Balance Disorders

Our ears, eyes, joints, and muscles work together to help us stay steady and upright. If any of them don’t work properly, it can cause a problem with balance.

Balance disorders aren’t common in kids and teens, but might happen more than we realize. Symptoms can be missed or blamed on another cause. Kids with balance problems might seem clumsy or uncoordinated. They may have trouble walking, riding a bike, doing schoolwork, or playing.

What Are the Signs & Symptoms of a Balance Disorder?

Some kids and teens may only have mild signs that are barely noticed while others may have more serious symptoms. Very young kids might not be able to describe how they feel. Older kids and teens may complain of feeling dizzy, lightheaded, or disoriented.

In general, kids and teens with balance disorders might:

• have problems with equilibrium, like an unsteady, "woozy" feeling that makes it hard to stand up, walk, turn corners, or climb the stairs without falling, bumping into things, stumbling, or tripping
• walk with their legs far apart or not be able to walk without staggering or holding on to something. Walking in the dark or over uneven surfaces can be tricky too.
• have vertigo. Vertigo is a feeling like you or the things around you are moving. Kids may describe it as spinning, swinging, sliding, or feeling like they are on a merry-go-round.

Other signs can include:

• nausea, vomiting, and stomach pain
• involuntary eye movements
• vision problems
• headaches or migraines
• delayed development
• frequent falls
• tiredness and feeling unwell
• fear, anxiety, or panic
• depression

People with balance disorders may also have hearing loss or other hearing problems. Sounds might seem muffled, especially when there’s background noise. Kids might also have ear pain, pressure or "fullness" in the ears, and tinnitus (ringing or other sounds like whirring, humming, or buzzing in the ears).

At school, balance problems can make it hard to remember things, concentrate, pay attention, and follow directions. Kids might not be able to hear the teacher or focus on the board, screen, or assignments. Balance issues also can make gym class or sports hard for them.

Kids and teens might get frustrated because they feel like they're trying their best, but can’t do some things they want or need to do, and they don’t know why.

What Are the Types of Balance Disorders?

Balance disorders that can affect kids and teens include:

• benign paroxysmal torticollis of infancy, which usually starts during a child's first 6 months. Kids with this condition tend to keep their heads tilted from feeling so dizzy. It usually goes away by 5 years old.
• benign paroxysmal vertigo of childhood (BPV), in which vertigo comes on suddenly. Kids may briefly seem scared and unsteady. It usually goes away on its own as kids get older. Some kids with BPV will have migraines in the future.
• vestibular neuritis is caused by a viral infection. The infection causes inflammation of the vestibular nerve. The vestibular nerve sends information about balance from the inner ear to the brainstem.
• labyrinthitis is vestibular neuritis with hearing loss. It is caused by a viral or bacterial infection of the inner ear's labyrinth.

Less often, kids and teens might have:

• perilymph fistula (PLF), a connection between the inner ear and middle ear that shouldn’t be there
• Meniere's disease, an inner ear problem. Kids with Meniere’s disease often have a problem with how the inner ear formed.

What Causes Balance Disorders?

Doctors can't always find the exact cause of a balance problem. But symptoms may be brought on by things such as:

• ear injuries
• head or neck injuries
• ototoxicity
• migraines
• hearing loss
• middle ear infections (otitis media) or cholesteatoma
• other infections (like herpesvirus, chickenpox, colds, the flu, meningitis, measles, mumps, or rubella)
• motion sickness 
• seizures

If hearing or vestibular problems, migraines, or motion sickness run in families, children are more likely to get balance disorders.

How Are Balance Disorders Diagnosed?

To look for a balance problem, doctors ask about symptoms and do an exam, including watching your child walk, checking balance, and testing motor skills. They’ll also want to know about the child’s medical history and the family’s medical history.

The doctor might want the child to see an audiologist (a hearing specialist), an otolaryngologist (an ear, nose, and throat specialist, or ENT), and/or a neurotologist (a specialist in ear disorders).

Tests to look for a problem can include:

• imaging tests, like an MRI or a CT scan
• hearing tests
• electronystagmogram (ENG) to assess balance using electrodes placed around the eyes while a computer monitors involuntary eye movements
• videonystagmography (VNG), in which the child focuses on the visual target while wearing special video recording goggles
• vestibular evoked myogenic potential (VEMP), which checks parts of the inner ear as the child wears earphones to listen to loud clicks. Electrodes on the head and neck record responses as the child's neck muscles contract.
• posturography, which measures the ability to balance while standing on a stable or unstable platform
• balance questionnaires for kids who are old enough to describe their level of dizziness throughout the day while doing different things

How Are Balance Disorders Treated?

Some types of balance disorders get better on their own. For others, symptoms may come and go or continue for weeks, months, or longer. Depending on the cause, medicine or surgery may help some children. Physical therapy and balance training can help kids manage their symptoms.

Balance training (also called vestibular rehabilitation or therapy) with a physical therapist or vestibular therapist may include exercises that help strengthen legs and core muscles, and improve balance and coordination.

Treating hearing loss may also help improve balance.

When Should I Call the Doctor?

Dizziness and clumsiness can be signs a balance disorder, but also can be caused by many other things. For example, kids can feel woozy if they're dehydrated or they stand up too fast. And lots of kids stumble and fall sometimes, especially toddlers just learning to walk and preschoolers who are getting used to how their bodies move.

But if one or more signs of a balance disorder happen regularly, check in with your doctor to find out what's going on. Diagnosing and treating balance disorders early can help kids become steadier and more coordinated, do the things they like, and feel better.