The Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology has issued a report on the assessment of vestibular testing techniques in adults and children. The evidence is based on a review of published articles obtained through the MEDLINE database. The majority of normal children demonstrate vestibular responses to caloric and rotational stimuli by age 2 months. The absence of a vestibulo-ocular reflex (VOR) by age 10 months is abnormal. Lack of a response to ice water and rotational vestibular responses in a child less than 6 months may be normal. Technical modifications of vestibular tests for children are discussed. Among clinical indications and contraindications, vestibular testing is not recommended in the diagnosis of dyslexia and learning disabilities. Testing is most commonly used in the evaluation of vertigo, imbalance, recurrent unexplained falling, acquired jerk nystagmus, or suspected malformation of the inner ear. Caloric (air or water) ENG and rotational chair testing are established tests. Rotational testing may be more convenient in small children 3 years of age or younger. 
COMMENT. Most vestibular tests used in adults can be applied to children. Caloric (ENG) and rotational chair tests are standard. VOR responses in neonates are poor, but normal results can be obtained as early as 2 months and no later than 10 months.