TürkçeDizziness in children is often caused by inner ear problems, infections, or migraine. In children whose balance system is still developing, such symptoms should be evaluated carefully. Dizziness may indicate a serious underlying condition.
Vestibular system disorders related to the inner ear are among the most common causes of dizziness in children. Infections such as viral labyrinthitis and vestibular neuritis negatively affect balance. In these cases, audiological and neurological evaluation is of great importance.
Visual disorders, anemia, low blood sugar, or fluid loss may also cause dizziness in children. Prolonged fasting, dehydration, or suddenly standing up in hot weather may trigger this condition. Dietary patterns and lifestyle habits should be reviewed.
Treatment is shaped according to the underlying cause. When necessary, referral is made to a pediatric neurologist or an ear, nose, and throat specialist. Symptoms can be brought under control with vestibular rehabilitation through physical therapy, medication treatment, or lifestyle changes.
| What You Need to Know | Information |
| Definition | Dizziness in children is a condition that may occur for various reasons and presents as the perception that the surroundings are spinning or as a feeling of loss of balance. |
| Common Causes | Middle ear infections (otitis media), inner ear diseases, migraine, vestibular neuritis, benign paroxysmal positional vertigo (BPPV), anxiety, low blood pressure, anemia, dehydration, visual disorders, trauma. |
| Vestibular Causes | It occurs when the vestibular system (balance organs) is affected. Vestibular migraine and viral infections are among the main causes. |
| Auditory Causes | Hearing loss, ear infections, and fluid accumulation may affect balance. Problems related to the inner ear in particular may lead to dizziness. |
| Neurological Causes | More serious neurological diseases such as brain tumors, epilepsy, and multiple sclerosis may rarely cause dizziness. |
| Psychological Causes | Conditions such as anxiety, panic attacks, stress, or school phobia may lead to psychosomatic dizziness. |
| Temporary Causes | Conditions such as standing up quickly (orthostatic hypotension), hunger, lack of sleep, and fluid loss in hot weather may cause temporary dizziness. |
| Diagnostic Methods | Detailed medical history, physical examination, audiological tests (hearing and balance tests), blood tests, eye movement analysis (videonystagmography), magnetic resonance imaging (MRI), computed tomography (CT). |
| When It Should Be Taken Seriously | If dizziness is accompanied by symptoms such as fainting, vomiting, double vision, changes in consciousness, speech impairment, or weakness in the arms or legs, urgent evaluation is required. |
| Treatment Methods | Depending on the cause, infection treatment, vestibular rehabilitation, medication treatment (antivertigo medications, antibiotics, migraine medications), psychological support, and assistive tools such as glasses may be used. |
| Measures That Can Be Taken at Home | Factors such as adequate fluid intake, regular sleep, avoiding sudden head movements, dietary regulation, limiting screen time, and stress management may reduce dizziness. |
| Specialties | Audiology, pediatrics, neurology, ear, nose, and throat (ENT), and child psychiatry are the specialties that evaluate dizziness according to its cause. |
What Are the Symptoms of Dizziness in Children?
Children, especially those whose speech ability has not yet fully developed, show that they are dizzy through their behavior instead of saying that their head is spinning. The word “vertigo” does not exist in their world; instead, there is fear, immobility, or restlessness. Parents need to be very good observers here. This is because the greatest clue to the diagnosis is hidden in the small details you observe at home, in the park, or at school.
When a child feels dizzy, they generally want to feel safe. Suddenly stopping play and crouching on the ground or holding tightly onto an object or a parent are the most typical symptoms. The child may begin avoiding activities such as climbing and running that they previously performed comfortably. Walking in a seemingly “drunken” manner and being unable to move in a straight line are also situations we frequently encounter.
Sometimes the symptoms may be confused with those of the gastrointestinal system. Unexplained vomiting and frequent complaints of abdominal pain may actually indicate a problem in the vestibular (balance) system. Motion sickness in particular, meaning the child becoming extremely uncomfortable during car or bus journeys, provides us with very important information about the sensitivity of the balance system.
Some physical and behavioral symptoms that you should pay attention to are as follows:
- Frequent falls
- Staggering while walking
- Wanting to close the eyes tightly
- Difficulty getting out of bed
- Avoiding sudden movements
- Trying to keep the head still
- Motion sickness
- Nausea
- Vomiting
- Unexplained crying episodes
- Fear of the dark
- Needing to hold on while going up and down stairs
- Difficulty riding a bicycle
When several of these symptoms occur together, it is necessary to consider that the condition may not be simple clumsiness but may have an underlying physiological cause and to take action.
What Are the Causes of Dizziness in Children?
Although blood pressure or loss of cervical curvature immediately comes to mind when dizziness is mentioned in adults, the situation is very different in children. The underlying causes of childhood dizziness are generally benign and respond excellently to treatment. However, establishing the correct diagnosis is of course essential.
The most common cause we encounter and the one that surprises families the most is “Vestibular Migraine.” When migraine is mentioned, severe headache comes to everyone’s mind. However, migraine in children does not always occur with a headache. Sometimes it presents only with attacks of dizziness, abdominal pain, or a sudden feeling of fatigue. If the child has attacks of dizziness that last for a few minutes or hours and then resolve spontaneously, and there is a family history of migraine, our suspicions shift in this direction.
Another important cause is Benign Paroxysmal Positional Vertigo (BPPV), known as displacement of the inner ear crystals. Although it is less common in children than in adults, it may occur especially after head trauma, as a result of collisions in the park or falls from bunk beds. The child experiences sudden and short-term dizziness when turning in bed or bending the head forward.
Viral infections may also affect the balance nerve. After a simple flu or upper respiratory tract infection, temporary inflammation of the balance nerve (Vestibular Neuritis) may develop. This condition may lead to very severe dizziness and nausea lasting for days.
The main factors that cause dizziness in children are as follows:
- Vestibular migraine
- Inner ear infections
- Middle ear fluid accumulation
- Head trauma
- Inner ear crystals
- Genetic inner ear anomalies
- Side effects of certain medications used
- Vitamin deficiencies
- Visual disorders
- Psychological stress factors
- Looking at screens for a long time
What Preparations Should Be Made Before Visiting an Audiologist?
A medical consultation is like detective work, especially for pediatric patients. Since children cannot fully describe their feelings, the information provided by the parent is as valuable to us as laboratory tests, and sometimes even more valuable. Carefully observing your child for a while and taking some notes before going to the appointment greatly accelerates the diagnostic process.
First, you should note when the dizziness begins and how long it lasts. Does it last for seconds, or does it continue for hours? This distinction in duration plays a critical role in determining whether the condition originates from migraine or crystals. It is also important to determine whether there is a movement that triggers the dizziness. Does it occur only when getting out of bed, or does it begin spontaneously?
You should also review external factors that affect the child’s complaints. Do hunger, lack of sleep, bright lights, or noisy environments increase the dizziness? Has your child recently had a febrile illness or received a blow to the head? Such historical information helps us put the pieces of the puzzle together.
The details you should note before the consultation are as follows:
- Duration of the attack
- Frequency of the attack
- Triggering movements
- Accompanying tinnitus
- Suspicion of hearing loss
- Presence of headache
- Recent illnesses
- Medications used
- Family history of migraine
- Sleep pattern
- Dietary habits
Which Tests Are Applied During the Diagnostic Process?
The greatest concern of families is whether the tests to be performed will hurt the child or whether the child will be able to cooperate with these tests. With the development of technology, we now have child-friendly, fast, and completely painless testing methods. We turn the testing process into a game for children, allowing them to participate in the process without fear or boredom.
In the first step, hearing tests and middle ear pressure tests are generally performed. This is because the balance organ and the hearing organ are located within the same bony structure and are intertwined. Determining whether there is fluid accumulation or infection in the ear is the first rule for identifying the cause of dizziness.
We then proceed to special tests in which we objectively evaluate the balance system. None of these tests involves an injection or surgical procedure. They are mostly performed using special goggles or headphones.
The main testing methods we apply are as follows:
- Videonystagmography
- Video Head Impulse Test
- VEMP test
- Posturography
- Audiometry
- Tympanometry
How Is the Videonystagmography (VNG) Test Performed on a Child?
The VNG test is a remarkable technology that examines the connection of the balance system with the brain through eye movements. Signals coming from the balance center in the inner ear directly affect the eye muscles. In other words, if your child has a problem in the inner ear, this condition causes involuntary eye movements that we call “nystagmus.” VNG allows us to record and analyze these movements.
For children, we design this test within a scenario such as an “alien game” or “pilot training.” We place a lightweight mask resembling ski goggles, with infrared cameras attached to it, over the child’s eyes. This mask is dark and records the child’s eye movements down to the finest detail.
During the test, we ask the child to follow certain illuminated points on the screen. While the child follows points moving right, left, up, and down, we measure on the computer screen how sensitively the balance system is functioning. We may also ask the child to turn the head from side to side or lie in certain positions.
In some cases, we gently stimulate the inner ear by blowing warm or cool air into the ear (caloric test). This may feel somewhat strange to the child and may create mild dizziness, but it is a temporary sensation and one of the most important parts of the test. In this way, we can measure the balance functions of the right and left ears separately and clearly determine which one has a problem.
Why Is the Video Head Impulse Test (v-HIT) Important?
v-HIT is a fast and practical test that has revolutionized vestibular diagnosis in recent years and is particularly suitable for children. It measures how quickly the semicircular canals in our balance system respond to sudden head movements. In daily life, when we turn our head, our eyes automatically remain fixed on the target we are looking at. When this reflex (Vestibulo-Ocular Reflex) is impaired, the world also shifts with the child when the child turns the head, and the image becomes blurred.
In this test, lightweight, non-tight goggles are placed on the child. While the child looks at a target in front, for example a favorite sticker or cartoon character, the specialist quickly turns the child’s head to the right or left at very small angles. These movements last for seconds.
The greatest advantage of the test is its duration. In only a few minutes, we can see whether each of the six different balance canals in the inner ear is functioning separately. It is difficult for children to remain still for a long time, but v-HIT finishes so quickly that the child does not even have time to become bored. Thanks to this test, we can precisely determine which canal has the problem and plan the treatment accordingly.
What Is Measured with the VEMP Test?
Our inner ear does not contain only canals that detect rotational movements; it also contains special structures with stones, called “otoliths,” that detect gravity, moving up and down in an elevator, or the acceleration of a car. The VEMP test (Vestibular Evoked Myogenic Potentials) measures the function of these structures.
This test is performed by attaching small adhesive electrodes, a kind of sticker, to the child’s neck muscles or around the eyes. Headphones are placed on the child, and clicking sounds are delivered. These sounds stimulate the balance sacs in the inner ear, and this stimulation creates a reflex response in the muscles. We then record this response on the computer.
During this test, the child only sits or turns the head slightly and waits. There is no painful stimulus. It is a unique method, especially for understanding the condition of the inner ear crystals and whether the lower and upper branches of the balance nerve are functioning.
Is Medication Treatment Necessary for Dizziness in Children?
When parents visit a doctor, they generally expect a syrup or pill that will immediately stop the complaints. However, medication treatment is not always the first or best option in childhood dizziness. In fact, we often prefer to avoid medications.
Most dizziness medications belong to the group we call “vestibular suppressants.” In other words, they prevent the brain from perceiving the dizziness signal. During the acute period, if the child is vomiting severely and is in a miserable state, these medications may be life-saving for a short period, a few days. However, with long-term use, these medications stop the brain’s recovery mechanism (compensation). The brain must detect the error in the balance system in order to correct it. If we suppress this signal with medication, the brain ignores the problem and permanent recovery does not occur.
Especially in mechanical problems such as BPPV (crystal displacement), medication has no effect. The solution here consists entirely of physical maneuvers. In dizziness caused by migraine, protective measures such as lifestyle changes, sleep regulation, avoiding triggering foods, and drinking plenty of water form the main framework of treatment rather than painkillers.
What Is Vestibular Rehabilitation and How Is It Applied?
In cases where medications are insufficient or permanent balance damage exists, the most powerful weapon of modern medicine comes into play: Vestibular Rehabilitation. You can think of this as a type of “physical therapy” for the balance system.
The child’s brain has an enormous capacity for what we call “neuroplasticity,” meaning the ability to reshape itself and learn. Even if the balance signals coming from the inner ear are impaired, the brain can learn to re-establish balance by using vision and the sensations coming from the soles of the feet more effectively. Vestibular rehabilitation is a set of special exercises that trains the brain in this regard.
Rehabilitation programs prepared for children do not consist of boring repetitive movements like those for adults. We completely turn the process into a game. The aim is for the child both to have fun and to recover.
The main methods used in the rehabilitation program are as follows:
- Gaze stabilization exercises
- Walking on a balance board
- Standing on one foot on a soft surface
- Ball throwing and catching exercises
- Trampoline exercises
- Eye and head coordination movements
- Virtual reality applications
Virtual Reality (VR) technology in particular has broken new ground in pediatric rehabilitation. We place VR goggles on the child, and the child thinks they are controlling a spaceship or collecting fruit in a forest. However, the head movements, bending, and reaching performed within the game are actually movements we have designed to strengthen the child’s balance system. The child recovers by playing without realizing that they are receiving treatment. This motivation accelerates the recovery process tremendously.
Does Untreated Dizziness Affect School Performance?
The balance system does not only allow us to remain standing; it also controls our eye muscles, helps us concentrate, and manages our spatial perception. An untreated balance problem may cause serious difficulties in the child’s academic life.
During reading, the eyes must move smoothly along the line and remain unaffected by head movements (Vestibulo-Ocular Reflex). When this reflex is impaired in a child with a balance problem, the child may skip lines while reading, confuse letters, or become tired quickly while reading. Actions requiring head movement, such as looking at the board and then writing in a notebook, may turn into a nauseating ordeal for these children.
These children may generally be labeled in the classroom as “inattentive,” “clumsy,” or “having learning difficulties.” However, the problem is not intelligence or attention deficit but entirely a sensory processing error. In addition, a child who constantly fears falling or becomes dizzy when moving may avoid participating in games during breaks, become withdrawn, and experience social isolation.
Possible effects that may be seen at school age are as follows:
- Difficulty reading
- Difficulty writing
- Slowness in copying from the board
- Distractibility
- Becoming tired quickly
- Avoiding physical education classes
- Not playing with friends
- Restlessness in the classroom
- Lack of self-confidence
What Are the Responsibilities and Recommendations for Parents?
Do not panic when a balance problem is detected in your child. Remember that children’s recovery capacity is many times greater than that of adults. With the correct diagnosis and a patient rehabilitation process, the vast majority of children recover completely.
The greatest responsibility in this process falls to the parents. Monitoring the exercises performed at home, lifestyle adjustments, and the psychological support provided to the child determine the success of treatment. Dietary regulation, avoiding cocoa, fermented foods, and packaged products, and sleep discipline are especially important in children diagnosed with migrainous vertigo.
Excessive use of technological screens, such as tablets and phones, may overstimulate the visual system and fatigue the balance system (“Cybersickness”). Therefore, it is necessary to limit screen time during the treatment process and direct the child toward physical activities.
Recommendations for parents are as follows:
- Encourage plenty of water consumption
- Establish regular sleeping hours
- Avoid triggering foods
- Limit screen time
- Reduce fall risks at home
- Turn exercises into games
- Be patient and supportive
- Inform teachers about the condition
Frequently Asked Questions
Dr. Audiologist Emel Uğur was born in 1982 in Çanakkale. She specialized in Pediatric Audiology, Otologic Disorders, and Vestibular System Disorders, and served for 15 years at the Istanbul Training and Research Hospital. In 2015, she joined the Acıbadem Healthcare Group. She currently works as an Audiologist at the Acıbadem Altunizade Hospital and also serves as a faculty member and program director in the Acıbadem University Vocational School of Health Services Audiometry Program.
Location of our clinic in Istanbul, Turkey