Vertigo is a sensation of spinning or feeling that the world around you is spinning, even when you are standing still. This differs from general dizziness, which is typically a feeling of lightheadedness or unsteadiness. While more commonly associated with adults, children can indeed experience vertigo, a disorienting sensation. This article helps parents understand how vertigo manifests in children, its causes, diagnosis, management, and when to seek medical attention.
How Vertigo Appears in Children
Younger children may struggle to articulate the sensation of “spinning” or “dizziness.” Instead, their vertigo often manifests through observable behaviors and physical signs. They might become unusually unsteady, appear clumsy, or have difficulty walking in a straight line. Parents may notice a child refusing to move, clinging to a caregiver, or appearing fearful due to the disorienting feeling.
Physical symptoms accompanying vertigo can include nausea, vomiting, or a pale complexion. Nystagmus, involuntary eye movements where the eyes may dart back and forth or flutter, is a common sign. Unlike general lightheadedness, vertigo involves a distinct sensation of motion and significantly impacts balance, making it harder for a child to maintain stability. Episodes can last from seconds to minutes or even days, depending on the underlying cause.
Underlying Causes of Childhood Vertigo
Several conditions can lead to vertigo in children.
Benign Paroxysmal Vertigo of Childhood (BPVC)
One of the most common causes is Benign Paroxysmal Vertigo of Childhood (BPVC), also known as Benign Vertigo of Childhood (BVC). This condition involves sudden, brief episodes of spinning that typically last seconds to minutes, often resolving on their own, and are thought to be related to migraines. Children with BPVC usually do not experience hearing loss, and their symptoms are not triggered by head position changes.
Vestibular Migraine
Another frequent cause is vestibular migraine, which can occur with or without a headache and is a common cause of childhood vertigo. Children with vestibular migraine may experience dizziness, unsteadiness, nausea, and sensitivity to light and sound. Triggers can include lack of sleep, skipping meals, certain foods, or stress, and there is often a family history of migraines.
Inner Ear Infections
Inner ear infections, such as labyrinthitis and vestibular neuritis, can also cause vertigo. Labyrinthitis involves inflammation of the inner ear that affects both balance and hearing, leading to dizziness and potential hearing loss or ringing in the ears. Vestibular neuritis, conversely, typically affects only the balance nerve, causing dizziness without hearing changes. These infections are often viral, but can sometimes be bacterial, stemming from common illnesses like colds or flu.
Head Trauma
Head trauma, including concussions, can result in vertigo. This can happen if the injury dislodges tiny calcium crystals in the inner ear, a condition known as benign paroxysmal positional vertigo (BPPV), or if there is direct damage to inner ear structures. Less commonly, fluid buildup behind the eardrum from a middle-ear infection can temporarily disrupt balance.
Rare Causes
More rare causes of vertigo in children include Meniere’s disease, which involves excessive fluid buildup in the inner ear leading to episodes of vertigo, hearing loss, and ear fullness. This condition is significantly less common in children than adults. Certain medications can also be ototoxic, meaning they can damage inner ear structures and cause dizziness or hearing loss. Neurological conditions like brain tumors, while very rare, can present with vertigo, requiring comprehensive evaluation.
Diagnosing and Managing Vertigo in Kids
Diagnosing the cause of vertigo in a child begins with a detailed medical history, focusing on symptoms, duration, and triggers. A physical examination, including a neurological assessment and a thorough check of the head and ears, is performed. Specialists like pediatric otolaryngologists (ENTs) or audiologists may be involved, as children may not fully describe their sensations.
Diagnostic tests might include audiometric evaluations to check hearing, and specialized vestibular tests to assess inner ear function. These can involve tests like rotational chair testing, which records eye movements, or video head impulse tests (vHIT), which measure eye movements in response to rapid head turns. In some cases, imaging studies like an MRI or CT scan may be considered to rule out more serious neurological conditions, though this is not routine.
Management of vertigo in children is tailored to the specific underlying cause. For conditions like BPVC, reassurance and supportive care are often sufficient, as episodes frequently resolve on their own. If an infection is the cause, antibiotics or antiviral medications may be prescribed. For vestibular migraines, management strategies include lifestyle adjustments like adequate sleep, regular meals, and stress management, alongside medications to alleviate symptoms or prevent attacks. Symptomatic relief for nausea and vomiting can be provided with antiemetic medications. Vestibular rehabilitation therapy, involving specific exercises, can also help improve balance and coordination, especially if balance problems persist.
When to Consult a Doctor
Parents should seek medical attention if their child experiences vertigo. An urgent doctor’s visit is warranted if vertigo is severe, lasts longer than usual, or is accompanied by confusion, a severe headache, or fever. Other concerning symptoms include a stiff neck, double vision, weakness, changes in speech, or any new hearing loss. Persistent or worsening symptoms, or if vertigo significantly impacts daily activities, also warrant a medical consultation.