Evaluation of dizziness in children and adolescents
- Theresa Walls, MD, MPH
Theresa Walls, MD, MPH
- Assistant Professor of Pediatrics
- George Washington University School of Medicine
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Section Editors
- Douglas R Nordli, Jr, MD
Douglas R Nordli, Jr, MD
- Section Editor — Pediatric Neurology
- Chief of Neurology
- Children’s Hospital Los Angeles
- Vice Chair of Neurology
- USC Keck School of Medicine
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Departments of Otolaryngology, Head and Neck Surgery and Pediatrics
- Lewis Katz School of Medicine at Temple University
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will discuss the evaluation of dizziness in pediatric patients. The evaluation and causes of syncope in children and adolescents are discussed separately. (See "Emergent evaluation of syncope in children and adolescents" and "Causes of syncope in children and adolescents".)
Although a common pediatric complaint in ambulatory settings, dizziness is a vague term that can describe many conditions, including lightheadedness (presyncope), anxiety, intoxication, ataxia, visual disturbance, hyperventilation, weakness, depression, and true vertigo. Young children may not be able to describe their symptoms well, making their evaluation challenging. However, a thorough history and physical examination can establish a diagnosis in most cases.
Dizziness describes a disturbed sense of relationship to space . It is a chief complaint commonly used to describe many conditions.
True vertigo and pseudovertigo provide further categorization of dizziness:
●True vertigo refers to the perception that the patient is rotating relative to the environment (subjective vertigo) or that the environment is rotating relative to the patient (objective vertigo) . It results from a disturbance somewhere in the vestibular system, which has both peripheral and central nervous system components.
- Dizziness. In: Dorland's Medical Dictionary, 29th ed, WB Saunders, Philadelphia 2000. p.538.
- Teach SJ. Dizziness. In: Textbook of Pediatric Emergency Medicine, 6th ed, Fleisher GR, Ludwig SL, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2010. p.226.
- Bower CM, Cotton RT. The spectrum of vertigo in children. Arch Otolaryngol Head Neck Surg 1995; 121:911.
- Choung YH, Park K, Moon SK, et al. Various causes and clinical characteristics in vertigo in children with normal eardrums. Int J Pediatr Otorhinolaryngol 2003; 67:889.
- Ravid S, Bienkowski R, Eviatar L. A simplified diagnostic approach to dizziness in children. Pediatr Neurol 2003; 29:317.
- Riina N, Ilmari P, Kentala E. Vertigo and imbalance in children: a retrospective study in a Helsinki University otorhinolaryngology clinic. Arch Otolaryngol Head Neck Surg 2005; 131:996.
- Gioacchini FM, Alicandri-Ciufelli M, Kaleci S, et al. Prevalence and diagnosis of vestibular disorders in children: a review. Int J Pediatr Otorhinolaryngol 2014; 78:718.
- Raucci U, Vanacore N, Paolino MC, et al. Vertigo/dizziness in pediatric emergency department: Five years' experience. Cephalalgia 2016; 36:593.
- Sommerfleck PA, González Macchi ME, Weinschelbaum R, et al. Balance disorders in childhood: Main etiologies according to age. Usefulness of the video head impulse test. Int J Pediatr Otorhinolaryngol 2016; 87:148.
- Lee JD, Kim CH, Hong SM, et al. Prevalence of vestibular and balance disorders in children and adolescents according to age: A multi-center study. Int J Pediatr Otorhinolaryngol 2017; 94:36.
- Casselbrant ML, Mandel EM. Balance disorders in children. Neurol Clin 2005; 23:807.
- Saka N, Imai T, Seo T, et al. Analysis of benign paroxysmal positional nystagmus in children. Int J Pediatr Otorhinolaryngol 2013; 77:233.
- Tusa RJ, Saada AA Jr, Niparko JK. Dizziness in childhood. J Child Neurol 1994; 9:261.
- CLINICAL ANATOMY
- DIFFERENTIAL DIAGNOSIS
- Life-threatening conditions
- - Head trauma
- - Central nervous system infection
- - Intracranial tumor or abscess
- - Stroke
- - Drug overdose and other poisons
- Common conditions
- - Otitis media
- - Migraine syndromes
- - Benign paroxysmal vertigo of childhood (BPVC)
- - Adverse effects of medications
- - Motion sickness
- - Paroxysmal torticollis of infancy
- - Pseudovertigo
- Other conditions
- - Vestibular neuritis
- - Benign paroxysmal positional vertigo
- - Meniere disease
- - Perilymphatic fistula
- - Seizures
- - Ramsay Hunt syndrome
- - Multiple sclerosis
- - Congenital defects
- Physical examination
- - Vital signs
- - Ear examination
- - Nystagmus
- - Neurologic examination
- Provocative vestibular testing
- Ancillary studies