Vertigo in Children: What You Need to Know

Overview 

Vertigo can cause a great deal of distress for a child and can impact children of any age. Parents may become aware of their child’s vertigo when they observe signs such as clumsiness, nausea, or rapid eye movements. It is crucial to seek treatment for vertigo, as it could indicate a more severe condition and potentially result in balance and coordination issues that may lead to injuries. 

Vertigo in children 

Vertigo, a sudden and disorienting sensation of the room spinning, can persist for varying durations, ranging from minutes to days or weeks, depending on its underlying cause. It is more prevalent among children, with balance issues and dizziness being commonly experienced by this age group. 

A comprehensive study revealed that approximately 1 in 20 children have encountered dizziness problems; among them, 29 per cent attributed their symptoms to vertigo. 

Vertigo can be caused by various factors, commonly occurring when there is an imbalance in the brain or inner ear. Typically, it is a secondary effect of a less severe ailment, such as sinus congestion resulting from a cold. Nevertheless, seeking medical attention for your child is essential, as vertigo may indicate a more significant underlying issue. 

Maintaining balance in the body depends on the inner ear, which detects head and body position and motion. In conjunction with the eyes and other bodily components, the inner ear provides crucial signals for balance. The brain receives signals from the inner ear, eyes, and other regions to ensure the body remains stable. 

Symptoms of vertigo in kids 

Some of the symptoms in children include:

• Dizziness 
• Paleness 
• Headache 
• Visual disturbance 
• Fear in young children 
• Migraine 
• Hearing loss or ringing in the ears 
• Clumsiness or loss of balance 
• Nausea 
• Nystagmus, or rapid eye movements 

Causes of vertigo in kids 

Vertigo or dizziness can occur in children with or without an eardrum problem. An eardrum problem can lead to dizziness because the inner ear’s vestibular system, responsible for the body’s sense of balance, is affected. Most eardrum problems that cause vertigo are associated with minor illnesses, which can be treated to eliminate the vertigo. 

However, it is essential to note that vertigo can also be caused by other systems in the body. Depending on the underlying disorder, the episodes of dizziness may be more persistent.

In such cases, a change in head position often triggers the symptoms, and your child may also experience additional symptoms like nausea and nystagmus (darting eye movements). There are numerous potential causes of vertigo. 

Middle-ear infection or middle-ear effusion, characterised by the accumulation of thick fluid behind the eardrum, without the presence of infection, can temporarily disrupt your child’s sense of balance located in the inner ear.  

Inner ear infections, such as labyrinthitis and vestibular neuritis, can also cause similar disruptions to balance. Vestibular neuritis is an infection of one of the two vestibular nerves in the inner ear and is typically viral. These nerves are responsible for transmitting positional information to the brain, and inflammation can disrupt balance. Other infections, including flu, chicken pox, measles, mononucleosis, rubella, and shingles, can cause vestibular neuritis. 

Labyrinthitis commonly arises from a viral infection and occasionally from a bacterial infection, impacting the vestibular and cochlear nerves. It induces vertigo and impairs hearing, similar to its effects on the body. 

Concussions or other head traumas can lead to disturbances in balance. Furthermore, small bone-like particles floating in the inner ear fluid, which may result from a concussion or infection, can also affect balance. 

Migraines, classified as vascular disorders due to the blood vessel dilation in the brain resulting in throbbing headaches, can often be accompanied by a form of vertigo known as “motion sickness” or intolerance. 

Vestibular migraine, one of the primary factors contributing to childhood vertigo, is characterised by an uncertain aetiology. Although the exact cause remains unidentified, genetic factors are believed to be influential, potentially accompanied by the constriction of cerebral blood vessels. 

Basilar artery migraine can result in the occurrence of both headache and vertigo. Typically, the symptoms of vertigo tend to subside once the headache dissipates. 

Meniere’s disease, characterised by excessive fluid production in the inner ear, results in recurring episodes of vertigo accompanied by tinnitus and hearing impairment. Although relatively rare, this condition can also manifest in pediatric patients. Psychiatric disorders might cause psychogenic vertigo.

Diagnosis of vertigo 

Your child’s primary care provider will probably refer them to a pediatric otolaryngologist (ENT specialist) to diagnose vertigo, as it can be complex. It is crucial to distinguish vertigo from other types of dizziness, and a meticulous assessment of all potential causes may be required. 

An otolaryngologist is the most qualified professional to conduct a comprehensive evaluation and to determine when to seek the assistance of other specialists. Throughout the evaluation process, the specialist may perform various tests, including: 

• Extensive medical history-taking with inquiries for the patient and their child; an exploration of the family’s migraine history may be conducted.  
• A thorough physical examination will be performed, particularly of the head and ears. Audiometry, or hearing testing, will be conducted. Vestibular function tests, such as those performed in a rotational chair, will be administered.  
• Electronystagmography (ENG) will be utilised, which involves the placement of electrodes above and below the patient’s eyes to detect rapid eye movements (nystagmus).  
• Electroencephalography, a test that measures the electrical activity in the patient’s brain, will be conducted. Lab (blood) tests will be carried out.  
• Imaging tests may be performed, including CT scans, X-rays, or MRIs.
• Vestibular-ocular tests involving games and gaze fixation will be conducted.  
• Dynamic visual acuity, which requires the patient to shake their head “no” quickly, will be assessed.  
• Coordination and gross motor skills will be evaluated, such as hopping, skipping, and jumping with both eyes open and closed. 

Treatments 

The appropriate action for addressing your child’s vertigo depends on the underlying cause. In numerous instances, relief from vertigo can still be achieved despite the persistence of the root cause. 

Medication such as antibiotics, decongestants, or antihistamines may be prescribed to alleviate fluid in the ear. Motion sickness medicine can also be used to address this issue. In cases of vertigo associated with migraines and seizures, antidepressant medication may be recommended. 

Additionally, behavioural modifications and lifestyle changes should be implemented, such as avoiding certain positions or activities that can trigger vertigo or pose a risk to the child. For example, activities like skateboarding or driving a car should be avoided during bouts of vertigo.  

Physical therapy techniques, such as the Epley or Semont manoeuvre, can reposition floating bone-like particles within the inner ear, thereby reducing vertigo symptoms. 

Keep your child away from these activities until vertigo is fully treated. 

• Driving 
• Skateboarding 
• Dancing 
• Riding a bike or scooter 
• Gymnastics 
• Rollerskating 

When to consult a doctor 

Suppose your child exhibits confusion, experiences chronic or persistent vertigo, or also presents symptoms such as ear ringing, headache, or vomiting. In that case, it is advisable to seek a healthcare professional. Bouts of vertigo are not uncommon during childhood, and while many cases resolve spontaneously, it is essential to consult a medical expert in these situations. 

Summary 

It is vital to know the indications and manifestations of vertigo in children and the possible reasons and remedies. If your child is encountering any of these indications, it is imperative to consult a healthcare expert to exclude any significant underlying conditions. 

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