Background: Dizziness and balance disorders are common in children, affecting approximately 6% of children in the United States. There is little known about the causes of these symptoms in the pediatric population, partly due to a lack of specialized programs for children with vestibular disorders.

Objective: To evaluate the relative incidences of different etiologies of dizziness and imbalance in children and adolescents at a pediatric vestibular program.

Methods: We retrospectively reviewed our internal database of 639 patients ?21 years of age that were evaluated at the Balance and Vestibular Program at Boston Children’s Hospital for dizziness and/or imbalance period between January 2012 and January 2017. Demographic features and causative diagnoses were analyzed. All patients were assigned a primary diagnosis, and some also had secondary diagnoses contributing to their dizziness and/or imbalance. Relative incidences of specific diagnoses and distribution across systems-specific categories were determined.

Results: There were 385 boys and 254 girls included in the analysis, with ages ranging from 10 months to 21 years (mean 12.23 years +/- 4.98). Primary diagnoses were distributed as follows: Traumatic brain injury = 176 (28%), migraine = 164 (26%), otological = 130 (20%), neurological = 53 (8%), autonomic = 48 (8%), psychological = 46 (7%), ophthalmological = 7 (1%), and other = 15 (2%). Secondary diagnoses were also identified in 51.3% of patients, with the most frequent being migraine (14%), benign paroxysmal positional vertigo (13%), generalized anxiety disorder (12%), dysautonomia (8%), and chronic otitis media (3%).

Conclusion: The causes of pediatric dizziness and balance impairment are widely distributed across a variety of systems and specialties. More than half of patients were found to have more than one contributing diagnosis. Pediatric providers should become familiar with the most common causes of these symptoms in children in order to facilitate appropriate evaluation and management.