Vertigo in childhood (vertige de l’enfance) is a distressing condition. Often more so for the parents than for the child. Contributing to this is the inability in most cases of young children to express themselves, leaving the parents worried and often fearing the worst.
It is estimated that the prevalence of children, older than 3 years, suffering from vertigo and dizziness is 8%. Although many conditions may be held responsible for childhood vertigo, not many appear to be so distressing as benign paroxysmal vertigo (BPV).
BPV is a syndrome that is characterised by brief sudden and recurring episodes of vertigo lasting seconds to minutes. In rare cases it may last longer. It occurs without warning and ends spontaneously. BPV is seen in younger children, usually before the age of 4, and usually disappears by the age of 8. However, a recent study by Krams and coworkers demonstrated that BPV may persist in as many as 50% of patients beyond the age of 11 years.
A typical presentation would be a child that suddenly stops playing and reporting that the world is spinning. In other cases, the child may suddenly grasp the parent, trying to avoid a fall. Those without support appears ataxic, as if walking on a broad base. It is not uncommon for children to be pale, nauseas and even vomit during attacks. Headaches may be present.
BPV occurs in otherwise healthy children and the clinical examination and special investigations are normal. A triggering factor such as stress, fever or fatigue is often present but not always recognised.
The exact mechanism of BPV is not fully understood yet, but it is generally accepted to be a form of and related to migraine. It is also believed to be a pre-cursor for migraine. There is usually a positive family history of migraine. Genetic susceptibility for migraine is a strong possibility. Children with BPV may develop emotional and behavioural problems. This is often more of a problem than the vertigo.