{"id":3725,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/balanceinchildren\/"},"modified":"2023-09-14T14:31:13","modified_gmt":"2023-09-14T13:31:13","slug":"balanceinchildren","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-ent\/balanceinchildren\/","title":{"rendered":"Balance in children"},"content":{"rendered":"\n

This page was last reviewed 12-01-21<\/strong><\/p>\n\n\n\nBalance in children<\/title>\n\n\n\n<h4 class=\"wp-block-heading\">\u200bIntroduction<\/h4>\n\n\n\n<p>In children it can be very difficult to obtain a coherent or convincing history. <\/p>\n\n\n\n<p>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. <\/p>\n\n\n\n<p>Young children suffering from OME might display intermittent balance disturbance but would rarely complain of dizziness.<\/p>\n\n\n\n<p>Young peri-pubescent females often present with “dizziness”.  It is important to consider anaemia (diet, recent onset of periods), postural hypotension and psychological factors. <\/p>\n\n\n\n<p>Dizziness in children is most commonly connected to the migraine spectrum disorders; however children can suffer from the same spectrum of disorders as adults.<\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Primary care management and Referral Guidelines<\/h4>\n\n\n\n<h4 class=\"wp-block-heading\">Symptom Duration<\/h4>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Symptom duration<\/strong><\/td><td><strong>Likely diagnosis<\/strong><\/td><td><strong>Management<\/strong><\/td><\/tr><tr><td><strong>Seconds to minutes<\/strong><\/td><td>BPV (of childhood)-Migraine<\/td><td>Refer to Neurology<\/td><\/tr><tr><td>\u200b<\/td><td>\u200b<\/td><td>\u200b<\/td><\/tr><tr><td> <\/td><td>BPPV<\/td><td>Epley Manoeuver<\/td><\/tr><tr><td> <\/td><td> <\/td><td> <\/td><\/tr><tr><td><strong>Minutes to hours<\/strong><\/td><td>Meniere’s<\/td><td>Refer ENT<\/td><\/tr><tr><td> <\/td><td> <\/td><td> <\/td><\/tr><tr><td><strong>Hours to days<\/strong><\/td><td>Meniere’s<\/td><td>Refer ENT<\/td><\/tr><tr><td>\u200b<\/td><td>\u200b<\/td><td>\u200b<\/td><\/tr><tr><td><strong>Days to weeks<\/strong><\/td><td>Vestibular neuronitis<\/td><td>Supportive – Refer ENT if no improvement after 3 months<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>Is this true vertigo (spinning)?<\/strong><br>If no consider cardiology, neurology, psychiatry<\/p>\n\n\n\n<p>Is this true rotating vertigo lasting for a few seconds\/minutes and associated with lying down, bending over or head movement?<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Is this true rotating vertigo lasting for a few seconds\/minutes and associated with lying down, bending over or head movement?<ul><li>Check lying\/standing BP<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Refer to audiology for assessment for Benign Paroxysmal Positional Vertigo (BPPV)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>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?\n<ul class=\"wp-block-list\">\n<li>Consider diagnosis of Migraine Associated Vertigo and give dietary advice +\/- Propranolol (see ref help) before referral to Neurology<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Is this true rotatory vertigo associated with unilateral change in hearing\/tinnitus during attack?<\/li>\n<\/ul>\n\n\n\n<p>Consider diagnosis of Meniere\u2019s disease – refer to ENT<br><br><strong>Red flags \u2013 Refer to ENT<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Unilateral hearing loss or tinnitus<\/li>\n<\/ul>\n\n\n\n<p><strong>Urgently<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Discharging ear (particularly if ongoing)<\/li>\n\n\n\n<li>Facial nerve palsy<\/li>\n<\/ul>\n\n\n\n<p> <strong>Benign paroxysmal positional vertigo<\/strong> (BPPV) can be excluded with      <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/hallpiketest\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/hallpiketest\/\" target=\"_blank\" rel=\"noreferrer noopener\">Hallpike’s test<\/a>   and    <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/epleymanoeuvre\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/epleymanoeuvre\/\" target=\"_blank\" rel=\"noreferrer noopener\">Epley’s Manoeuvre<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n\n\n\n<iframe src=\"\/refhelp\/list-resources-and-links\/?post_id=3725\"><\/iframe>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>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<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4246,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[165],"class_list":["post-3725","page","type-page","status-publish","hentry","category-balanceinchildren"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/entpaediatric\/balanceinchildren\/\" rel=\"tag\">Balance in Children<\/a>","rttpg_excerpt":"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","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3725","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3725"}],"version-history":[{"count":6,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3725\/revisions"}],"predecessor-version":[{"id":14837,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3725\/revisions\/14837"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4246"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3725"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3725"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}