{"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":"2026-10-16T09:08:10","modified_gmt":"2026-10-16T08:08:10","slug":"balanceinchildren","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-ent\/balanceinchildren\/","title":{"rendered":"Balance in children"},"content":{"rendered":"\nBalance in children<\/title>\n\n\n\n<p class=\"wp-block-paragraph\">In children it can be very difficult to obtain a coherent or convincing history.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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 class=\"wp-block-paragraph\">Young children suffering from Otitis Media Effusion (OME) might display intermittent balance disturbance but would rarely complain of dizziness.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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 class=\"wp-block-paragraph\">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<p class=\"wp-block-paragraph\"><strong>C.M & G.T – 16-10-26<\/strong><\/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\"><strong>Who to refer<\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration: underline\"><strong>Symptom Duration<\/strong><\/span><\/p>\n\n\n\n<figure class=\"wp-block-table aligncenter\"><table><thead><tr><th><strong>Symptom duration<\/strong><\/th><th><strong>Likely diagnosis<\/strong><\/th><th><strong>Management<\/strong><\/th><\/tr><\/thead><tbody><tr><td><strong>Seconds to minutes<\/strong><\/td><td>BPV (of childhood)-Migraine<\/td><td>Refer to Neurology<\/td><\/tr><tr><td><\/td><td>BPPV<\/td><td>Epley\u2019s Manoeuvre<\/td><\/tr><tr><td><strong>Minutes to hours<\/strong><\/td><td>Meniere’s<\/td><td>Refer ENT<\/td><\/tr><tr><td><strong>Hours to days<\/strong><\/td><td>Meniere’s<\/td><td>Refer ENT<\/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 class=\"wp-block-paragraph\"><strong>Is this true vertigo (spinning)?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If not, consider cardiology, neurology, psychiatry<\/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 \/ first line medication 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?\n<ul class=\"wp-block-list\">\n<li>Consider diagnosis of Meniere\u2019s disease – refer to ENT.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Benign paroxysmal positional vertigo<\/strong> (BPPV) can be excluded with\u00a0Hallpike’s test and Epley’s Manoeuvre: see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/audiology\/bppvbenignparoxysmalpositionalvertigo\/\" target=\"_blank\" rel=\"noreferrer noopener\">BPPV (Benign Paroxysmal Positional Vertigo) – RefHelp<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><span style=\"text-decoration: underline\">Refer to ENT<\/span><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Red flags –<\/strong> unilateral hearing loss or tinnitus.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><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 class=\"wp-block-paragraph\"><em>Refer to Neurology if other neurological concerns.<\/em><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Balance in children 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<\/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":"Balance in children 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","_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":2,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3725\/revisions"}],"predecessor-version":[{"id":30464,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3725\/revisions\/30464"}],"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}]}}