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Dizziness, Vertigo and Balance in children

Dizziness can have numerous different causes. It is important to talk to your GP if you are concerned.

What is vertigo?


Dizziness means different things to different people: sensation of movement or spinning, being off balance, fainting, passing out, and others. Vertigo means that the child is experiencing a sensation of movement. It's important for the doctor to know what your child is experiencing when they say they are dizzy (if this is possible), because different types of dizziness have different causes. Vertigo, a sensation of movement or spinning, can be caused by inner ear problems. Dizziness can make people anxious, and anxiety itself can also make dizziness worse.

In addition to wanting to know what it feels like, your doctor will also find it helpful to know when it happens, what sets it off, and how long it does on for. If you notice anything, a video recording could be helpful too.

Spinning episodes and poor balance can be related to hearing problems, because both hearing and balance are controlled by the inner ear. Other problems that you and your child might notice are clumsiness, difficulty walking, sickness and vomiting, or twitching of the eyes (nystagmus).

Your doctor may request a hearing test. A variety of tests may also be carried out in clinic, and brain scans can sometimes be useful.

What causes vertigo and poor balance in children?

There are a variety of different conditions. Causes related to the ear include

-middle ear problems such as middle ear infection or glue ear

-inner ear infections (labyrinthitis, also known as vestibular neuronitis)

-genetic causes affecting the inner ear

-benign paroxysmal vertigo of childhood

-vestibular migraine

-head injury

Benign paroxysmal vertigo of childhood and

Vestibular migraine

Benign paroxysmal vertigo of childhood (BPVC) is a common cause of vertigo. Children experience frightening episodes of spinning, and may vomit, and look pale and sweaty. The episodes can occur frequently or rarely. There is no associated hearing loss and the child does not experience any ringing sounds in the ear. There is no blacking out, and the child is back to normal as soon as the episode finishes. Attacks occur over a period of a few years, and often then just stop of their own accord.

Benign paroxysmal vertigo of childhood is not to be confused with benign paroxysmal positional vertigo (BPPV). Both conditions cause vertigo, and both are intermittent (paroxysmal), but in BPPV dizziness is brought on by position changes, and BPPV usually affects older people. Children can get BPPV though!

It is not known what causes BPVC exactly, but we think it is a type of migraine. The child may actually have migraine headaches, or dizziness associated with headaches and migraine, or there may be other family members with migraine. Although doctors may talk about benign paroxysmal vertigo of childhood and vestibular migraine as two separate conditions, in practice they are probably closely related and it may be difficult to tell them apart.   

Vestibular migraine sufferers typically have dizziness which can last from minutes to over a day, often with dislike of loud sounds or bright lights. There may also be visual disturbance, nausea, a flushed appearance, and difficulty concentrating. Many people with vestibular migraine don't experience any headaches.

Treatment of vertigo and balance problems

Treatment depends on the cause. Your child may be offered medications that switch off the inner ear balance function to help the child feel better. Such medications are OK in the short term, but in the long term are best avoided as it is not good to switch the inner ear off permanently. Vestibular therapy is useful in some, this consists of exercises to strengthen the inner ear balance function and help it recover. There is preventative medication available also, but this can be sedating or have side effects, so trying to find the trigger and waiting for your child to grow out of if is usually a better option.

 

For benign paroxysmal vertigo of childhood and vestibular migraine, it is worth looking for triggers that set if off. Like migraine headaches, if you can identify what brings it on, you can avoid the trigger. Common causes would be tiredness, dehydration, hunger, stress, chocolate, caffeine (for example in fizzy drinks), cheese, citrus fruit, and monosodium glutamate food additive (often in Chinese food). Excess salt intake is also a common trigger for a dizzy spell. Try avoiding one trigger for a month or so, and see what symptoms are like. Remember that symptoms may appear up to 48 hours after you eat the trigger. A general healthy lifestyle, exercise, plenty of sleep, and avoidance of hunger, dehydration and stress are also very important.