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 Otitis Media Effusion (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.
C.M & G.T – 16-10-26
Who to refer
Symptom Duration
| Symptom duration | Likely diagnosis | Management |
|---|---|---|
| Seconds to minutes | BPV (of childhood)-Migraine | Refer to Neurology |
| BPPV | Epley’s Manoeuvre | |
| 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 not, 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?
- 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 / first line medication 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.
Benign paroxysmal positional vertigo (BPPV) can be excluded with Hallpike’s test and Epley’s Manoeuvre: see BPPV (Benign Paroxysmal Positional Vertigo) – RefHelp
Refer to ENT
Red flags – unilateral hearing loss or tinnitus.
Urgently:
- Discharging ear (particularly if ongoing)
- Facial nerve palsy.
Refer to Neurology if other neurological concerns.
