Some children suffer from vertigo, but in most cases, the problem resolves spontaneously. Only rare conditions should cause concern.
Vertigo in children is one of the most common disorders, but it usually resolves spontaneously. However, knowing how to recognize it is important for any therapy, or to detect signs of other pathologies or disorders that can be treated in time.
Furthermore, symptoms are a range of specific signs or symptoms that can be confused with other age-related conditions or current illnesses. So here's how to behave.
How to recognize dizziness in children
Pediatric experts at Bambino Gesù Hospital describe this sensation in children as dizziness characterized by unsteadiness, weakness, and faintness. It is a common complaint in many conditions and can occur with or without lightheadedness. If dizziness is absent, it becomes essential to look for other signs.
Dizziness is a sensation characterized by feelings of unsteadiness, weakness, faintingIt is a complaint in many conditions and can occur with or without dizziness.
Vertigo is a disturbance of balance and is manifested by the sensation that the surrounding environment revolves around the body or that the body revolves around the environment.
It results from dysfunction of the vestibular system (vestibular and semicircular canals) or central nervous system (brainstem, cerebellum, and vestibulospinal tract).
In addition, in some cases, it is accompanied by nystagmus , that is, rapid eye tremors.
Common causes include migraine and migraine equivalents (benign paroxysmal vertigo of childhood, motion sickness), head trauma, and middle ear disease (effusion or infection).
Pediatric conditions are not serious. Among these, benign paroxysmal vertigo (40% of cases) and vestibular migraine (18% of cases) are the most common. Both conditions are linked to a condition called migraine.
They can occur in 15-20% of school-aged children .
In many conditions they present without vestibular dysfunction (pseudovertigo).
This sensation of displacement of the body in relation to the environment or of the environment in relation to the body manifests itself in specific ways.
Let's see which ones and how to recognize them.
When is a benign paroxysmal vertigo of childhood?
This type is the most frequent cause in children and is mainly characterized by brief and recurrent attacks of intense vertigo and inability to maintain body position and balance (postural instability), associated with other symptoms, such as:
- scare;
- nystagmus;
- nausea;
- vomiting;
- paleness of the skin
Parents may notice that a child having a vertigo attack will tend to seek support to avoid falling.
These seizures occur without warning, without an obvious triggering cause, and resolve spontaneously after a period of time that can vary from a few minutes to several hours. They can occur in clusters on consecutive days in perfectly healthy children.
This form typically presents in children between the ages of 2 and 6 , although it can also be observed at older ages. Cases often have a family history of migraine and a completely normal neurological examination between attacks.
They usually disappear with growth, but children who have suffered from it may present headaches with migraine characteristics over time, even many years after the resolution of the vertigo.
When is vestibular migraine?
This problem, however, usually occurs in childhood (between 7 and 12 years old) or adolescence. The episodes have very specific characteristics:
They manifest as vertigo of medium-strong intensity , such that it interferes with or prevents the performance of normal daily life activities;
They last between 5 minutes and 72 hours and are continuous in nature, with a false sensation of being in motion or of the environment swaying;
They also predict headache symptoms with migraine-like characteristics, such as: episodes of intense headache, with associated discomfort from lights and noises, nausea or vomiting.
When is it vestibular neuritis?
In this case, it is an acute inflammatory process that affects the vestibular nerve (acoustic nerve) and manifests as:
- Sudden onset of rotational vertigo;
- spontaneous fixed-direction nystagmus (horizontal or rotary eye movements);
- difficulty in balance;
- nausea and vomiting.
Vestibular neuritis is generally associated with a recent viral infection and accounts for 10-13% of pediatric vertigo cases.
When is benign positional vertigo?
This type of vertigo appears suddenly. The name "positional" indicates that dizziness is felt when changing position , following certain head movements.
It usually happens in the morning when you get out of bed , at night when you go to sleep when you assume a lying position or turn your head on the pillow, or bend down to pick something up.
The problem appears every day, constantly, following the movements of the head and causing a slight instability.
When vertigo occurs, it is very intense, giving the sensation that one is moving and that the environment around it is also rotating.
It lasts a few seconds, a few minutes at the most, but it is violent and is characterized by an increasing and then decreasing trend.
It can be accompanied by involuntary and abnormal eye movements, nystagmus.
Other symptoms associated with vertigo can be:
- Nausea;
- vomit;
- tachycardia;
- sweating
The mechanism is the presence of calcium carbonate crystals (called otoliths) in the inner ear.
In childhood it is uncommon and is usually related to a recent head injury in the last 24-48 hours (domestic accidents, sports accidents, school injuries).
When is infantile torticollis?
It is called paroxysmal torticollis and is a benign self-limiting condition characterized by recurrent episodes of head tilting often accompanied by vomiting, pallor, irritability, ataxia or drowsiness that usually occurs in the first months of life.
Individual attacks usually last for hours , but sometimes even days.
They tend to occur less frequently as the child grows and disappear in most cases by age 5.
The pathogenesis of this condition is not known, so much so that it is considered a "migraine equivalent".
Why is it important to recognize causes and symptoms?
In most cases, when the problem affects children, it tends to resolve spontaneously . However, it is important to understand the signs, as the choice of therapy depends on the type of vertigo the child is experiencing.
In fact, the neurologist should be provided with all the useful information for careful history taking and an equally accurate neurological visit.
For a detailed reconstruction it is important to recognize the triggering causes and associated factors, such as:
- Motion;
- nystagmus or position changes (in this case it is useful to consult an otolaryngologist or perform an electronystagmography);
- head position;
- traumas, fractures, whiplash;
- middle ear infections;
- travel by car, boat or plane;
- the possible presence of a history of headache in the patient or his family.
When the symptoms are not clear?
In younger children who cannot describe their symptoms, a history of gait disturbance or nystagmus may indicate dizziness. Based on these initial assessments, the need for instrumental examinations is usually determined.
When are the symptoms frequent?
The recurring nature of dizziness generally leads the doctor toward a diagnosis of migraine or migraine equivalents.
Children and adolescents with vestibular migraine should be referred to a neurologist (preferably a pediatric headache center) for possible treatment and follow-up. For more information on migraine, you can consult our article on the differences between dizziness and vertigo.
When are the dizziness sporadic?
In the case of sporadic episodes, it is most likely benign paroxysmal vertigo, which almost always resolves spontaneously with growth.
The diagnosis of benign positional vertigo is made by observing the appearance of nystagmus, therefore eye movements, during the neurological examination.
When should we worry?
If the nausea and vomiting are non-specific symptoms, accompanied by more intense vertigo, the doctor should prescribe additional tests to rule out the possibility of tumors or more serious pathologies.
The patient's age is also important in guiding the differential diagnosis. Children under 5 years of age often have complicated otitis media, benign paroxysmal vertigo, or, rarely, paroxysmal infantile torticollis.
The most common cause of dizziness in preschool and school-aged children remains benign paroxysmal vertigo, while children 13 years of age and older are most commonly diagnosed with vestibular migraine.
Children under 10 rarely develop multiple sclerosis or Ménière's disease, a disorder characterized by recurring attacks of debilitating vertigo, fluctuating hearing loss (at lower frequencies), and ringing in the ears (tinnitus). If you'd like to learn more about the evil eye, consider consulting our guide on how to tell if you have the evil eye.
How should parents behave?
During episodes of vertigo, it is important to reassure the child that they may find benefit in resting.
Changes in behavior and lifestyle are helpful, especially to avoid positions or movements that trigger vertigo attacks.
Vestibular neuritis is treated with medications used to control vomiting and short-term cortisone. To better manage stress during these episodes, you can explore stress management techniques.
When it comes to ear infections, antibiotics and antihistamines are needed.