Maturation of the Balance System: A Necessary Factor to Consider When Assessing Children with Dizziness

Increasingly, children with balance deficits and symptoms of dizziness are being referred to audiology for assessment and treatment. In response to this increase in referrals, the United States and other countries are seeing a marked increase in the number of audiology centers offering balance and vestibular services for the pediatric patient.

Although the assessment of the pediatric balance system may seem contemporary, David Cyr was studying and publishing on this topic in the early 1980s. His work was centered on identifying vestibular-system deficits in children and describing the effects that these impairments had on long-term quality of life. His approach to the vestibular system in children was not unlike the work done by Marion Downs in 1964 on the auditory system, where she reported on the incidence of hearing loss in newborns.

Unfortunately, following his passing, Cyr's work was cut short and it has not been until more recently that others have picked up the banner and continued the work. Although we can use, to some degree, the scientific work that resulted in universal newborn hearing and methods to treat hearing loss as a roadmap for children with balance disorders, the path forward is somewhat more complicated.

The challenge for those investigating balance and dizziness in children is that dizziness can arise from structural deficits in the peripheral or central nervous system and also from psychiatric and functional disorders. In fact, it is a consistent finding that the most common form of dizziness in children is related to headaches (e.g., migraine). If we are going to “move the needle” on identifying, treating, and understanding the effects of balance disorders on children's quality of life, a multidisciplinary approach is needed. Understanding childhood dizziness and imbalance will require comprehensive diagnostic testing and a close collaboration with physicians and physical therapists.

In this issue of the Journal of the American Academy of Audiology, Sinno and colleagues report on their investigation describing postural control development in healthy children. If we are to understand what a balance deficit looks like in children with impairments, we will need a comprehensive set of normative data to compare them against. The purpose of this study was to evaluate postural control development in a large group of healthy children and study what effect anthropometric characteristics (i.e., height, weight, body mass index) have on the ability to control posture. We encourage you to read the study and, if you are engaged in, or considering, assessing children with balance deficits, this study will be enlightening.

Publication History

Article published online:
18 May 2021