Balance (Vestibular) Disorders

small child concentrating

Kids stumble and fall sometimes, especially toddlers. However, if you're seeing a pattern of possibly balance-related symptoms (dizziness, falling, blurred vision, disorientation or nausea) — find out what's going on. The Nemours Balance Disorders Program provides a unique and effective way to evaluate, diagnose and care for children with balance and vestibular (inner ear balance) disorders.

Read More About Vestibular Disorders

In our state-of-the art center for pediatric vestibular testing we are able to perform specialized testing in labs where we can stimulate the inner ear and see how balance and gross motor skills (that is, movement of the large muscles) are affected. We believe that our comprehensive approach has allowed us a high rate of success in identifying and managing children with a variety of vestibular disorders.

A balance disorder may be caused by the pathology (problem) of the labyrinth, which is an organ of the body located in the inner ear, consisting of three semicircular canals and the vestibule. The labyrinth interacts with the eyes, muscles, and joints to maintain the body’s position. This system, along with the brain and the nervous system, can be the source of balance disorders.

Balance disorders can be traced to four key areas:
  • Peripheral vestibular disorder, a disturbance in the vestibule
  • Central vestibular disorder, a problem in the brain or its connecting nerves
  • Systemic disorder, a problem in the body other than the head and brain
  • Vascular disorder or blood flow problems

Nemours/Alfred I. duPont Hospital for Children, Wilmington

1600 Rockland Road
Wilmington, DE 19803
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For Appointments: (888) 495-5218

What to Bring
  • photo ID
  • medical and pharmacy insurance cards
  • preferred pharmacy name and phone number
  • names and dosage of all medications, including over-the-counter medication, your child is currently taking
  • guardianship and custody papers, if a legal guardian rather than a parent accompanies your child
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The Pediatric Balance Disorders Program at Nemours/Alfred I. duPont Hospital for Children in Wilmington, DE, is one of the most advanced centers for pediatric vestibular disorders in the country and leads the way in the evaluation, diagnostics, and care for children with balance and vestibular (inner ear balance) disorders. We’ll try to pinpoint what may be causing your child’s balance issues and create a customized treatment plan. 

Our vestibular team at duPont Hospital for Children is multi-disciplinary and includes experts from:

In addition, Neurology, Neurosurgery, and Ophthalmology may be called upon for input.

Our collaborative approach has helped us achieve a high rate of success in identifying and managing children with a variety of vestibular disorders. Children can be referred to our program by community pediatricians or from various specialty clinics such as ENT, neurology, ophthalmology, and developmental pediatrics.

How are hearing and balance related?

The ear houses both the auditory system (for hearing) and the vestibular system (for balance). These two systems are connected and, together, they are about the size of a dime. It stands to reason then, that when a problem occurs in one of those areas, there may also be a problem in the other region.

In some people, a balance problem may give rise to a hearing loss (often temporary, sometimes permanent). And in others, hearing loss may be recognized first and then a balance problem may be discovered. Studies have shown that as many as 30% of children with permanent hearing loss may also experience a balance problem; whereas about 10% of patients that have a vestibular problem will also exhibit a hearing loss.

Our balance depends on input from three different systems: the eyes, the inner ears, and the legs/torso. These signals are sent to the brain, which in turn keeps us upright and oriented in space. When one of these systems is faulty, a balance problem may occur. When two of these systems are faulty, there will very likely be an obvious balance problem.

Symptoms of Balance Disorders

Many different terms are often used to describe what is collectively known as dizziness. Common descriptions include unsteadiness, spinning, or an abnormal feeling that things are moving. Parents also may describe their child as clumsy, report concerns about delayed physical milestones (i.e. walking), or notice a head tilt. 

Other symptoms may include:
  • migraine headaches
  • falling or a feeling of falling
  • lightheadedness
  • visual blurring
  • disorientation
  • nausea and vomiting
  • diarrhea
  • faintness
  • changes in heart rate and blood pressure
  • fear, anxiety, or panic
Vestibular Testing

Comprehensive Vestibular testing is scheduled as a panel appointment – this means, your child will  receive evaluations in the Audiology Department, Physical Therapy, and the Gait Lab on the same day. The entire vestibular evaluation will last about 5-6 hours, with many breaks throughout. 

Audiological Vestibular Tests include Videonystagmography (VNG), Rotational Chair (RVT), and Vestibular Evoked Myogenic Potential (VEMP) in addition to a basic hearing evaluation. Testing may be modified depending on the age and developmental abilities of the child:

  • Videonystagmography (VNG) records and measures eye movements (nystagmus) generated by the semicircular canals and central vestibular system. First we place lightweight goggles with miniature video cameras on the child. Then we ask the child to perform simple tasks, such as staring at or following a small light, or turning the head or body to one side. The final part of the VNG allows us to compare the right and left vestibular organs by stimulating each ear with warm or cool air and comparing the strength of the resulting eye movement.
  • Rotational Chair (RVT) designed to test the function of the vestibuloocular reflex (VOR). First we place lightweight goggles with miniature video cameras on the child. Then we measure eye movements as the child sits in a computer-controlled rotating chair in a darkened room. We ask children to keep their eyes open while the chair gently rotates at various speeds (the chair doesn't move fast and kids generally tolerate the movement well).
  • Vestibular Evoked Myogenic Potential (VEMP) provides information regarding the function of a vestibular organ called the saccule and the inferior vestibular nerve. Soft electrode stickers are placed on the child’s neck and forehead while click sounds are presented to the ear. The child is asked to contract the neck muscles by turning the head to the side.

Physical Therapy Evaluation typically includes a balance evaluation, developmental assessment, and lower extremity strength and flexibility assessment.

Gait and Motion Analysis Laboratory provides state-of-the-art computer-assisted motion analysis (also known as biomechanics) of the gait cycle (how children walk). During the analysis, we're to gather detailed information about the movement of various joints, the patterns of muscle contractions, the associated forces affecting the limbs, and the energy demands involved.

Treatment for Balance Disorders

There are many management options for balance disorders and they vary depending on the causes underlying each child’s symptoms. Every child is unique, and our underlying goal is always to maximize your child’s ability to fully and comfortably participate in activities of daily living.