse than others for enduring travel sickness. I know you can’t do much about it now, but something to bear in mind next time you buy one.

You can buy over the counter drugs for travel sickness . Personally I don’t bother but go chat to your pharmacist if you’d like to give them a try.

You can also buy a million different gadgets and gizmos that promise to cure you of motion sickness, from things that trail off your car, to pressure points on your wrists.

When there are a million different cures that “kind of work” I strongly suspect that they aren’t that great, but they might work for you so try them if you like.

We all clamber back in the car after an impromptu stop. (Our record being about 10 times on the 3 hour journey to grandma’s.) Dante is feeling better, we are all feeling happy.

During my childhood I was affectionately referred to as the “vomiter”. My dad used to tease me about writing a book called “Places I have vomited”. It appears the tradition has been passed on to my son. He is busy building child hood memories. As we drive up to grandma’s we play “spot the place we’ve stopped to let someone vomit”.

Travel sickness is unpleasant and as much as you can try to reduce the chances of it happening, it’s not a disaster when it does. Just remember to have a bag, wipes, water and clean clothes easily accessible.

“My tummy aches!” moans Dante.

We pull over as soon as we can, get out, stretch our legs and decide to eat our lunch. We clamber back into the crammed car, tummies full and less queasy. We are now pros at surviving road trips with kids and luckily this time we have avoided travel sickness , or at least travel vomiting.

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Vomiting in children

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Babies often bring up small amounts of food after feeding but this is different to vomiting.
Children vomit for many different reasons, but viral gastroenteritis is the most common cause.
If your baby or child is vomiting a lot, they may become dehydrated.
Vomiting is one of the most common reasons for taking your child to the doctor.
You can give your child small amounts of oral rehydration solution or plain water to keep them hydrated.

What is vomiting?

Vomiting is a very common symptom in children. It’s one of the most common reasons parents take their child to the doctor.

If your child is vomiting, the contents of their stomach is forced up through their mouth. Vomiting is also known as throwing up or being sick.

Babies often bring up small amounts of food after feeding — it’s known as posseting or reflux . It happens without any effort. This is in contrast to vomiting — which involves strong contractions of the muscles in their stomach.

Babies and children are especially at risk of dehydration when they are vomiting. This is when your child may not be able to take in enough fluids to make up for those lost from vomiting.

Your child may vomit for many different reasons. Viral gastroenteritis (‘gastro’) is the most common cause of sudden vomiting in children. Vomiting from viral gastroenteritis usually clears up in a couple of days.

What symptoms are related to vomiting in children?

Vomiting in children often happens with other symptoms, such as diarrhoea .

Other symptoms that can occur together with vomiting in children are:

nausea (feeling sick and feeling that you are about to vomit)
abdominal (tummy) pain
coughing or breathing problems

Children can also projectile vomit. Projectile vomiting is when they vomit out of their mouth so forcefully that it can travel over a metre.

CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

What causes vomiting in children?

Your child may be vomiting for a short time due to an infection. But vomiting in children can also be very serious or have a longer term cause.

Causes of vomiting in children include the following conditions:

gastroenteritis
food poisoning
urinary tract infections
Gastroenteritis

Gastroenteritis (also known as ‘gastro’ or a stomach bug) is caused by an infection in the digestive system . This is usually due to a virus, but sometimes it’s bacterial.

Gastroenteritis causes vomiting, diarrhoea, fever and abdominal pain. Gastro is easily spread between people, especially children.

Children and small babies are more likely to get dehydrated from gastroenteritis. If your baby is under 6 months old, and has gastroenteritis see a doctor.

Rotavirus is a common cause of severe gastroenteritis in babies. Your baby can have a free vaccine against this virus as part of the National Immunisation Program .

Older children are more likely to have gastroenteritis caused by norovirus .

Food poisoning

Food poisoning is caused by germs growing in food that has been poorly prepared or stored. The symptoms are the same as those caused by gastroenteritis, but usually more severe.

Your baby or small child could be at risk of dehydration. Take care that they stay hydrated (see below).

If you think a child has swallowed a poisonous substance or someone has taken an overdose, contact the Poisons Information Centre by phoning 13 11 26 for advice (24 hours).

Poisoning is most common in young children, who often put things in their mouths.

Many household items are poisonous if swallowed . Symptoms of poisoning include:

nausea and vomiting
breathing difficulties

Do NOT attempt to make the child vomit, unless instructed by a medical professional.

Urinary tract infections

Vomiting can be a sign of a urinary tract infection (UTI) in children. They are common in young children. The symptoms of UTIs in children are often vague but can also include:

being irritable
pain when urinating (weeing)
fewer wees than normal
smelly urine

Symptoms of COVID-19 in children include:

shortness of breath

Motion sickness

Motion sickness is more common in older children than babies. Car, train and air travel can cause it.

Motion sickness can also be triggered by virtual reality games and amusement park rides.

Appendicitis

Appendicitis is a medical emergency. If you think your child may have appendicitis, you should take them immediately to a doctor or hospital. A burst appendix can lead to a life-threatening infection.

Appendicitis causes pain around the navel (belly button) which then moves to the lower right side of the abdomen and becomes sharper.

A child with appendicitis may:

have worsening tummy pain
lose their appetite
feel uncomfortable when sitting upright or standing up
experience pain when moving — they may try to keep very still

If a baby or child has symptoms of meningitis, you should call triple zero (000) for an ambulance or go straight to emergency.

Meningitis is an infection and swelling of the membrane that covers the brain and spinal cord. It’s usually caused by a bacterial or viral infection. It’s rare but serious, and can quickly cause death.

Meningitis can cause symptoms such as:

a stiff neck
avoidance of bright lights (photophobia)
distinctive skin rash

If your baby has meningitis they may be irritable and have a high-pitched cry. They may arch their back or hold their head back. The baby’s fontanelle (the soft spot on the top of the head) may be swollen and bulge.

Diabetic ketoacidosis

Diabetic ketoacidosis is a medical emergency. Take a child straight to the emergency department if they are vomiting and are dehydrated.

Diabetic ketoacidosis is sometimes the first sign that a child has diabetes . It happens when the body does not have enough insulin to use glucose (sugar) in the blood for fuel. The body breaks down fat instead and produces ketones as a by-product. The ketones make the blood too acidic (ketoacidosis).

Symptoms of diabetic ketoacidosis include:

dehydration
breathing fast

You may notice that your child is more thirsty than normal and urinates (wees) more often.

Food allergy

If you think a child is having a severe allergic reaction, call triple zero (000) for an ambulance.

A food allergy is more likely to happen in the first year of life, when you try a new food with your child.

If the allergic reaction is severe, the child may have anaphylaxis — a potentially life-threatening emergency. Symptoms of anaphylaxis are:

swelling of the throat

Cow's milk allergy is an example of a food allergy that may cause vomiting in young children.

Other acute medical conditions

These include:

intussusception (a part of the bowel slides into another part of the bowel)
bowel obstruction (gut blockage)
pyloric stenosis (narrowing of the valve between the stomach and the small intestine)
raised intracranial pressure (pressure inside the skull)

How is the cause of vomiting diagnosed in children?

Your doctor will want to check how long your child has been vomiting. Tell your doctor about any other symptoms that your child has along with vomiting to help with diagnosis.

They will examine your child, and see if there are any signs of dehydration.

Tests that may help your doctor to understand the cause of chronic vomiting include:

blood tests
urine tests
lumbar puncture

If your child has been vomiting for a while, your doctor may suggest referring your child to a specialist. This could be a gastroenterologist, an allergy expert, a neurologist or a paediatrician .

ASK YOUR DOCTOR — Preparing for an appointment? Use the Question Builder for general tips on what to ask your GP or specialist.

When should I take my child to the doctor?

Babies younger than 6 months should always be taken to the doctor if they are vomiting or you think they have gastroenteritis.

If your child has another health condition such as diabetes or epilepsy and they are vomiting they should see a doctor.

When should I get urgent medical care for my child?

Vomiting can be more dangerous in young babies. Here is a guide on when to get medical care for vomiting:

All babies under 6 months old or weighing less than 8kg.
Children aged under 3 years who have been vomiting for 12 hours.
Children aged under 6 years who have been vomiting for 24 hours.
Children 6 years or more who have been vomiting for 48 hours.

If your child is vomiting and has any of these symptoms, you should take them to the emergency department at your nearest hospital as soon as possible:

blood in their vomit
green or brown vomit
vomiting that is projectile or isn’t stopping
they can't keep fluids or water down
severe pain in their abdomen (tummy) or rectum (bottom)
stiff neck — with or without photophobia (pain when looking at bright lights)
high fever (over 38.5°C)
signs of dehydration, such as fewer wet nappies, darker coloured urine, or dry lips and mouth

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

How is vomiting treated in children?

Most vomiting episodes in children are due to viral gastroenteritis. This can usually be treated at home.

If your child is dehydrated or is a baby under 6 months take them to the doctor.

Self-care at home

Vomiting will often clear up without any specific treatment. Focus on keeping your child hydrated.

Help them replace any lost minerals and salts by giving oral rehydration solution. You can buy it from a pharmacy or supermarket.

You may be able to care for your child with viral gastroenteritis at home. Vomiting caused by viral gastroenteritis usually gets better in 1-2 days, but the diarrhoea can go on for longer.

Here is some advice for caring for a baby or child aged over 6 months with vomiting due to gastroenteritis:

Breastfed babies should continue to be breastfed, but more often. Offer milk each time after they vomit. You can also offer them oral rehydration solution or water for the first 12 hours.
Bottle-fed babies should have their formula replaced with oral rehydration solution or water for the first 12 hours. Then they can have normal formula in small amounts. Give them this more often than normal. They should be offered a drink each time after they vomit.
Make sure your baby rests.

Here is some advice for caring for an older child with vomiting due to gastroenteritis:

Give older children small amounts of clear fluids to drink often — about every 15 minutes.
Oral rehydration solutions are strongly recommended for any child with frequent diarrhoea or vomiting.
Oral rehydration solution can be chilled or made into ice blocks for a child to suck.
Don't give your child sports drinks, lemonade or cordial. These can make diarrhoea or dehydration worse.
Children with gastroenteritis may refuse solid food. This is ok for a day or two, as long as they are still having fluids. You can get them back to eating when they are ready. Start by offering plain foods at first.
Make sure your child rests.

Don't send them to nursery, day care or school until they have not had a loose bowel motion for at least 24 hours.

If your child is vomiting and you are worried that they are not getting better, seek help from your doctor or pharmacist.

Medicines for vomiting in children

Anti-vomiting medicines (antiemetics) are not generally recommended in children. Do not give your child an antiemetic without health professional advice.

You can give your child oral rehydration solution from the pharmacy.

LOOKING FOR A MEDICINE? — To search by brand name or active ingredient, use the Medicines information search feature.

Other ways that vomiting in children can be treated

Any other specific treatment will depend on the underlying cause of vomiting. Here are some examples:

Motion sickness in children can often be prevented. If your child is over 2 years they may be able to try medicines. Talk to your doctor or pharmacist about what medicines may be suitable.
Infections caused by bacteria, such as urinary tract infections, are usually treated with antibiotics.
Meningitis is treated in hospital. Bacterial meningitis is treated with antibiotics. Viral meningitis is not helped by antibiotics. Your child may also need steroids to reduce swelling on the brain.
Diabetic ketoacidosis will need to be treated in hospital. This involves safely reversing any dehydration, stabilising blood sugar levels with insulin and closely monitoring your child.
Surgery is usually needed for conditions where there are blockages or problems in the digestive system — such as appendicitis, bowel obstruction and pyloric stenosis.

Can vomiting in children be prevented?

Gastroenteritis is the most common cause of vomiting in children. It’s highly infectious and can easily spread between children.

You can help stop the spread of gastroenteritis by:

washing your hands regularly, before food preparation and after going to the toilet or changing a nappy
practising good food safety
wearing gloves when cleaning up diarrhoea or vomit — seal these in a plastic bag before putting it in the bin
keeping your child away from nursery, day care or school until they have not vomited for 24 hours

If your child is vomiting after eating particular foods, speak to your doctor or a dietitian for advice.

There are vaccines available to prevent some causes of vomiting in children, such as rotavirus or meningitis.

Complications of vomiting in children

Whatever the cause of vomiting, you need to ensure that your child doesn’t become dehydrated. This can happen because of the fluids lost when vomiting.

Dehydration in babies or small children can be fatal. Some signs of severe dehydration are:

less than 4 wet nappies a day for a baby
dry mouth, tongue and lips
sunken eyes
being listless or irritable
shedding fewer tears when crying

If your child becomes dehydrated, they may need to go to hospital for rehydration. At the hospital they can get fluids via a nasogastric tube, which goes down their nose into their stomach, or intravenously on a drip.

Resources and support

For more information and support, try these resources:

The Royal Children’s Hospital Melbourne — Kids’ health information .
The Sydney Children’s Hospitals Network — Fact sheets .

Learn about food allergy symptoms at Nip allergies in the Bub .

Find information on how to introduce solid foods to babies for allergy prevention .

For resources in languages other than English, visit The Royal Children’s Hospital Melbourne — Gastroenteritis .

If you need advice on what to do for your child, call healthdirect on 1800 022 222 to speak with a registered nurse, 24 hours, 7 days a week.

Pregnancy, Birth and Baby has a helpful list of resources. Visit Who can I call for information and advice?

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Last reviewed: February 2024

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Br J Clin Pharmacol
v.75(6); 2013 Jun

Paediatric travel medicine: vaccines and medications

The paediatric aspects of travel medicine can be complex, and individual advice is often required. Nonetheless, children are much more likely to acquire common infections than exotic tropical diseases whilst travelling. Important exceptions are malaria and tuberculosis, which are more frequent and severe in children. Overall, travellers' diarrhoea is the most common illness affecting travellers. This review discusses vaccines and medications that may be indicated for children who are travelling overseas. It focuses on immunizations that are given as part of the routine schedule, as well as those that are more specific to travel. Malaria and travellers' diarrhoea are also discussed.

Introduction

It is becoming increasingly common for families with young children to travel overseas to exotic locations. Travelling with children poses some challenges but can also be very rewarding. Children encounter the same problems as adults, but do not always receive appropriate pretravel advice. There are some issues that are more complex to deal with in children. For example, some travel-related vaccines are not immunogenic in young children, and the use of certain vaccines or medications that are first line in adults may be contraindicated in children.

Rather than unusual tropical diseases, travel-related illness in children is more likely to be due to common problems, such as trauma, skin and respiratory tract infections and diarrhoea. Malaria and tuberculosis are important exceptions; both tend to be more frequent and severe than in adults 1 – 4 .

This review discusses vaccines and medications that may be indicated for children travelling overseas.

Immunizations

Routine immunizations.

Many of the diseases for which routine immunizations are given are rarely seen in industrialized countries. However, some remain prevalent in developing countries; examples include measles in many African countries 5 , 6 . Travelling children may be at risk of these vaccine-preventable diseases. Influenza, varicella and measles all cause morbidity in travellers 7 , 8 .

Routine immunization schedules vary from country to country. However, most include some or all of the following vaccines: hepatitis B; diphtheria–tetanus–pertussis (DTP); poliomyelitis (polio); Haemophilus influenzae type b (Hib); pneumococcal conjugate (7-, 10- or 13-valent; PCV); meningococcal C conjugate (MenCCV); measles–mumps–rubella (MMR); varicella; influenza; and human papillomavirus (HPV).

Young children may not be fully immunized with the routine schedule vaccines. It is worthwhile ensuring that a child's immunization schedule is up to date at the time of travel. Moreover, it may be prudent to accelerate the schedule. Newer multivalent and conjugate vaccines may not be available in some of these countries, or may not be included in their national vaccination programmes 9 .

Almost all of the routine vaccines can be given earlier and more frequently than national schedules recommend (see Tables 1 and and2). 2 ). For example, DTP-containing vaccines, which are given at 2 months according to many national schedules, can be given from 6 weeks, and subsequent doses given 4 weeks apart. This means that the primary course of DTP vaccine could potentially be completed by 14 weeks of age. An accelerated schedule may be of particular benefit to an infant being taken overseas for several months in their first year of life.

Lower age limit and minimum interval between doses of vaccines

DTP, diphtheria–tetanus–pertussis; Hib, Haemophilus influenzae type b; MenCCV, meningococcal C conjugate; MMR, measles–mumps–rubella; PCV, pneumococcal conjugate (7-, 10- or 13-valent); polio, poliomyelitis; PRP-OMP, polyribosylribitol phosphate-outer membrane protein conjugate; PRP-T, polyribosylribitol phosphate conjugated with Tetanus toxoid.

Accelerated schedules for vaccines

DTP, diphtheria–tetanus–pertussis; Hib, Haemophilus influenzae type b; MMR, measles–mumps–rubella; PCV, pneumococcal conjugate (7-, 10- or 13-valent); and polio, poliomyelitis.

Injectable polio vaccine

If the third dose of injectable polio vaccine is given after 4 years of age, a fourth dose is not required. However, if using a combination vaccine, it is acceptable to receive a fourth dose.

Measles–mumps–rubella vaccine

Measles is still common in many countries, and travel in densely populated areas may favour transmission. The MMR vaccine may be given from 9 months of age. Children given MMR at less than 12 months of age should receive a booster 3 months later.

Hepatitis B vaccine

Regardless of travel, all children should be immunized against hepatitis B, because infection at an early age carries a higher risk of chronic infection. Infection most often occurs by social contact with other children and cannot be effectively prevented by any other means. If the first dose is given at birth or within 7 days of birth, then three subsequent doses should be given; otherwise two subsequent doses are required.

Pneumococcal conjugate vaccine

The incidence of invasive pneumococcal disease is higher in less-developed countries than in many industrialized countries. Pneumococcal conjugate vaccine is the preferred pneumococcal vaccine for children under 5 years of age. It should be offered to all children aged between 3 months and 2 years, and to those with underlying medical conditions under the age of 5 years. The polysaccharide vaccine may be offered in certain circumstances.

Meningococcal C conjugate vaccine (MenCCV)

If two doses of MenCCV are given before 12 months of age, a booster dose should be given at 12 months of age.

Varicella vaccine

If a child receives varicella vaccine at less than 12 months of age, a further dose should be given at 18 months of age. Children over the age of 12 years should receive two doses, 4–8 weeks apart.

Influenza vaccine

Influenza is one of the most common travel-acquired vaccine-preventable diseases 7 , 8 . Influenza infection can cause significant disruption to a family's travel plans. Vaccination should therefore be considered for all children greater than 6 months of age travelling during the (local) influenza season. It is especially important in children with risk factors, including underlying chronic cardiorespiratory disease, a neurological condition or impaired immunity.

Travel-specific vaccines

Travel-specific vaccines that may be recommended or required, depending on the particular trip, include: hepatitis A; typhoid; meningococcal A, C, W-135, Y; Bacille Calmette–Guérin (BCG); yellow fever; rabies; Japanese encephalitis; and cholera.

Hepatitis A vaccine

Hepatitis A is a significant cause of morbidity globally, although the mortality rate is low. It is transmitted from person to person by the faecal–oral route and through contaminated food and water. Improved sanitation and living standards mean that fewer countries remain highly endemic, but in countries where the endemicity of hepatitis A is low or intermediate, more people lack immunity to hepatitis A virus (HAV) infection, and the risk of outbreaks grows. Travellers from these countries to endemic regions are at particular risk.

Exposure to HAV in the first 6 years of life usually results in mild or asymptomatic infection 10 , 11 . It could therefore be argued that children under 6 years do not require hepatitis A vaccine, because if infected, they will most probably remain well and will develop natural lifelong immunity. However, HAV is excreted in saliva and stool for up to 6 weeks after infection; these children may therefore spread hepatitis A to others, particularly on their return to their home country.

Given that the hepatitis A vaccine is safe, effective and long lasting, it should generally be offered to all children over the age of 1 year. However, it may be reasonable to waive immunization of children less than 6 years old, particularly if they are travelling for more than 6 weeks, because by the time they return, they are unlikely still to be excreting HAV.

There are a number of inactivated hepatitis A vaccines, some of which are combined vaccines (with typhoid or hepatitis B). Although the vaccines are prepared from differing strains of HAV, there is only one known serotype; immunity induced by a particular strain probably provides protection against all strains 12 .

Paediatric formulations of hepatitis A vaccine are available for children from 1 year of age. The vaccines are highly immunogenic, and protective efficacy approaches 100% 13 . Serological testing to assess immunity after vaccination is unnecessary. As in adults, a single dose is given, followed by a booster 6–12 months later. However, immunity may persist for up to 8 years after a single dose of hepatitis A vaccine 14 , 15 , and there is no evidence to support booster doses after a full primary vaccination course in a healthy individual 16 , 17 .

Typhoid vaccine

The vast majority of typhoid (and paratyphoid) fever cases occur in less-developed countries, where poor sanitation, poor food hygiene and untreated drinking water all contribute to endemic disease with moderate to high incidence and considerable mortality. Geographic regions with high incidence (>100 cases per 100 000 population per year) include the Indian subcontinent, most southeast Asian countries and several south Pacific nations, including Papua New Guinea.

In industrialized countries, typhoid fever is predominantly a travel-related disease, with a considerably greater risk following travel to the Indian subcontinent than to other regions 18 . Those who travel to endemic regions to visit friends and relatives appear to be at considerably greater risk of acquiring typhoid fever than other travellers 19 , 20 . For example, there are approximately 50–80 cases of typhoid fever reported in Australia each year, with most following travel to regions with endemic disease 21 .

Two typhoid vaccines are available: injectable polysaccharide and oral live attenuated vaccines. Injectable killed Vi typhoid vaccine can be given to children aged 2 years and over. Only one dose is required, and side-effects are minimal. The optimal timing of revaccination against typhoid fever is uncertain, and therefore, international recommendations vary considerably 22 .

However, if repeated or continued exposure to Salmonella typhi is likely to occur, a second dose of the parenteral vaccine should be given 3 years after the initial primary vaccination.

The oral vaccine is as effective as the injectable one, has few side-effects, and is safe in children over the age of 1 year, although it is not generally recommended for children younger than 6 years. The factor limiting its use in children is their ability to swallow the capsules. The vaccination schedule consists of one capsule of vaccine on days 1, 3 and 5. The capsule must be swallowed whole with water and must not be chewed, because the organisms can be killed by gastric acid. It should not be given concurrently with antibiotics that are active against S. typhi . If possible, antibiotics and other relevant drugs should be delayed for 3 days after the last dose of the vaccine. A fourth capsule taken on day 7 has been shown to result in a lower incidence of typhoid fever than three doses 23 .

Meningococcal A, C, W-135, Y vaccine

Meningococcal vaccine covering serotypes A, C, W135 and Y is indicated for children travelling to highly endemic areas, particularly sub-Saharan Africa (see Figure 1 ) and parts of the Middle East.

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African countries with frequent epidemics of meningococcal meningitis 32 . http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/meningococcal-disease.htm#2572

A polysaccharide vaccine has been available for many years. However, this vaccine is not immunogenic against serogroup A in children less than 3 months of age, nor against serogroup C in children less than 18 months of age.

Two quadrivalent (A, C, W-135 and Y) conjugate vaccines are now available, and a third is under investigation. MenACWY-CRM, known as Menveo®, consists of meningococcal groups A, C, Y and W-135 oligosaccharides conjugated to CRM197 (nontoxic diphtheria toxin mutant) 24 . This vaccine is licenced for use only in children over 11 years of age. However, the vaccine is safe and immunogenic in infants as young as 2 months 25 . An ACWY vaccine in which the polysaccharides are conjugated to diphtheria toxoid (Menactra®) is licenced from the age of 9 months 26 .

Bacille Calmette–Guérin vaccine

Risk of potential exposure to tuberculosis should be assessed at a pretravel consultation. For many travellers, the risk will be low. However, families who are visiting friends and relatives in developing countries may be at high risk of exposure, even if their trip is short 27 , 28 . The protective efficacy of BCG is only 50% overall, but it is approximately 80% protective against disseminated tuberculosis, tuberculous meningitis and death from tuberculosis, which are more common in young children 4 , 29 , 30 . The BCG vaccine is recommended for these children less than 5 years of age who are expected to stay for more than a few weeks in areas with a high prevalence of tuberculosis (this includes most developing countries).

Prior tuberculin skin testing is indicated only if there is deemed to be the possibility of previous exposure to tuberculosis 31 . The dose of BCG for infants less than 12 months of age is 0.05 ml given intradermally, and 0.1 ml after 12 months of age.

Yellow fever vaccine

Yellow fever vaccine entry requirements are established by countries to prevent the importation and transmission of yellow fever virus, and are allowed under the International Health Regulations. Travellers must comply with these to enter the country, unless they have been issued with a medical waiver. Certain countries require vaccination from travellers arriving from all countries, while some countries require vaccination only for travellers coming from a country with risk of yellow fever transmission. Country requirements are subject to change at any time. The Centers for Disease Control provides up-to-date details 32 http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/yellow-fever.htm , as does the World Health Organization 33 http://www.who.int/ith/en/ , which also has an interactive map ( http://apps.who.int/tools/geoserver/www/ith/index.html ). Figures 2 and and3 3 show the yellow fever vaccine recommendations in Africa and the Americas.

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Yellow fever vaccine recommendations in Africa, 2010 32 . http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/yellow-fever.htm#2853

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Yellow fever vaccine recommendations in the Americas, 2010 32 . http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/yellow-fever.htm#2854

The vaccine should be given to children aged greater than 9 months travelling in the relevant countries. It should not be given to children younger than 6 months, owing to the risk of vaccine-associated encephalitis.

Rabies vaccine

Rabies is endemic throughout much of Africa, Asia, the Americas and Europe, where the virus is maintained in certain species of mammals 34 , 35 . Rabies virus is transmitted in the saliva of rabid mammals via a bite. The incubation period usually ranges from 1 to 3 months after exposure, but can range from days to years. Infection is almost always fatal.

Rabies vaccine can be given for prophylaxis before or after exposure, although the former is more reliable. Postexposure prophylaxis also includes prompt wound care and the administration of rabies immunoglobulin. Access to appropriate rabies immunoglobulin and rabies vaccine cannot be assured in all countries. Those who have completed a pre-exposure vaccine course and are subsequently exposed to rabies need less vaccine and no rabies immunoglobulin treatment.

Rabies vaccine is recommended for children over 1 year of age staying for prolonged periods in endemic areas, particularly where rabies immunoglobulin and vaccine are difficult to obtain. Vaccination is more important in children than in adults, because they are attracted to animals and are more likely to try to pat, play with or feed them, may not reliably report a minor animal bite, and are more likely to suffer animal bites that are severe and multiple, or involve the upper limbs, head and neck 34 .

Vaccination consists of a total of three intramuscular injections of 1 ml of vaccine; the second and third doses are given on day 7 and 28 after the first. The vaccine is expensive; if cost is prohibitive and more than one person is to be immunized, an effective alternative is to give 0.1 ml of vaccine intradermally 36 . However, antibody levels are lower and decline more rapidly following intradermal compared with intramuscular immunization.

Japanese encephalitis vaccine

Japanese encephalitis (JE) is a mosquito-borne flavivirus infection and the most common vaccine-preventable form of encephalitis in Asia. It is a significant public health problem in many parts of Asia, including India, Sri Lanka, southeast Asia and China, and outbreaks have occurred in northern Australia 37 , 38 .

Japanese encephalitis virus is transmitted in a cycle between Culex species mosquitoes and birds, with pigs serving as amplifying hosts. Humans are an incidental host, infected when living in close proximity to this cycle, usually in rural areas with lots of water (e.g. rice fields). Clinical JE is a severe disease, with a high case fatality rate (30%). Up to 50% of those who survive encephalitis suffer from long-term or permanent disabilities, such as physical and mental impairments. The risk of JE in travellers to endemic areas is very low, although it is likely to be higher in those who stay for prolonged periods in rural areas 39 .

Although JE vaccines have been available for many years, serious adverse effects that were temporally associated with vaccination led to their discontinuation. Two new JE vaccines have recently become available: a purified inactivated vaccine containing the attenuated SA14-14-2 JE virus (JESPECT® or IXIARO®) and a live attenuated yellow fever–JE chimeric viral vaccine (IMOJEV®) 40 .

Japanese encephalitis vaccine is recommended for children greater than 1 year of age who will spend at least 1 month in endemic rural areas of Asia, or a year or more than 6 months in nearby endemic urban areas. However, the vaccine that has been used in many industrialized countries for several years was highly reactogenic and is no longer being manufactured. Reactions to the vaccine (for example, fever and aches and pains) are common in children. JESPECT®/IXIARO® is not currently indicated for children less than 16 years of age. Phase 3 studies in children are ongoing 39 , 41 – 43 . It has been shown to be safe and immunogenic down to 2 months of age (K. Dubischar-Kastner, unpublished data). IMOJEV® is indicated for use in children from the age of 12 months 40 , but is not widely available.

Cholera vaccine

The risk of cholera is extremely low for most travellers. The vaccine is recommended only if travel is to an area with a known outbreak. The oral live-attenuated vaccine (Dukoral®) can be given to children greater than 2 years.

Travellers' diarrhoea

Travellers' diarrhoea (TD) is the most common illness in travellers to developing countries; it affects up to 70% of those who visit developing countries 44 . It is part of the spectrum of gastrointestinal infections that travellers may encounter 45 , 46 .

Children are more likely to acquire TD, because they have reduced killing of ingested bacteria owing to their higher gastric pH and more rapid gastric emptying time. Moreover, they are more immunologically naïve, and young children may be indiscriminate about what they put in their mouths.

Aetiology of TD

Bacteria cause 50–75% of cases of TD, viruses 5–20% and parasites up to 10% 47 , 48 . Enterotoxigenic Escherichia coli (ETEC) is the most common cause overall. Co-infection with one or more pathogens occurs in 10–15% of cases. The aetiology is much the same in children 49 . The aetiology of TD is shown in Table 3 .

Aetiology of travellers' diarrhoea

Prevention of TD

The most important way of preventing of TD is to avoid contaminated food and water. Standard advice includes drinking boiled or bottled water only, eating freshly cooked food and eating only those fruit or vegetables that have been bought whole and peeled. Water may be disinfected with iodine or chlorine.

The oral cholera vaccine, Dukoral®, combines killed Vibrio cholerae with purified recombinant cholera B subunit, which is nearly identical to the heat-labile toxin of ETEC. This vaccine provides approximately 60% protection against ETEC for 3 months; the protection against TD is much lower 50 , 51 . In a study of the vaccine in Finnish tourists to Morocco, overall reduction in TD was 23% 52 . Two doses must be taken at least 1 week apart, and at least 1 week before travelling to an at-risk area; for children between 2 and 6 years, three half-doses are taken at weekly intervals.

A new vaccine with heat-labile enterotoxin from ETEC delivered via a skin patch may be effective and is being studied. In a phase 2 study in adults, the patch had a 70% protective efficacy against moderate-to-severe diarrhoea and 84% efficacy against severe diarrhoea 53 . Although there is some evidence for the use of antibiotics to prevent TD, antibiotic prophylaxis is generally not recommended.

A recent randomized controlled trial of a tablet formulation of hyperimmune bovine colostrum for prevention of TD showed protective efficacy of up to 90% against ETEC 54 . However, tablets must be taken before every meal, which may limit its practicability, and concerns about instability of the formulation have led to its recall in the USA.

Treatment of TD

The emphasis in management should be on fluid and electrolyte replacement and continued nutrition. Antimotility agents, such as loperamide and diphenoxylate, may provide symptomatic relief, but should be used with caution in children, because they may cause lethargy, ileus and coma. They are contraindicated below different ages in various countries. Antiemetics, e.g. metoclopramide (Maxolon®), prochlorperazine (Stemetil®) or ondansetron (Zofran®) should be avoided in children under 2 years of age. Ondansetron is available as a wafer, which may be easier to administer than a tablet. Dystonic reactions caused by antiemetics are more commonly seen in children.

Prompt (self) administration of antibiotics is effective in the treatment of TD 55 . Ciprofloxacin and azithromycin are the best choices, given the aetiology of TD. The latter is particularly recommended for Southeast Asia, where Campylobacter is a higher risk 56 . Rifaximin is a rifampicin analogue that is poorly absorbed from the gastrointestinal tract. It treats non-invasive enteric organisms and has been shown to be effective in the treatment of TD 57 , 58 . It is approved by the US Food and Drug Administration for the treatment of TD caused by non-invasive strains of E. coli in patients aged 12 years and older. It has been studied in children from the age of 8 years with inflammatory bowel disease and shown to be safe 59 .

The risk of malaria (and other insect-borne diseases) can be substantially reduced by minimizing mosquito exposure, particularly at dawn and dusk. This can be achieved to some extent by wearing light-coloured clothes that cover the arms and legs and using mosquito nets. Impregnating clothes and nets with the insecticide permethrin has been shown to reduce malaria infection rates 60 . N , N -Diethyl-3-methylbenzamide, formerly known as N , N -diethyl- m -toluamide (DEET), is the most effective insect repellent available 61 , 62 . Products with up to 30% DEET can be used safely in children 63 . There have been numerous case reports of toxicity associated with DEET in children. However, these have mostly been poorly documented, and in many, >30% DEET was used and applied excessively. A retrospective study of 9086 reports of DEET toxicity showed that children were no more likely to develop adverse affects than adults; two-thirds of those exposed had no adverse effects, and 99% had no long-term sequelae 64 .

Detailed information regarding the selection of specific antimalarials for chemoprophylaxis and treatment of malaria is beyond the scope of this review.

Prophylaxis

Young children are at increased risk of severe Plasmodium falciparum malaria, and death may occur within 24 h of the onset of symptoms. Chemoprophylaxis should be offered to all children travelling to areas where malaria transmission is high. However, there are lower age/weight limits for each of the most commonly used drugs. None of them is widely available as a suspension.

The antimalarials most commonly used for prophylaxis include mefloquine, doxycycline and atovaquone–proguanil (Malarone®). Randomized controlled trials show that these all have similar efficacy (>95%) against P. falciparum 65 , 66 . Some countries advocate chloroquine plus proguanil for the limited regions of low-level chloroquine resistance, such as parts of India and Indonesia. Chloroquine remains effective only in Mexico, areas of Central America that are west of the Panama canal, the Caribbean, East Asia and a few Middle Eastern countries.

All antimalarial chemoprophylactic regimens are associated with mild adverse events, but serious events are rare 67 , 68 . Chloroquine, proguanil and quinine are safe to give to children of all ages. Mefloquine tends to be tolerated better by children than adults 69 . It can be given to children over 5 kg. Many mefloquine-associated adverse events occur by the third dose 70 . Starting mefloquine prophylaxis 3 weeks before departure allows for evaluation of tolerability to the regimen. Atovaquone–proguanil (Malarone®) is not recommended for prophylaxis in children who weigh less than 5 kg. Paediatric tablets are available and can be given to children over 5 kg in weight. It is generally very well tolerated. Doxycycline is contraindicated for children under 8 years of age (and mothers who are breastfeeding) because it affects growing bones and teeth. Each of these drugs is excreted in breast milk but will not protect the breastfed infant.

Table 4 provides summary information about the three most commonly prescribed antimalarials for prophylaxis.

Commonly prescribed antimalarials for prophylaxis

Artemisinin-based combination therapies are now the recommended treatment for P. falciparum malaria worldwide. As the effectiveness of chloroquine for treatment of Plasmodium vivax declines, alternative therapies are needed. Artemisinin-based combination therapies appear at least equivalent to chloroquine at effectively treating the blood-stage P. vivax infection 71 . One of the most commonly used artemisinin-based combination therapies, artemether–lumefantrine (Coartem® or Riamet®) achieves high cure rates and rapid resolution of parasitaemia, fever and gametocytaemia in adults and children, and has an excellent safety and tolerability profile 72 . Newer artemisinin-based combination therapies, such as dihydroartemisinin–piperaquine, appear to be associated with a lower risk of recurrent infections 73 .

Children may find it very difficult to settle on a long flight, and this may be distressing to them, their parents and others. Sedation may assist them to relax and fall asleep. Chloral hydrate has been well studied in children and is safe and effective 74 . It is available as a suspension and has a wide dosing range. Doses as low as 8 mg kg −1 can be given and repeated during the trip if required (up to 50 mg kg −1 ), or up to 50 mg kg −1 can be given as a single hypnotic dose. Adverse effects include gastric irritation and vomiting in 5%, which can be reduced by diluting with water or milk. Importantly, paradoxical agitation occurs in only 1–2%, compared with up to 15% for antihistamines such as promethazine (Phenergan®).

The paediatric aspects of travel medicine can be complex. This review provides some information regarding the vaccines and medications that may be indicated for children who are travelling overseas.

Competing Interests

There are no competing interests to declare.

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Travel Sickness Oral: Uses, Side Effects, Interactions ...
Dimenhydrinate is an antihistamine used to prevent and treat nausea, vomiting, and dizziness caused by motion sickness.Do not use this medication in children younger than two years unless directed ...
Motion Sickness
For children aged 2-12 years, dimenhydrinate (Dramamine), 1-1.5 mg/kg per dose, or diphenhydramine (Benadryl), 0.5-1 mg/kg per dose up to 25 mg, can be given 1 hour before travel and every 6 hours during the trip. Because some children have paradoxical agitation with these medications, encourage parents to try a test dose before departure.
Travel Motion Sickness (Meclizine) Oral: Uses, Side Effects ...
Find patient medical information for Travel Motion Sickness (meclizine) oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings.
Motion Sickness Meds: Are They Safe for Children?
Two OTC medications that are commonly available include: Dimenhydrinate: This antihistamine is an effective treatment for motion sickness, but should not be given to children 2 or younger ...
Motion sickness (travel sickness): Causes, remedies, and symptoms
Scopolamine - the most commonly prescribed medication for motion sickness. It must be taken before symptoms start. It is available as a patch that is placed behind the ear 6-8 hours before ...
Motion Sickness
Motion Sickness. Motion sickness happens when the movement you see is different from what your inner ear senses. This can cause dizziness, nausea, and vomiting. You can get motion sick in a car, or on a train, airplane, boat, or amusement park ride. Motion sickness can make traveling unpleasant, but there are strategies to prevent and treat it.
Travel Sickness Advanced Patient Information
For oral dosage form (tablets): For nausea, vomiting, and dizziness caused by motion sickness: Adults—At first, 25 to 50 milligrams (mg) taken 1 hour before travel. You may take another dose once every 24 hours while traveling. Children 12 years of age and older—Use and dose must be determined by your doctor.
List of 37 Motion Sickness Medications Compared
Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Data sources include Micromedex (updated 1 Apr 2024), Cerner Multum™ (updated 21 Apr 2024), ASHP (updated 10 Apr 2024) and others.
Prevention and Treatment of Motion Sickness
To prevent and reduce symptoms of motion sickness, passengers should look forward at a fixed point on the horizon and avoid close visual tasks. C. 2 - 5. To prevent and reduce symptoms of motion ...
Motion Sickness (Travel Sickness): Prevention and Treatment
Ondansetron. Ondansetron is a powerful antisickness medicine which is most commonly used for sickness caused by chemotherapy, and occasionally used for morning sickness in pregnancy. It is not usually effective for motion sickness. This, and its relatively high cost means that it is not prescribed for motion sickness alone.
How to Treat Motion Sickness in Kids
Nothing makes travel miserable like a vomiting child, but the good news is that even the worst motion sickness is treatable. If your child is car sick, air sick, or sea sick, the right drugs combined with tried-and-true home remedies can stop the nauseated misery and help your whole family enjoy travel together.
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Medically necessary liquid medications can be brought in your carry-on or checked luggage in reasonable quantities. Tell an officer that you have a medically necessary liquid before starting the screening process. You may be asked to open the liquid medication for additional screening. Insulin is allowed in carry-on or checked luggage in ...
List of 79 Anti-Nausea/Vomiting Medications Compared
H1 antihistamines or antimuscarinics, such as diphenhydramine, meclizine, or dimenhydrinate. These are effective for nausea and vomiting secondary to motion sickness and vertigo. Serotonin (5-HT3) antagonists, such as ondansetron, granisetron, dolasetron, or palonosetron. These are effective at controlling nausea and vomiting that has already ...
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Antihistamines. Phenergan (promethazine) is a prescription-only antihistamine that can prevent or control nausea related to anesthesia or surgery. Anticholinergics. Transderm Scop (scopolamine) is an anticholinergic medicine that prevents nausea and vomiting. It is a removable patch that is applied to the skin.
Antiemetic Medicines: OTC Relief for Nausea and Vomiting
Medicines that treat nausea and vomiting are called antiemetics. Several OTC medicines are used as antiemetics. These include: Bismuth subsalicylate (2 brand names: Kaopectate, Pepto-Bismol). This medicine may help treat some types of nausea and vomiting, such as from gastroenteritis (stomach flu). They are also used for upset stomachs and as ...
Nausea Medicines For Children: Reminders for Parents
Drowsiness. Dry mouth. Stomach cramps. Report to the doctor if your child experiences any of the side effects above. 3. Metoclopramide. Metoclopramide is a pediatric nausea medication belonging to the prokinetic class. Besides reducing the reflexes for nausea and vomiting, this drug also triggers stomach emptying.
9 Successful Tips to Avoid Travel Sickness in Kids
Avoid lots of sweet sugar treats. Just stick to your healthy eating routine as normal. Avoid strong smells in the car. (Ponky cheese and bananas are sure to trigger anyone's car sickness.) Have a bag ready, plus wipes, water and a change of clothes. Neck. Personally I hate anything around my neck when I feel sick.
Vomiting in children
Gastroenteritis. Gastroenteritis (also known as 'gastro' or a stomach bug) is caused by an infection in the digestive system. This is usually due to a virus, but sometimes it's bacterial. Gastroenteritis causes vomiting, diarrhoea, fever and abdominal pain. Gastro is easily spread between people, especially children.
Paediatric travel medicine: vaccines and medications
Pneumococcal conjugate vaccine is the preferred pneumococcal vaccine for children under 5 years of age. It should be offered to all children aged between 3 months and 2 years, and to those with underlying medical conditions under the age of 5 years. The polysaccharide vaccine may be offered in certain circumstances.
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Motion sickness

In this article :

Is motion sickness normal?

Triggers for motion sickness

Prepare for your journey

Plan where you sit

Breathe fresh air

Use your eyes and ears differently

Treat your tummy gently

Try alternative treatments

Side-effects of motion sickness medicines

Antihistamines

Hyoscine patch

Prochlorperazine

Metoclopramide

Domperidone

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Next review due: 14 Mar 2028

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