Dizziness in Children

Details

Title

Dizziness in Children

Type

Stage Two

Module code

HPS240

Requirement

Compulsory

Module objective

By the end of this module Clinical Scientists in HSST, with respect to dizziness in children, will be able to analyse, synthesise, evaluate and apply knowledge and perform a specialist assessment of patients demonstrating the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist, working in collaboration with a paediatrician, audiovestibular physician or ENT consultant colleague within a patient focused service and in particular to: 

• differentiate between vertigo and other causes of dizziness or ‘funny turns’ in children.
• determine the cause of episodes of vertigo in children.
• Instigate, lead and interpret an appropriate set of investigations and define a management plan.
• assess the impact of the attack on the individual and family and manage appropriately.

Knowledge and understanding

By the end of this module Clinical Scientists in HSST will analyse, synthesise, evaluate and apply their expert knowledge required with respect to:

• the various otological, neurological, general medical and psychological causes of acute and recurrent dizziness and ‘funny turns’ in children and how to differentiate between them.
• the different causes of acute and recurrent attacks of vertigo/dizziness in a child.
• the ways in which a child may express their symptoms of dizziness in sign, gesture and spoken language and how parents or carers may interpret these symptoms second hand when the child has inadequate vocabulary to describe the episode.Child safeguarding.
• the impact of recurrent vertigo/dizziness on a child particularly with regard to education and social integration.
• the eye movement abnormalities that may be associated with vestibular disorders.
• appropriate audiovestibular tests and other investigations for acute and recurrent vertigo/dizziness.
• the techniques available to investigate vestibular disorders, which are suitable for children of different ages.
• the age related changes in balance function and how this is expressed in investigative results.
• the treatment options and vestibular rehabilitation approaches for children.
• the life style changes and pharmacological options available to treat acute and recurrent vertigo including the role of diet and the place of prophylaxis in patients with migraine, and specific treatment of episodic ataxia type 2.
• when to refer the patient to an audiovestibular physician, paediatrician, paediatric neurologist, cardiologist, ENT surgeon, geneticist, occupational therapist or psychologist for advice on management.
• the natural history of acute and recurrent vertigo in children.
• the difficulties inherent in assessing children with balance problems and the possibility of life-threatening pathology which can present as dizziness.
• Child safeguarding.

Technical and clinical skills

By the end of this module, with respect to dizziness in children, Clinical Scientists in HSST will be able to demonstrate a critical understanding of current research and its application to the performance and mastery of the following technical skills and will:

• perform and lead assessment using the following procedures:
  • videonystagmography.
  • postural sway measurements, including Equitest.
  • tests of oculomotor function
  • tests of vestibulo-ocular function e.g. Halmagyi, head shaking, visual dynamic acuity
  • positioning tests including the Dix Hallpike manoeuvre.
  • caloric function testing including water and air calorics.
  • bedside test battery to identify signs distinguishing central from peripheral causes of vertigo.
  • vestibular evoked myogenic potentials (VEMPs).electronystagmography
  • hyperventilation evoked nystagmus.

By the end of this module Clinical Scientists in HSST will apply in practice a range of clinical and communication skills with respect to dizziness in children to advise and communicate effectively with patients, parents or carers and other healthcare professionals and will:

• take an appropriate and detailed history of the dizzy episodes from the child and parent or carer, including a developmental, psychosocial and family history.
• liaise closely with an audiovestibular physician, paediatrician or ENT consultant surgeon to investigate the cause of the balance disorder
• perform an accurate and developmentally appropriate neurotological examination within the scope of a Consultant Clinical Scientist including examination of the eye movements, characterising any nystagmus.
• identify the likely cause of dizziness in the child and correctly distinguish peripheral from central vestibular causes of acute and recurrent vertigo.
• identify any associated psychological factors, whether as the precipitant or consequence of the dizziness, and refer as appropriate.
• perform and interpret the appropriate range of vestibular tests and be able to recognise abnormalities on those tests as distinct from age related irregularities.
• perform and interpret appropriate audiological tests, discuss causes, prognosis and management strategies in a sensitive way with both the child and parent or carer.
• reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence.

Attitudes and behaviours

By the end of this module Clinical Scientists in HSST will be expected to evaluate their own response to both normal and complex situations demonstrating the professional attributes and insights required of a Clinical Scientist in HSST working within the limits of professional competence referring as appropriate to senior staff and will:

• recognise the impact of acute and recurrent vertigo on the child and family, including the effect on education and respond appropriately.
• recognise that anxiety can present as dizziness, make sensitive enquiries about possible worries including bullying or child abuse and respond appropriately.
• recognise the complexity and potential seriousness of dizziness in children and be prepared to seek an opinion from an audiovestibular physician, paediatrician or ENT surgeon with paediatric expertise as appropriate.
• recognise the importance of child safeguarding.
• be committed to and support continuous improvement of therapeutic services, with particular reference to auditing practice, evidence based practice, innovative, new and improved technologies.