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Let's Talk About . . . Childhood Dizziness and Imbalance

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Let's Talk About . . . Childhood Dizziness and Imbalance Let’s talk about . DIZZINESS AND IMBALANCE IN CHILDREN This handout is intended as a general introduction What is dizziness and imbalance in to the topic. As each person is affected differently, speak with your health care professional for children? individual advice. Most problems with dizziness and unsteadiness in children are temporary and easy to treat. Unfortunately, they are often overlooked, untreated or misdiagnosed. To rule out the possibility of a Key points more serious condition, it is important to take your • May be hard to spot by caregivers. child to the doctor if they have repeated signs of dizziness or imbalance. • Check with child’s doctor if a regular pattern of dizziness and/or imbalance is Children with a malfunctioning vestibular noticed. system have dizziness and imbalance. Many also have developmental delays. Vestibular disorders are • Younger children may not have the quite common in children. About 1 in 20 children words to describe what they feel. between the ages of 3 and 17 may be affected. Girls • Diagnosis relies on a caregiver giving are slightly more affected than boys. Dizziness is the child’s medical history. more common in older children and teens. • Most problems are temporary and easy What are the causes? to treat. A child’s ability to keep an upright position • Significant longer-lasting or more (postural stability) develops in step with motor serious problems include middle-ear development. A baby first develops control of the infections, sensorineural hearing loss, head, then the torso, and finally the ability to stand. inner-ear abnormalities, cytomegalovirus Toddlers use their eyes more than information from (CMV), meningitis, migraine-related their skin, muscles, and joints (proprioception) to disorders, Usher syndrome, auditory balance. By 3 to 6 years of age, children use neuropathy spectrum disorder (ANSD), proprioceptive input in a similar way to adults. and vestibular toxicity. Communication between the brain and the 3 parts of • Treatment and management depend on the balance system – vestibular, eyes and the specific disorder and other health proprioception – fully matures by 12 years of age. conditions. The balance organs in the inner ear (semicircular • Vestibular rehabilitation (an exercise- canals and otoliths) send information to the brain based therapy) helps many children. through the vestibular nerve. These structures are developed at birth. The vestibulo-ocular reflex • Often linked to developmental and (VOR) does not fully mature until about 2 months learning challenges. of age. The VOR maintains gaze stability during • head movement. SUPPORTING, INSPIRING AND EDUCATING THOSE AFFECTED BY BALANCE AND DIZZINESS DISORDERS Let’s talk about . DIZZINESS AND IMBALANCE IN CHILDREN Balance & Dizziness Canada Common causes of short-lived dizziness and As well as hearing impairments that may affect imbalance in children include: speech and language development, middle ear • reduced blood flow to the brain for a short time, infections impact a child’s balance and general brought on by common events such as standing motor function. Sometimes middle ear infections up suddenly (orthostatic hypotension) or happen repeatedly or persistently. If this happens standing still for a long time during an important stage of a child’s development, such as learning to walk, overall development may • not drinking enough fluid (dehydration) be delayed even after a middle ear infection is over. • increased sweating, for example on a hot day or Children who already have motor or vestibular playing sports problems before having a middle ear infection may be particularly affected. • skipping a meal Middle ear infections usually result in unsteadiness • viral illnesses that is noticeable but not striking. Occasionally, • fever children with an acute middle ear infection will have a sudden and dramatic episode of vertigo, • side effects of some medications nausea, vomiting, and an inability to walk. In these Risk factors connected with dizziness and balance cases, complications such as meningitis need to be problems in children include: ruled out. • impairments that limit a child’s ability to crawl, Sensorineural hearing loss walk, run or play Sensorineural hearing loss (SNHL) is caused by • frequent headaches or migraines damage to the hair cells in the inner ear or the nerve • certain developmental delays pathways leading from the inner ear to the brain. It is by far the most common type of hearing loss. Up • a history of seizures in the past 12 months to 70% of children with SNHL in both ears have a • stuttering or stammering vestibular problem and 20 to 40% have bilateral • anemia during the past 12 months vestibulopathy (vestibular loss in both ears). Children with a family history of hearing or About half of children born with SNHL in one ear vestibular problems, dizziness, or motion (unilateral) have no vestibular nerve. This condition sickness are more likely to have a balance disorder. is sometimes called “dead ear”. The balance structures in the affected ear may also be damaged. Causes of dizziness and imbalance in children that may be longer lasting or more serious include: It is important for children with SNHL to be screened for vestibular dysfunction. Children with Middle ear infections complete vestibular loss in both ears have serious Middle ear infections (otitis media) are very delays in controlling posture and movement. common in young children. Persistent infections are Children with unilateral SNHL have similar delays. among the most common reason children develop Symptoms may include: balance problems. • delayed walking Often children with middle ear infections have • frequent falls problems with a blocked or infected Eustachian tube and fluid builds up in the middle ear. The medical • decreased ability to detect gravity term for this condition is otitis media with effusion • difficulty thinking, understanding, learning, and (OME) or middle ear effusion (MEE). It is remembering (cognitive dysfunctions) sometimes referred to as glue ear. SUPPORTING, INSPIRING AND EDUCATING THOSE AFFECTED BY BALANCE AND DIZZINESS DISORDERS 2 Let’s talk about . DIZZINESS AND IMBALANCE IN CHILDREN Balance & Dizziness Canada As a result, children with SNHL may have: vestibular impairment. One study showed that • attention deficit disorders (ADD) vestibular dysfunction was more common than hearing loss in children born with CMV. • problems with learning and reading There have been recent advances in prevention, • spatial disorientation diagnosis, and drug therapies for CMV. Screening • difficulty sequencing all babies for CMV is being considered in some countries and has already started in Ontario. • memory-retention problems Meningitis Research suggests early diagnosis of complete loss of vestibular function in both ears as well as timely Meningitis is an inflammation (swelling) of the rehabilitation reduces future developmental deficits. protective membranes that cover the brain and spinal cord (meninges). It usually happens when A cochlear implant (an electronic device that partly fluid surrounding the meninges becomes infected by restores hearing for those with SNHL) comes with a bacteria or a virus. risk of impaired balance. Ask your child’s audiologist and doctor about the risks and benefits Routine vaccination of Canadian children has of cochlear implantation. greatly reduced the incidence of meningitis. Between 5 to 35% of childhood survivors of Inner ear abnormalities meningitis have sensorineural hearing loss (SNHL). Congenital (present at birth) inner ear abnormalities Between 3 to 12% have loss of balance function. are a major cause of sensorineural hearing loss Migraine-related disorders (SNHL) and imbalance in children. Causes include: Dizziness and imbalance are symptoms of two • semicircular canal dehiscence (SCD) episodic syndromes that may be associated with • enlarged vestibular aqueduct (EVA) migraine and affect children – benign paroxysmal CT (computerized tomography) scans and MRI torticollis (BPT) and benign paroxysmal vertigo (magnetic resonance imaging) can diagnose these (BPV). Children with BPT and BPV often have a abnormalities. Hearing loss and balance impairment family history of migraine. Research suggests may worsen over time. Children with congenital children with these conditions have a greater inner ear abnormalities may have severe vertigo likelihood of developing migraine later in life or lasting days to weeks. These abnormalities are having them at the same time as migraine sometimes mistaken for vestibular neuritis. (comorbidity). There is a possible progression from Congenital inner ear abnormalities may occur on BPT to BPV, and from BPV to vestibular migraine. their own or along with a genetic disorder such as Benign paroxysmal torticollis (BPT) is a rare Waardenburg, CHARGE, branchio-oto-renal, or disorder that is fairly harmless and short-lived. It Pendred syndrome. consists of recurrent spells of tilting the head to one Cytomegalovirus (CMV) side - torticollis means “twisted neck” - in otherwise healthy children. Spells can be as short as 10 CMV is the leading cause of congenital (present at minutes or, in rare cases, last for up to 2 months. birth) non-genetic sensorineural hearing loss Other symptoms may include: (SNHL). In Canada, 1 in 200 babies are infected with CMV during pregnancy. Up to 90% show no • dizziness early symptoms however 8 to 15% will go on to • looking pale develop SNHL. CMV is the leading cause of • vomiting intellectual disability,
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