Cinetosi (travel sickness): what it is and what we can do about it
By Sandra Jacopucci
It always strikes at the worst possible moment — on the motorway, on a bend, with no exit in sight. I know that feeling all too well: the nausea, the exhaustion, the contorted face, the churning in the stomach that gets worse with stress, the frantic search for a towel that’s gone who knows where, the enthusiasm that seems to go up in smoke, as if to say: why on earth did we do this?!
Travel sickness is an unwelcome travelling companion. We spoke to Professor Giovanni Cristalli, Head of the Otorhinolaryngology Unit at the Bambino Gesù Children’s Hospital in Rome, who explained what really happens in our bodies when the vehicle we’re travelling in isn’t moving under ideal conditions – bends, rough seas, turbulence, city traffic – and what we can do, both before and during the journey.
Professor, what exactly do we mean when we say ‘travel sickness’?
It is a common experience, especially when travelling by car with children, to come across a phenomenon that is as frequent as it is often baffling: ‘Mum, I feel like I’m going to be sick!’. And then come the pallor, the nausea and the inevitable stop, perhaps put off with a thousand excuses.
We’re dealing with travel sickness, a very common phenomenon in children, particularly between the ages of 2 and 12, but one that often affects adults too, especially when travelling by ship or aeroplane.
Are car sickness, seasickness and airsickness the same thing?
If we think that car sickness, seasickness and airsickness are different phenomena, we are mistaken: in reality, they are all caused by the same mechanism, namely a conflict and overstimulation between our balance system – the vestibular system – and the visual system.
What happens in our bodies during a car trip?
The vestibular system is a complex network of peripheral receptors and nerve pathways. It originates in the inner ear, a bony structure within the skull, characterised by the presence of the semicircular canals and a small cavity called the vestibule. These structures contain receptors capable of converting movements in the three spatial directions, as well as sensations of acceleration and gravity, into electrical impulses.
These impulses travel along central nerve pathways and are integrated with a wide range of other information: visual information, information from the muscular and joint systems, and information related to the system that regulates gastric functions.
But what is the point of all this? Let’s try to imagine switching off this complex mechanism, even if only for a moment. The father takes a bend in the car, even at low speed, and the child is pushed against the door; if the child is strapped into the car seat, their head moves towards the outside of the bend. It takes the whole body a moment to work out how to stay upright, and it ends up off-balance. Similarly, the eyes can no longer stay still and dart about, trying to focus on random points.
In short, it is as if, in a symphony orchestra, everyone started playing on their own: the listener can no longer make out any melody, and the result can be a feeling of unease, nausea and vomiting.
What to do when symptoms appear?
Let’s continue our journey. After phrases such as ‘stay still’, ‘it’ll pass’, ‘breathe’ and ‘it’s just a sensation’, paleness, nausea and often the first retching spasms set in. What should you do?
The most logical thing is to stop, because by reducing the stimuli causing the problem, the whole system gradually tends to regain its balance. However, when it is not possible to stop, it can be helpful to fix your gaze on a steady point, close your eyes, try not to move your head any further and, in practice, hold on until your body manages to adapt.
A brief stop on the Altopiano delle Rocche during a trip to AbruzzoCan a smartphone make things worse?
These principles also underpin certain applications and devices – which are still undergoing scientific testing – that aim to synchronise vision with movement cues. Giving a child a smartphone or tablet during an episode of motion sickness can make the situation worse, as vision comes into even greater conflict with the other movement-related stimuli. However, if an image is projected onto a tablet or virtual reality headset that matches the body’s movements, at least in theory, the sensation of dizziness may be alleviated.
Similarly, by stimulating the joint receptors in the wrist, a stimulus can be sent to the central nervous system that is, at least artificially, in harmony with the input from the eyes. We shall not delve into other techniques, such as the stimulation of specific areas based on traditional Chinese medicine, which nevertheless interfere with the vast amount of information flowing from the body’s periphery to the central nervous system and vice versa.
How do you prevent this, especially with children?
On our imaginary journey home, however, we must take precautions against travel sickness. As we cannot stay on holiday forever, after the exhausting task of packing our bags, gathering all manner of comforts and saying our goodbyes to relatives, we can minimise external stimuli as much as possible.
If possible, the child should travel in a position that allows them to look straight ahead and focus their gaze on a fixed point on the horizon, with their car seat securely fastened and head movements kept to a minimum relative to the car’s movements.
It is also helpful to avoid extreme heat or cold and not to set off on a full stomach, especially after eating foods that take a long time to digest.
On a plane, too, if possible, it is advisable to ask for seats near the wings; on a ship, however, it may be helpful to stay in the centre of the vessel and, if possible, on a lower deck.
When is it necessary to use medication?
When all these measures prove to be ineffective, and as it is not possible to leave the children with their grandparents during the holidays or wait until they are older before putting them back in the car, in the most severe cases certain medicines may be used, such as dimenhydrinate, scopolamine, meclizine or promethazine.
These categories of medication, as well as some common antihistamines, work through different mechanisms to reduce the sensitivity of the vestibular system. However, they do have a sedative effect, and you must always carefully check for any contraindications, especially if the child is taking other medicines or has heart or respiratory conditions.
These medicines should be taken before symptoms set in, generally 15–20 minutes before setting off, always as directed by a doctor.
Have a safe journey, and don’t forget to pack some sick bags and an old towel: they might come in handy.
Prof. Giovanni Cristalli
Head of the Otolaryngology Clinical Unit
“Bambino Gesù” Children’s Hospital, Rome
Giornalista detentore dal 2015 del Guinness World Records TV e Ambasciatore Borghi più Belli d’Italia.
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