“Help! Riding Rear Facing Makes My Child Sick!”

This article originated in the November/December 2022 issue of Safe Ride News.

Emoji indicating nauseousness.

CPSTs are occasionally approached by caregivers whose children struggle with car sickness, and those with younger children sometimes wonder if riding rear facing is the crux of this problem. In Washington state (where the law requires children to ride rear facing until age 2), state CPS coordinator Cesi Velez was asked a question on this theme. The caregiver of a 19-month-old wanted to know if a doctor could issue her a letter of exemption from the state’s child occupant protection (COP) law. Her child had been vomiting in her car seat, and the parent felt that having the child face forward would solve the problem.

Although medical exemptions are not addressed in Washington’s law, Velez wondered if there was any guidance a CPST could provide to parents in this difficult situation. When a child feels sick—and parents are taxed with messy cleanups—what can CPSTs do to help?

The situation is challenging and requires tact. While CPSTs can use a good-better-best approach to assist, they can’t advise a caregiver to go against instructions or the law, so suggesting early transitioning through CPS stages isn’t an option. But when a caregiver reports resolutely that riding rear facing is a problem for their child, how can CPSTs guide them to make safe choices while showing compassion and respect for their predicament?

Naturally, it is essential to explain state laws as well as the laws of physics. The caregiver must understand that the law is not arbitrary and staying rear facing to the maximum allowed height or weight provides the best protection, especially for their child’s brain and spine. However, the tone and timing of these messages are key to successful delivery. Acknowledge their difficulties first so that the caregiver feels heard. Then, invite them to join you in problem solving in ways that keep their child safe and adhere to laws.

Sharing some medical perspective—and helpful tips—would also be effective. To get medical insight, SRN described the situation to Dr. Marilyn Bull and Dr. Ben Hoffman, prominent pediatricians, CPSTs, and members of SRN’s Editorial Review Board. Both noted that a CPST should urge the caregiver to discuss the problem with the child’s pediatrician—not to get an exemption letter but to work together to find child-specific solutions. The doctors gave the following general advice:

SRN: What causes motion sickness?

Dr. Hoffman: In general, motion sickness is due to a disconnect between what the eyes/brain are seeing and what the brain/vestibular system is sensing in terms of motion. This happens regardless of the direction. If changing to being forward facing were the answer, then adults would not get motion sickness!

SRN: So, it has to do with motion while facing any direction, not only while rear facing. Are there ways to prevent motion sickness from happening?

Dr. Hoffman: There are definitely some kids who are more prone to motion sickness than others. In general, finding ways to allow the child to see that they and the car are moving will help. This can be a bit more challenging for a child riding rear facing but not insurmountable. For instance, selecting a seat with a higher profile that allows a view out the back and/or side window can help. This could be a consideration when transitioning to a rear-facing convertible CR. Also, locating the CR in an outboard seating position in the vehicle might help, so the child can see things passing by out the window and take advantage of an open window generating a little breeze, which can also be helpful.

Dr. Bull: Since young children (under age 2) don’t tend to focus on the outside of the vehicle as much as older children—whether rear facing or forward facing—another suggestion is to have an adult sit in back to interact with them, maybe while sharing a book. The medical literature also suggests allowing some screen time to counteract motion sickness, but if the video player is portable (smartphones, iPads, etc.), CPSTs can’t advise using these devices in the car because they can become dangerous projectiles in a crash.

SRN: Are there ways to prevent motion sickness from causing vomiting?

Dr. Bull: If vomiting is part of the problem, do not feed the child for an hour prior to the trip; 90% of the stomach contents should be emptied after an hour. It also helps to keep the car well aerated and for an adult seated with the child to provide interactive distractions.

Dr. Hoffman: There are also acupressure bands that parents can try (as long as they are not a choking risk for the specific child). This approach to motion sickness works for some kids (and adults) but not others. It is a relatively inexpensive option to try that has no side effects (though, again, the child should be monitored, and this isn’t the best option for a child who is likely to aggressively chew on the band.)

SRN: Are there medications that children can take?

Dr. Bull: If other interventions fail, it is possible that a pediatrician will recommend an over-the-counter medication (like Benadryl) or prescribe one of a couple of other options.

Dr. Hoffman: Medications might prove helpful for some children and be worthwhile for longer trips. However, they would not be appropriate for daily use. It would still be important to try nondrug interventions.

SRN: Would you ever sign an exemption from following a COP law?

Dr. Hoffman: I personally would not sign an exemption unless it was for a child with a serious underlying medical condition (like chemotherapy or a gastrointestinal disorder).

Dr. Bull: Such a situation would have to be assessed on a case-by-case basis. But I would always be inclined to stress the important safety trade-offs with the caregiver. The alternative approaches we’ve discussed are far better than putting their child in a less-protective position in the car.