Once upon a time, vestibular dysfunction in children was thought to be exceptionally rare. Our occupational and physical therapists know, however, that pediatric vestibular disorders, which affect as many as 35 percent of adults, are increasingly being identified earlier than ever. Symptoms include chronic dizziness and imbalance. In children, vestibular system disorders can also cause problems in early development, impacting:

• Ability to maintain an upright position when sitting;
• Delays in crawling and walking;
• Difficulty with steady vision when moving the head (for example when copying words or letters at a chalkboard when seated at a desk);
• Diminished balance and motor function.

Long-term, this can have significant and painful social, educational and economic impacts for kids. Professionals on our FOCUS Fort Myers occupational and physical therapy teams are committed to identifying and addressing these issues early on, promoting the highest possible level of relief and function and ultimately mitigating the worst adverse impacts.

What is the Vestibular System and How Do I Know if My Child’s is Dysfunctional?

As our FOCUS Fort Myers physical therapy team can explain, the vestibular system is the one that helps us interpret certain types of sensory input, like motor coordination, movement and head/body position as it relates to the environment. Your vestibular system (particularly the inner ear organs) is mission-critical to compiling all that sensory information – tactile, visual, auditory and proprioceptive (sense of self-movement/body position) – and unifies it ways that help us coordinate our bodies to perform everyday tasks.

Example: You trip on the sidewalk. Your body starts falling forward toward the ground. Before your mind even has a chance to fully process and formulate a response, your vestibular system is on it. It identifies the fact that you’re falling forward. In less than a blink, it alerts other body parts to respond with protective reflexes. You turn your head, shift your torso and outstretch your arms. Your vital organs, head and face will be the first protected. That’s all your vestibular system. You can see how dysfunction with this could start to snowball very quickly.

Pediatric Vestibular Function Screening Not Standard, Problems Overlooked

Children with vestibular function issues may unfortunately hear themselves referred to commonly as “clutzy,” “hyper,” “reckless,” “fearless,” “not athletic” “lazy” or “scrawny.” Pediatric occupational and physical therapy professionals can explain these broad (and, let’s face it, unkind) range of descriptors stems from the fact there are two main types of vestibular dysfunction: hypersensitive or hyposensitive to vestibular input. 

Children with hypersensitivity input generally avoid movement, are afraid or get irritated when they are moving. Their brains have trouble sequencing the vestibular input messages they are receiving, making intense movement uncomfortable and disconcerting.

Children with hypersensitive input vestibular dysfunction may be observed:

• Steering clear of motion-intense playground equipment like slides, see-saws, balance beams, swings or merry-go-rounds.
• Being more content to sit, be stationary than run, spin or jump.
• Avoiding sports or physical games.
• Having lower than average muscle tone.
• Eschewing any activity that requires careful balancing.

On the other side of the spectrum, children with hyposensitivity input vestibular dysfunction are identified in occupational and physical therapy settings often after parents report symptoms associated with conditions like attention deficit hyperactivity disorder (ADHD). The child may or may not have ADHD too and the two conditions may een be related if not causal (researchers still don’t know exactly what causes ADHD). Generally, though, ADHD and vestibular hyposensitivity (not sensitive enough to input) are thought to be two separate disorders.

Symptoms of hyposensitivity input vestibular dysfunction in children include:

• Excessive seeking of movement-intense activities, like bouncing, swinging, jumping and spinning.
• Appears impervious to dizziness.
• Seems to lack safety awareness/self-preservation.
• Gravitates toward playground equipment and tends to play harder/longer than most peers. Takes risks and seeks thrills.
• Shows low muscle tone, poor balance and inadequate body awareness.

Research recently published in the Hearing Journal pointed out that screening for vestibular dysfunction in children diagnosed with hearing impairments is inadequate. It’s been well-established that children with hearing deficits often also experience vestibular dysfunction (related to issues with appropriate inner ear function). Of hundreds of kids automatically screened for vestibular dysfunction at a single large hospital over a six-month period, 50 percent had bilateral vestibular loss and a third had peripheral vestibular dysfunction.

For more info on Recognizing Vestibular Problems in Children, check out the American Physical Therapy Association’s Section on Neurology.

How Pediatric Occupational Therapy, Physical Therapy Can Address Vestibular Dysfunction in Children

The sooner children with vestibular disorders begin treatment, the better chance we have of minimizing the long-term impacts and reducing delays. An experienced pediatric physical therapist can conduct a comprehensive diagnostic evaluation and vestibular rehabilitation, supported by occupational therapists, who work to improve daily function.

Usually the goals our FOCUS child disability therapists in Southwest Florida will be to understand the individual needs of your child and then develop a therapy plan (with instructions on home carryover for parents) on how best to provide that input to meet their needs.

So for example, if our pediatric physical therapy and occupational therapy team members are working on helping a child with hypersensitivity vestibular dysfunction (remember, that is when vestibular systems are overwhelmed with sensory input, something with which a lot of children on the autism spectrum suffer), we’re going to look at improving tolerance for certain sensory stimuli. We’ll do things like:

• Swing (slow and rhythmic for help with calm, self-regulation, input organization).
• Trampoline jumping.
• Therapy ball bouncing.
• Somersaults.
• Bike-riding.
• Practice with balance on unstable surfaces.
• Obstacle course navigation practice.

These strategies are going to help a child better process the vestibular system’s ability to process those messages, improve their body awareness and ultimately promote better posture, protective reactions and visual-motor skills.

If you have concerns about your child’s vestibular system function, our occupational and physical therapy professionals in Fort Myers, Florida can help.

FOCUS offers pediatric physical and occupational therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.

Additional Resources:

Identifying Red Flags for Vestibular Dysfunction in Children, March 2019, The Hearing Journal

More Blog Entries:

Should My Child be Crawling by Now? FOCUS Fort Myers Pediatric Physical Therapists Weigh In, Feb. 26, 2019, Fort Myers Physical Therapy for Children Blog