I have a parenting confession to make.

Husband and I dosed BabyC with Benadryl during a flight last week.

In my last post, I wrote about what we got right on our trip. Now it’s time to come clean and tell you what we may have gotten wrong.

Before you jump to judgment, let me explain the situation. We were on a red-eye flight from Portland, OR to Newark, NJ. A 5.5 hour flight. This was the first time we had attempted a red-eye with BabyC. At the time that I booked the tickets, the red-eye was the best choice for several reasons, but I knew it was a gamble.

However, as our trip grew closer, I started to feel nervous. What if she wouldn’t sleep? What if the novel situation – being surrounded by strangers on an airplane and being held in our laps (we didn’t purchase her own seat) – was just too much for her?

I know that many frown upon the idea of “drugging” kids for smoother travel. To be honest, it is not something that I have ever considered before this trip. But several parents had told us that it worked for them, and we were feeling desperate. It wasn’t because we were hoping for a relaxing flight with cocktails and an in-flight movie. We just wanted BabyC to sleep for her sake and for the sake of our fellow passengers.

Don’t worry. We checked and double-checked the dosage. We knew that some kids have a “paradoxical reaction” to the antihistamine drugs found in Benadryl – turning hyper instead of drowsy – so we tested it out the night before our trip. We dosed her 30 minutes before bedtime, and she went right to sleep that night without a fuss, as usual, so we figured that either it helped her sleep a bit or had no effect.

On travel night, we gave BabyC the same dose of Benadryl while we waited at the gate to board our plane. It was 10 PM, several hours after BabyC’s bedtime, but she was busy watching the lights on the runway and the people around us. We figured that once we settled into our seats and the engines started, she would snuggle up and sleep restfully for the duration of the flight.

Unfortunately, this was not to be.

Instead, she flipped and flopped around on my lap. She refused to nurse. I tried to rub her back, and she pushed my hand away. I pointed out to her that it was dark outside and that the passengers sitting around us had closed their eyes, trying to sleep. In answer, she cried.

Our foolproof sleep formula in travel situations is our Ergo carrier and a walk. So I strapped BabyC to my chest and walked up and down the aisle a few times. Now, going from the back to the front of the plane wasn’t so bad, except for the fact that BabyC is now big enough to kick the shoulders and elbows of the passengers seated in the aisle. What sucked was turning around to walk back the other direction and seeing the sea of tired faces, some annoyed, but most of them full of pity. I smiled apologetically and patted BabyC on the back, just in case anyone on that plane thought that I wasn’t doing my absolute best to calm my child.

A flight attendant called me out of the aisle so that they could run their beverage service. I stood in the brightly-lit galley of the plane, bouncing BabyC as only a parent knows how, and let the sounds of the plane wash over us: the slamming of metal drawers, ice dumped into cups, soda cans opening, lavatory door lock sliding into place. Thirty minutes later, BabyC’s body had relaxed and she was asleep.

I eased back into my seat and tried to get comfortable enough to sleep myself. BabyC, however, was restless. She shifted around in the Ergo and whimpered. A few minutes later, her back arched and she started crying, full on. We were back to square one.

Husband’s turn. He tried the aisle walk but quickly realized that it only succeeded in waking up the entire plane. With nowhere else to go, he carried BabyC into the tiny airplane bathroom and locked the door behind them. I sat in my seat, listening to BabyC’s faint cries, feeling helpless. The minutes passed, and her cries finally grew quiet, but the lavatory door remained closed. The captain turned on the seatbelt sign and a flight attendant warned us of approaching turbulence. Still no sign of life from the bathroom. It was only after we had passed through the rough patch and other passengers began pulling at the bathroom door that Husband finally emerged.

He told me later that he had drifted off to sleep on the plastic airplane toilet, but not before losing all sensation in his right arm. He was determined not to budge as long as BabyC was sleeping. I knew better than to check the time during the flight, but he must have been in there for close to two hours.

Back in the seat, BabyC slept off and on for the last couple of hours of the flight. Every ten minutes or so, she would try to shift herself into a more comfortable position, but it seemed impossible to find. She would wake, flail around, and fuss, and then usually settle somehow. Husband and I hardly slept at all.

The red-eye was a gamble, and we lost. We vowed that this would be our last. It is one thing to have a crappy flight, but quite another to start the first day of vacation with the entire family in a zombie-like state.

Flying with a fussy child is really one of our greatest fears as parents. We are in a tight space with stale air. We feel extremely vulnerable to the judgment of those around us. Our parenting is on display. Our children are almost always out of sorts in one way or another. Their routines have been disrupted, and surely they feel some anxiety about all the new sights and sounds of the airplane.

Traveling with a toddler is hard enough, but did we make it worse by dosing BabyC with Benadryl? Back at home, I wondered what research and recommendations had been published on using Benadryl to help kids sleep.

In the U.S., the active drug in Benadryl and its generic versions is an antihistamine called diphenhydramine (DPH). According to Wikipedia, Benadryl marketed in the U.K, Australia, and New Zealand contains second-generation antihistamines that do NOT have a sedative effect. The information in this post applies only to the DPH formulations.

DPH is usually used to treat allergy symptoms, but a common side effect is drowsiness. Capitalizing on this effect, DPH is used to treat insomnia in adults. However, according to the NIH, “DPH should not be used to cause sleepiness in children.” Notably, they warn that DPH may have a paradoxical effect, causing excitement rather than drowsiness, particularly in kids.

Despite these official warnings, several studies report that pediatricians commonly condone the use of DPH to help children sleep. In a survey of pediatricians practicing primary care in the U.S. [1], 45% reported recommending nonprescription medications to help children sleep during travel, with antihistamines such as Benadryl being the most common. A study of sleep medication used in pediatric patients in three U.S. academic children’s hospitals found that hospitalized kids were routinely given drug(s) to help them sleep [2] and again, antihistamines were the most frequent choice. The authors of this last study express some concern that there are no FDA-approved medications for pediatric sleep aids and no standard guidelines for use, off-label or not [3].

So does it work? Does Benadryl, or rather the DPH in it, help kids sleep better? There aren’t any studies of Benadryl use in fussy toddlers on airplanes, but DPH has been investigated as a sleep aid for kids who generally have trouble sleeping at home.

A 1976 study tested DPH in kids aged 2-12 identified as having sleep problems [4]. Although small (50 kids), this was a careful double-blind, crossover trial in which kids received a placebo for two weeks and DPH for two weeks. Kids were given a standard dose of 1 mg/kg 30 minutes before bedtime. DPH reduced both the amount of time it took kids to fall asleep and the number of night wakings compared to the placebo. Importantly, the study reported no paradoxical or otherwise adverse reactions to DPH at this dose.

However, several more recent studies have found different results. The aptly-named TIRED study, published in 2006, tested DPH (1 mg/kg) or a placebo in 44 babies aged 6 to 15 months [5]. However, the trial was stopped after just one week because the DPH did not appear to be effective in improving sleep – either falling asleep or staying asleep. Mild hyperactivity was observed in one child taking DPH, but it was also noted in one of the children taking the placebo. The authors conclude:

“Many in the medical and lay community accept diphenhydramine as effective treatment for sleep problems. Unfortunately, this attitude is based on anecdote and studies of adult physiological interactions. However, the TIRED study results demonstrated that at the most commonly used dose, diphenhydramine may play no role in treating infant sleep problems. Although parents did not report increased hyperactivity in the diphenhydramine group compared with the placebo group, it is also possible that diphenhydramine caused low-level hyperactivity in children, thereby negating the sleep benefits seen in some adults.”

Another recent study on older kids (2-16 years old) with nighttime coughing found that DPH on a single night did not improve sleep quality (or coughing) [4]. It also didn’t cause hyperactivity or insomnia.

So we have one study that found that DPH helped kids aged 2-12 to sleep and two more recent studies, including one on infants, which found no effect on sleep. None of the three studies found a paradoxical reaction of hyperactivity to be a problem. This doesn’t give us much data to work with, particularly since all three studies were rather small. In addition, these studies were conducted in familiar environments of the children’s homes. Hyperactivity may be more likely to occur in a place as stimulating as an airplane. Regardless, DPH seems to be neither overwhelmingly effective nor risky.

That said, all drugs are risky to some extent. Other side effects listed for DPH include dry mouth, dizziness, nausea, vomiting, constipation, chest congestion, headache, and vision problems. You wouldn’t wish these on your kids in any circumstance, and especially not on an airplane. Since there isn’t strong evidence that it works to help kids sleep in the first place, why risk it? At the very least, talk with your pediatrician if you are considering it.

We had a rough red-eye flight with BabyC, but we’ll never know if Benadryl made it worse. She’s had these kinds of inconsolable can’t-get-to-sleep tantrums before when we were traveling, just not in flight. Whatever the cause, we aren’t inclined to try using Benadryl again. But then, you won’t find us on a red-eye anytime soon either.

Have you ever tried using Benadryl to help your child sleep for travel? Have you considered it?

REFERENCES

1. Owens, J.A., C.L. Rosen, and J.A. Mindell, Medication use in the treatment of pediatric insomnia: results of a survey of community-based pediatricians. Pediatrics, 2003. 111(5 Pt 1): p. e628-35.

2. Meltzer, L.J., et al., Use of sleep medications in hospitalized pediatric patients. Pediatrics, 2007. 119(6): p. 1047-55.

3. Mindell, J.A., et al., Pharmacologic management of insomnia in children and adolescents: consensus statement. Pediatrics, 2006. 117(6): p. e1223-32.

4. Russo, R.M., V.J. Gururaj, and J.E. Allen, The effectiveness of diphenhydramine HCI in pediatric sleep disorders. J Clin Pharmacol, 1976. 16(5-6): p. 284-8.

5. Merenstein, D., et al., The trial of infant response to diphenhydramine: the TIRED study–a randomized, controlled, patient-oriented trial. Arch Pediatr Adolesc Med, 2006. 160(7): p. 707-12.