Paediatric balance services

Balance disorders are less common in children, affecting only 8%, but may be difficult to assess and manage.

Service delivery: This service is for children suspected to have difficulties with balance or complaining of dizziness/vertigo. Referrals are received from a range of professionals including paediatricians, paediatric neurologists, GPs, audiovestibular physicians and audiologists. To ensure high-quality person-centred care, the service is best delivered as a one-stop clinic where a clinical vestibular assessment is followed by audiovestibular testing, debriefing of results and planning of management including physiotherapy if required. The role of the physician is to conduct a detailed clinical assessment/examination, interpret the vestibular testing results in the context of the child’s development, make a decision about the diagnosis and plan management. The service is best used as a hub-and-spoke model in conjunction with local professionals (ie paediatricians, ENT consultants, audiologists, GPs and paediatric neurologists) to provide a specialist opinion on vestibular function and management. Where appropriate, follow-up can be delegated to the local services. There is some scope for providing a ‘testing only’ service through a trained audiologist where the clinical assessment is carried out and results interpreted by doctors trained in paediatric vestibular medicine (eg audiovestibular physicians).

Additional requirements: Specialised vestibular testing equipment to include:

  • a rotatory chair
  • electronystagmography
  • video oculography
  • video Frenzels glasses
  • head impulse testing equipment
  • VEMP testing equipment
  • caloric test equipment.

For more information see BAAP clinical standards (opens PDF, 199KB).

Workforce requirements: Audiovestibular physician, audiologist (with at least 1 year training in paediatric vestibular testing) and preferably a specialised paediatric physiotherapist with expertise in vestibular conditions (to manage rehabilitation). The more specialist centres have more extensive multidisciplinary teams (MDTs) and additional expertise, often providing additional subspecialty services. One hour is usually required for seeing a new patient and 20–30 minutes for a follow-up appointment.

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