Childhood vertigo is uncommon. In younger children it may be difficult to pick up due to the inability of younger children to accurately describe their symptoms. Often the parents may notice some strange behaviour, clumsiness or falling in their child. In the majority of cases the cause is not serious. Unfortunately it is also true that serious conditions such as brain tumours may present with dizziness and disequilibrium (balance problems).
Balance problems are more common. Otitis media with effusion (OME) or “glue ear “can lead to balance problems in up to 50% of patients. This is often overlooked. Medical treatment with or without grommet placement should cure a patient.
The most common causes of vertigo in children are benign paroxysmal vertigo of childhood (BPVC) and migraine-associated vertigo (MAV). Headaches are often reported by patients and in many cases a family history of migraine exists.
In some children with genetic disorders such as Usher syndrome vestibular function and balance may be impaired. Usher syndrome also affects hearing and vision.
Other causes of childhood vertigo include epilepsy, virus infections, medication side effects and allergies. Psychogenic vertigo can be difficult to diagnose and in some cases psychological assessment may be required.
Every child in whom vertigo and balance problems are expected should be investigated. A visit to a paediatrician is imperative to ensure a proper general evaluation. Depending on the age of the patient vestibular testing may be of benefit. In older children videonystagmography (VNG) may be performed whereas in younger children rotation chair testing with the child on the mother’s lap and electronystagmography (ENG) may be the only options.
In rare cases a brain tumour may present with balance problems in a child. Children who do not respond to treatment need contrast enhanced magnetic resonance imaging (MRI) of the brain to exclude a posterior fossa tumour.