DIZZINESS IN CHILDREN

PAEDIATRIC VERTIGO AND BALANCE DISORDERS

 

In Brief

Dizziness and unsteadiness are more common in children than is often thought; about one in twenty children experience them at some point. Unlike in adults, the most common causes are migraine-related conditions and middle-ear disease. Most causes are benign and treatable. Because young children cannot put their symptoms into words, the parents’ observations are the most valuable information for diagnosis.

 

EMERGENCY: If your child’s dizziness comes with any of the following, do not wait – call 112 or go to the nearest emergency department:

 

• Confusion or unusual drowsiness

• Repeated vomiting after a head injury

• Slurred speech, a drooping face, or weakness in an arm or leg

• Double vision or sudden inability to walk

• Fever with ear discharge, or swelling and redness behind the ear

• A worsening headache with morning vomiting

 

If you notice sudden hearing loss, see an ENT specialist the same day.

 

How Do Children Describe Dizziness?

Pre-school children cannot describe “dizziness”. Instead, you may notice:

• Suddenly becoming frightened and clinging to furniture or a parent, sitting down or refusing to walk

• Phrases such as “the room is spinning”, “I’m falling”, “everything is sliding”

• Unexplained crying spells, paleness, sweating, nausea and vomiting

• Involuntary eye movements (nystagmus) or tilting the head to one side

• Clumsiness compared with peers, frequent falls, delay in learning to ride a bike or go down stairs

 

Taking a short video during an episode is very helpful for diagnosis.

 

Common Causes

• Recurrent vertigo of childhood (formerly benign paroxysmal vertigo): Usually starts between ages 2 and 5. Spinning episodes lasting seconds to minutes begin suddenly and stop on their own; the child stays conscious and returns to play afterwards. It is considered an early childhood form of migraine and usually resolves by school age.

• Vestibular migraine of childhood: Seen in older children and adolescents. Episodes of dizziness lasting minutes to hours may come with headache and sensitivity to light and sound; a family history of migraine is common.

• Middle-ear infection (acute otitis media) and fluid in the middle ear (otitis media with effusion): A frequent cause of unsteadiness, clumsiness and reduced hearing, especially in young children; balance usually recovers once the ear problem is treated.

• Eye-related causes: Uncorrected refractive errors (vision problems needing glasses) and problems with the two eyes working together (binocular vision disorders) can cause dizziness, especially when reading or using screens.

• Head injury and concussion: After an injury, displaced ear crystals (BPPV), inner-ear concussion (labyrinthine concussion) or concussion-related balance problems may develop.

• Blood pressure and circulation problems in adolescence (orthostatic intolerance): Blackouts of vision, light-headedness and palpitations on standing up; low fluid intake and growth spurts make it more likely.

• Vestibular neuritis: Less common, mostly in adolescents; as in adults, it causes sudden, prolonged vertigo.

• Functional dizziness (including PPPD): May occur, especially in adolescents, after an episode of dizziness or a period of intense stress.

 

Less Common Causes That Must Not Be Missed

• Congenital inner-ear differences: For example, an enlarged vestibular aqueduct.

• Congenital infections: For example, congenital cytomegalovirus (CMV) infection; these usually come with hearing loss and delayed motor development.

• Brain-related causes: Tumours of the back of the skull (posterior fossa tumours), epilepsy and diseases of the cerebellum (cerebellar ataxias). They are rare, but must be investigated if any of the warning signs in the “Emergency” section are present.

 

Diagnosis

Diagnosis is based on the family’s account and an age-appropriate examination. The duration, frequency and triggers of episodes, accompanying symptoms and a family history of migraine are the most important clues. When needed, the following tests are used:

• Hearing test (audiometry) and middle-ear pressure measurement (tympanometry): Performed in almost every child.

• Balance tests: vHIT (Video Head Impulse Test) can usually be done from age 3–4; VEMP (Vestibular Evoked Myogenic Potentials) and VNG (Videonystagmography) are chosen according to the child’s age and cooperation.

• Eye examination: Visual acuity and how the two eyes work together.

• MRI (Magnetic Resonance Imaging): Requested if there are neurological findings, an atypical course or warning signs.

 

Treatment

Treatment depends on the cause:

• Migraine-related conditions: Regular sleep, regular meals, enough fluids and sensible screen time reduce episodes considerably in most children. Medication is considered only for frequent episodes that affect daily life.

• Middle-ear disease: Treated according to current guidelines. If fluid persists and affects hearing and balance, ventilation tubes in the eardrum may be considered.

• Displaced ear crystals (BPPV): Treated with repositioning manoeuvres, as in adults.

• Balance exercises (vestibular rehabilitation): Used for lasting balance loss or symptoms after concussion, with age-appropriate, play-based programmes.

• Eye-related causes: Improve with glasses or eye exercises.

 

Course

Most causes of dizziness in children are benign. Recurrent vertigo of childhood usually resolves on its own within a few years; some of these children develop migraine later in life.

 

Frequently Asked Questions

Is my child fainting or having a seizure? In recurrent vertigo of childhood the child remains conscious and recognises their surroundings throughout the episode. Loss of consciousness, jerking movements or prolonged sleepiness afterwards call for investigation of other causes.

Can my child go to school? Between episodes the child is completely normal and can continue school and sports. Informing the teacher helps them respond correctly if an episode happens at school.

Does screen use make dizziness worse? Long screen time, lack of sleep and skipped meals can trigger migraine-related episodes; a regular daily routine is recommended.

Will it go away as they grow? Most causes of dizziness in children lessen or disappear completely with age.

 

 

Research by Assoc. Prof. Mehmet Sürmeli on This Topic

The following studies were published in international peer-reviewed journals.

• Vestibular dysfunction in euthyroid children with Hashimoto's thyroiditis. Seymen G, Günay G, Cirik AA, Sürmeli R, Sürmeli M. J Int Adv Otol. 2024. PubMed →

 

Detailed information and diagnostic criteria for physicians: the Vestibology link at the top of the page (vestibology.com).

Last updated: November 2026 · Editor: Assoc. Prof. Mehmet Sürmeli · Source: Bárány Society and International Headache Society diagnostic criteria for vestibular migraine of childhood and recurrent vertigo of childhood (2021). This page is for general information and does not replace examination and diagnosis.