Special populations · Introduction
Vertigo at both ends of life
Two age groups, opposite problems. The child cannot tell you the room is spinning; the older adult has too many reasons for it. Both are routinely missed — for different reasons.
Why age changes everything
Vertigo looks different at the start and end of life. Young children often can’t describe dizziness, so it shows up as clumsiness, late walking or avoiding play — and gets mistaken for a behaviour problem. Older adults frequently have several mild problems adding up — eyes, balance organs, nerves, blood pressure, medicines — so the dizziness is real but hard to pin on one cause, and it raises the risk of falls.
In children, vestibular disorders are under-recognised because the classic symptom is unspoken: roughly 1 in 20 children report dizziness or imbalance, rising in adolescence, yet it surfaces as motor delay, clumsiness or school difficulty.1,2 In older adults, dizziness is among the commonest complaints and is usually multifactorial — a geriatric syndrome rather than a single diagnosis.3,4
The two extremes demand different reflexes. In children the task is to think of the vestibular system at all — to read non-verbal cues and screen the high-risk groups (SNHL, motor delay, post-concussion). In older adults the task is to disaggregate a multifactorial picture and find the modifiable contributors, recognising presbyvestibulopathy as a defined entity while not stopping there.5
The shared thread
For all their differences, both groups reward the same things: a high index of suspicion, a developmentally- or age-appropriate examination, and vestibular rehabilitation adapted to the patient — play-based for the child, falls-focused for the older adult. And in both, the cost of missing it is high: derailed development in children, and falls and lost independence in older adults.
How this chapter is organised
- Paediatric vertigo — epidemiology, the age-specific differential (peripheral and central), and the non-verbal presentation.
- Paediatric assessment & care — the developmentally-tailored work-up, condition-specific management, and play-based rehabilitation.
- Presbyvestibulopathy & dizziness — the Bárány criteria, age-related vestibular decline, and the multifactorial picture.
- Falls & prevention — the vestibular contribution to falls, assessment, and what actually reduces risk.
Key points
- Vertigo is under-recognised at both age extremes — for opposite reasons.
- Children rarely verbalise it; it presents as motor delay, clumsiness, motion intolerance or school difficulty.
- Older-adult dizziness is usually multifactorial — a geriatric syndrome, not one diagnosis.
- Presbyvestibulopathy is a defined age-related bilateral vestibular hypofunction.
- Both groups benefit from suspicion, tailored assessment and adapted vestibular rehabilitation.