Pediatric Balance Disorders

Pediatric Balance Disorders

When you think of balance, the role that ears play might not enter your mind. But ears are crucial to preserving balance thanks to their vestibulocochlear nerve. This nerve sends signals to the brain that control hearing (acoustic function) and help with balance (vestibular function).

But the ears aren’t the only organs that help us balance. Ears, eyes, joints, and muscles interact to keep us constant and upright. When several of these systems runs out whack, it can be difficult to get around and just function, everyday. The most basic things– like walking, riding a bike, doing school work, even playing– can end up being tough and discouraging.

Balance disorders are considered uncommon in kids and teenagers, but might be undervalued– symptoms might be misdiagnosed as something else or missed out on entirely. But fixing kids’ balance problems can make a big enhancement in their total lifestyle– their ability to play, find out, and feel as pleased and healthy as possible.

How Balance Works

To comprehend balance problems, it is essential to understand how balance works generally. Generally, the body relies on 3 separate systems, each sending out nerve impulses to the brain:

In the neck, torso, leg joints, and feet are pressure sensing units that send info to the brain about where the body remains in relation to the world (referred to as proprioception). Messages are sent out when we do things like turn our heads, relocation, and walk on different surfaces.

In the front of the inner ear, or labyrinth, are the cochlea, involved in hearing; in the rear are semicircular canals, which affect balance. Linking them is the vestibule (with sensory organs called the utricle and saccule), which affects balance and equilibrium. When we turn our heads rapidly, the liquid in the semicircular canals moves the small hairs lining the cochlea, sending out a message (through the vestibulocochlear nerve) to the brain about the movement. In less than a second, the brain sends messages to the muscles needed to maintain balance and help the eyes remain focused.

In the eyes, the nerve endings in the retina (at the back of the eye) have actually light-sensitive cells called rods and cones. When we look at something, light hits the retina, and the rods and cones send out electrical signals to the brain through the optic nerve. The brain uses these signals to interpret what we’re seeing and create visual images. Each eye gets a little various pictures of (and information about) the exact same item, which helps depth understanding (how far an item is) and is vital to keeping balance.

If any of these systems isn’t working right, it can impact balance.


Depending upon the type of balance condition and what’s triggering it, symptoms can vary from child to child. Some kids and teenagers might experience severe symptoms, making it difficult for them to work. Others may just have mild symptoms that are hardly discovered.

In basic, however, children with balance disorders have symptoms of disequilibrium– an unstable, “woozy” feeling that makes it hard to stand, walk, turn corners, or climb the stairs without falling, running into things, stumbling, or tripping.

They also might walk with their legs too far apart or be unable to walk without incredible. Walking in the dark or over uneven surfaces can be difficult, too. All of this can make them appear uncoordinated and clumsy.

Another typical symptom of a balance issue is vertigo. Most people consider this as an unexpected experience that the room is spinning or whirling or that you’re moving when sitting or standing still. However kids may describe it as feeling like they’re rocking, floating, or “on a merry-go-round.” Kids likewise might feel lightheaded, lightheaded, or disoriented.

Balance disorders can cause vision issues, too. Kids might see images that bounce or look blurry whenever they move their heads. This is called oscillopsia, which can make reading and writing actually tough.

Symptoms likewise can include:

  • involuntary eye motions (called nystagmus)
  • discomfort or problem looking at sun glare or lights (especially fluorescent, flashing, or moving lights)
  • discomfort in situations with “hectic” visuals (patterns, crowds, heavy traffic, and loaded areas like shopping center)
  • depth understanding disturbances that can affect hand-eye or eye-foot coordination (making things like catching or kicking a ball hard)

Balance issues also can affect hearing. Sounds may seem smothered, particularly in the middle of background noise. Kids may also have annoying, distracting ear issues like ear pain, pressure or “fullness” in the ears, and ringing in the ears (ringing or other seem like whirring, humming, or buzzing).

These kinds of balance-related symptoms can take a real toll on kids– physically and emotionally– and cause other symptoms like:

  • frequent headaches or migraines
  • nausea, vomiting, and diarrhea
  • movement (car) illness
  • modifications in heart rate and blood pressure
  • fatigue
  • seizures
  • worry, stress and anxiety, or panic
  • depression

Naturally, symptoms including kids’ motion, sight, hearing– and just how they feel, daily– can impact their ability to maintain in class, whether in preschool or high school. Balance issues can make it difficult to bear in mind things, concentrate, pay attention, and follow directions. Kids might not be able to hear the instructor or focus their eyes on the blackboard or their books. And they might become frustrated in physical education and with sports.

Some kids and teenagers with balance conditions may seem like they’re slouching or not paying attention or attempting in school. Probably the most irritating part for them is feeling like they’re trying their absolute best, however being not able to do some things they want or have to do– and not knowing why.

Types of Balance Disorders

Although balance disorders aren’t typical in kids and teenagers (once again, most likely due to the fact that they’re so difficult to capture), the most regularly detected vestibular conditions are:.

Benign paroxysmal torticollis of infancy, which generally starts during a child’s first 6 months. Torticollis actually implies “twisted neck” and kids with this condition have the tendency to keep their heads tilted from feeling so woozy. They might also have headaches, sweat a lot, vomit, look pale, seem picky, and walk or toddle strangely. Some might have BPV, too.

Benign paroxysmal vertigo of youth (or BPV, sometimes likewise called childhood paroxysmal vertigo), in which fluid or small particles can detach and develop in the inner ear. This may cause vertigo that comes on suddenly (often when rapidly moving the head) and vanishes in a matter of minutes. Kids might seem for a short while afraid and unsteady and also may have queasiness, vomiting, uncontrolled eye motions, or headaches. BPV, which usually impacts kids ages 2 to 12, can disappear by itself as kids grow or continue into adulthood to become benign positional vertigo or migraine-associated vertigo.

Vestibular neuronitis (or neuritis), an infection that causes swelling of the vestibular nerve, might cause an unexpected case of vertigo, nausea, vomiting, and involuntary eye motions.

Labyrinthitis can be caused by a viral (or, seldom, a bacterial) infection of the inner ear’s labyrinth, which likewise can induce sudden vertigo, ringing in the ears, and temporary moderate hearing loss in some kids.

Other conditions are far less common; for instance, perilymph fistula (PLF) is a problem (frequently a tear or problem) in the connections between the inner ear and middle ear that might cause vertigo, unsteadiness, hearing loss, and ear pressure. And an inner ear disorder called Meniere’s disease can induce tinnitus, hearing loss, ear fullness, and lengthy episodes of vertigo that may last anywhere from 30 minutes to an hour or longer.

Pediatric Balance Disorders


Medical professionals cannot constantly pinpoint the reason for a balance issue. However balance-related symptoms may be brought on by any number of things, such as:

  • ear, head, or neck injuries
  • ototoxicity (when certain medications, consisting of specific antibiotics and chemotherapy drugs, damage the inner ear)
  • migraines
  • hearing loss
  • chronic middle ear infections (otitis media)
  • other infections (like the cold, influenza, meningitis, measles, mumps, or rubella)
  • depression
  • alcoholic abuse
  • movement sickness or level of sensitivity
  • seizure disorders

Children who have a family history of hearing or vestibular problems, lightheadedness, or motion sickness might be more prone to balance disorders, too.


Identifying and diagnosing balance disorders in kids and teens can be tricky. Regrettably, kids with many typical balance issues may be so young that they cannot explain how they’re feeling or react to certain tests. And to parents, they may just appear clumsy and picky.

If you think your child might be having balance issues, call your doctor, who will do a physical exam and look at your child’s symptoms and medical history. If the doctor thinks that your child’s balance is affected, you might be described an audiologist (a hearing expert), an otolaryngologist (an ear, nose, and throat expert, or ENT), and/or a neurolotologist (a professional in ear conditions).

Tests can consist of:

  • imaging tests, like an MRI or a CT scan.
  • motor function tests to look at great and gross motor skills.
  • behavioral hearing tests. These involve cautious observation of a child’s behavioral response to seem like pure tones. Pure tones are the distinct pitches (frequencies) of sounds. Sometimes other signals are used to acquire frequency details.
  • otoacoustic emissions (OAE) test. A tiny probe is placed in the ear canal, then lots of pulse-type noises are introduced and an “echo” response from cells in the inner ear is taped. A typical recording is associated with regular inner ear function and reflects typical hearing. This test, along with the ABR, is generally used on infants and young kids.
  • electronystagmogram (ENG). To evaluate balance, electrodes are positioned around the eyes and a computer system keeps track of uncontrolled eye movements while a child is asked to concentrate on a visual target or while hot or cold water is injected into the ear canal. The head may also be manipulated into different positions while physicians observe eye motions.
  • videonystagmography (VNG). This test resembles an ENG, only the child has to focus on the visual target while wearing special video recording goggles. Then the eye movements are examined as cool and warm air is gently blown into the ear canals.
  • acoustic brainstem action (ABR) test. Tiny earphones are placed in the ear canals. Usually, click-type sounds are magnified through the earphones, and electrodes measure the auditory (hearing) nerve’s response to those sounds.
  • vestibular stimulated myogenic capacity (VEMP). This fairly new test examines parts of the inner ear that the ENG, VNG, and ABR tests don’t. Like the ABR, earphones are put in each ear to listen to loud clicks. And electrodes placed on the head and neck record the child’s action to the clicks as she or he contracts neck muscles.
  • posturography. This test measures a child’s capability to balance while basing on a steady or unsteady platform.
  • balance surveys. Kids who are old adequate to describe a medical problem might be asked questions about the level of lightheadedness experienced throughout the day while performing different activities.


Kids can simply grow out of some balance disorders. For example, both BPV of youth and benign paroxysmal torticollis of infancy generally disappear, without treatment, by the time a child is 5 years old. And vestibular neuronitis and labyrinthitis often disappear on their own, too.

Still, doctors can assist handle kids’ symptoms and make their lives a little much easier with rehab and sometimes medicine or surgery.

Balance therapy (likewise called vestibular rehab) with a physical or vestibular therapist might consist of training exercises that assist strengthen balance skills and coordination. Exercises may include things like bending down, standing or walking with eyes open and after that with eyes closed, swimming, or walking barefoot on different irregular surfaces. Kids often do very well with vestibular therapy since they’re much better able to adapt to balance problems than adults.

For kids with BPV of youth, a therapist can in some cases relieve vertigo and lightheadedness by gently rearranging the head at different angles to move fluid or the tiny particles drifting around in the inner ear (this is known as the canalinth repositioning or Epley maneuver).

And kids with significant hearing loss that’s affecting their balance might need several of the following:

  • a hearing aid (that fits inside or behind the ear and make noises louder).
  • an FM system or “acoustic fitness instructor” (specialized devices that shut out background sound).
  • a cochlear implant (a surgically implanted device that helps overcome issues in the inner ear, or cochlea).
  • listening therapy with an audiologist (which uses music and sounds to assist kids adjust their hearing and balance).

When to See a Doctor

It is very important to bear in mind that although things like dizziness and clumsiness prevail signs of a balance condition, by themselves these symptoms aren’t necessarily a sign of a balance problem– or any other chronic problem, for that matter. For instance, it’s completely typical for kids to feel woozy if they’re dehydrated or they stand too fast. And great deals of kids stumble and fall in some cases, especially toddlers simply learning to walk and preschoolers getting used to how their bodies move.

Nevertheless, if you’re seeing a pattern– if you observe several potentially balance-related symptoms occurring regularly– it’s a smart idea to call your doctor to discover what’s going on. Detecting and treating balance disorders can help kids develop more typically, become more constant and collaborated, and just function and feel better physically and emotionally.

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