Balance in children

This page was last reviewed 12-01-21

Balance in children

Introduction

In children it can be very difficult to obtain a coherent or convincing history.

The one important pathology not to miss is an intracranial lesion. Fortunately, these are exceedingly rare and even in specialist clinics do not present with “dizziness” as the main/only symptom. Usually other neurological symptoms are present.

Young children suffering from OME might display intermittent balance disturbance but would rarely complain of dizziness.

Young peri-pubescent females often present with “dizziness”. It is important to consider anaemia (diet, recent onset of periods), postural hypotension and psychological factors.

Dizziness in children is most commonly connected to the migraine spectrum disorders; however children can suffer from the same spectrum of disorders as adults.

Primary care management and Referral Guidelines

Symptom Duration

Symptom duration	Likely diagnosis	Management
Seconds to minutes	BPV (of childhood)-Migraine	Refer to Neurology

	BPPV	Epley Manoeuver

Minutes to hours	Meniere’s	Refer ENT

Hours to days	Meniere’s	Refer ENT

Days to weeks	Vestibular neuronitis	Supportive – Refer ENT if no improvement after 3 months

Is this true vertigo (spinning)?
If no consider cardiology, neurology, psychiatry

Is this true rotating vertigo lasting for a few seconds/minutes and associated with lying down, bending over or head movement?

Is this true rotating vertigo lasting for a few seconds/minutes and associated with lying down, bending over or head movement?
- Check lying/standing BP
- Refer to audiology for assessment for Benign Paroxysmal Positional Vertigo (BPPV)
Is this true rotatory vertigo associated with light sensitivity +/- headache, occurring with menstrual cycle or more frequently, past history of migraine in child or family?
- Consider diagnosis of Migraine Associated Vertigo and give dietary advice +/- Propranolol (see ref help) before referral to Neurology
Is this true rotatory vertigo associated with unilateral change in hearing/tinnitus during attack?

Consider diagnosis of Meniere’s disease – refer to ENT

Red flags – Refer to ENT