Most people think of dizziness as an adult problem, but children can also experience significant balance and vestibular (inner ear) issues. These problems are often overlooked because children don’t always have the language to explain what they’re feeling. Instead, they might fall more often, struggle to keep up in sports, or show delays in hitting motor milestones like sitting, walking, or running.
The vestibular system—the part of the inner ear and brain that helps with balance—is already developed at birth but keeps maturing as a child grows. When it isn’t working correctly, the effects can be far-reaching, influencing school participation, social confidence, and physical development.
Who Needs Testing?
The statement recommends vestibular testing in two main groups of children:
- Those who complain of dizziness or vertigo.
- Those with imbalance or delayed motor skills, especially if they also have hearing loss.
- Nearly half of children with significant hearing loss may also have vestibular problems.
Other common causes in kids include vestibular migraine, recurrent vertigo of childhood, ear infections, certain genetic conditions, and in rare cases, Meniere’s disease or superior canal dehiscence (a thinning of the inner ear bone).
Why Testing Matters
Testing helps doctors and audiologists figure out whether the problem comes from the inner ear (peripheral system) or the brain (central system), how severe it is, and what kind of support is needed. Even a “normal” test is useful, because it can rule out certain conditions. Early diagnosis leads to early intervention, such as vestibular rehabilitation therapy, which has been shown to improve balance skills in children.
Types of Tests
The paper outlines both simple bedside exams and more advanced laboratory tests:
- Bedside exams:
Standing balance tests (Romberg, tandem walk), single-leg stance, or head movement tests. These can be done quickly in a clinic or even at school screenings. - Eye movement checks (nystagmus tests):
Observing involuntary eye movements can show if the inner ear is misfiring. Goggles or toys help keep children’s attention during these exams. - Vestibulo-ocular reflex (VOR) tests:
This checks whether the eyes stay focused when the head moves. Examples include the head impulse test and dynamic visual acuity testing. - Vestibular Evoked Myogenic Potentials (VEMPs):
These are painless recordings of tiny muscle responses to sound or vibration. They are especially useful in children, since they don’t usually cause dizziness and can even be done in babies.
Special Considerations for Kids
Testing children requires flexibility. Toys, videos, and parent participation are often used to keep kids engaged. Results must be interpreted with an understanding that normal ranges differ by age, and children may fatigue quickly. Infection control, caregiver-friendly language in reports, and coordination with teachers and therapists are also emphasized.
Key Takeaways
- Children can and do have vestibular disorders, which may show up as dizziness, clumsiness, or delayed motor skills.
- Testing is essential, especially in children with hearing loss or unexplained balance problems.
- Simple bedside exams and advanced tests like VEMPs give doctors valuable information without being overly invasive.
- Early intervention helps kids thrive, preventing long-term educational and social impacts.
In short, this consensus statement provides audiologists and other clinicians with a structured framework for evaluating children’s balance and dizziness issues, ensuring that problems are identified early and managed effectively. It emphasizes that proper assessment can make a significant difference in a child’s everyday life, from participation in the playground to academic success in the classroom.
Source: Lavender V, Janky K, Bachmann K, Caine M, Castiglione M, Zhou G. American Academy of Audiology Clinical Consensus Statement: Assessment of Vestibular Function in the Pediatric Population. J Am Acad Audiol. 2025 May 1;36(3):196-229. doi: 10.3766/jaaa.24250301. Epub 2025 Jul 7. PMID: 40619806.
