dizziness imbalance in children

Dizziness and Imbalance in Children

Dizziness and imbalance are some of the most commonly reported medical symptoms in an adult population, but are rarely encountered in a pediatric population and are estimated to affect anywhere from 0.4 to 5% of children in the United States. While this is a relatively low percentage of the population, there is also the potential that dizziness symptoms in children are under reported.

Many children do not have the ability to verbally express dizziness symptoms and some children may have never experienced a state of normal equilibrium.


How to Know if a Child is Dizzy


Because children cannot or typically do not verbally express symptoms of dizziness, they are often first noticed as delays in overall motor function such as sitting, standing, walking or holding their head upright. Children experiencing these symptoms may also appear to be unsteady or “clumsy”, have poorer fine motor control, as well as impaired reading abilities when compared to their peers.

Of course, a child’s report of experiencing dizziness, or having nausea, vomiting or sweating should be taken into account when considering possible symptoms of dizziness.


Causes of Dizziness in Children


The breakdown of what causes dizziness and imbalance in a pediatric population is also very different from what is seen in an adult population. The large majority of these symptoms are believed to be caused by migraine or migraine equivalents, accounting for around 55% of cases.

The remaining, but statistically less-likely, causes of pediatric dizziness include ear, eye, and brain disorders. Some of these less common reasons for pediatric dizziness include vestibular neuritis/labyrinthitis (viral inner ear inflammation), physical trauma, and visual deficits each accounting for around 10% of cases. Mondini malformation (congenital malformation of inner ear) is thought to be the cause in 8% of cases. Psychogenic factors and otitis media (middle ear infection) are each thought to be the cause in 4% of cases.

The condition of benign paroxysmal positional vertigo or BPPV (displaced inner ear particles) is thought to account for 2% of cases. Conditions such as Ménière’s disease (inner ear disorder associated with abnormal inner ear fluid levels) and epilepsy each account for 1% of cases. Less than 1% of cases were thought to be due to a tumor.

As you can see from the above breakdown, the large majority of symptoms are caused by migraine, or migraine equivalents, making evaluation by a neurologist a logical initial step in evaluating dizziness in children.

If there are no significant neurologic abnormalities believed to be causing the symptoms, evaluation by otolaryngology would then seem to be the next logical course of action


Dizziness and Hearing Loss in Children


A peripheral vestibular (ear) disorder is much more likely to be the cause of dizziness symptoms in children who have congenital sensorineural (inner ear) hearing loss.

Recent studies show that around 70% of children with congenital sensorineural hearing loss have some degree of vestibular dysfunction.

While current medical treatments do not provide restorative function for most inner ear disorders, many individuals benefit greatly from vestibular rehabilitation therapy, usually by working with a physical therapist. It is essential to identify and appropriately treat peripheral vestibular disorders to avoid gross motor or other delays.

Many children with hearing loss are identified either at birth with newborn hearing screenings or through screenings in the school, but there is a potential that a child with hearing loss could fall through the cracks. If your child reports tinnitus (noises in the ears), ear pain, ear pressure, or you notice that they are having difficulty hearing or responding to you, then it is best to have this evaluated.


What to do if you Suspect Dizziness in a Child


If you think your child is experiencing dizziness or imbalance, it is best to consult with his or her pediatrician. Your child’s pediatrician is the provider who best understands his or her complete medical history and can direct referrals to appropriate specialties.

About Brady Workman

Brady Workman, AuD, is an audiologist in the Balance Disorders program at Wake Forest Baptist Health Center. Brady resides in Winston-Salem, North Carolina and is licensed by the North Carolina Board of Examiners for Speech Language Pathologists and Audiologists and is a fellow of the American Academy of Audiology. His primary clinical interests include comprehensive vestibular assessment and adult hearing diagnostics.