Ataxia in Children: Causes, Symptoms, and What To Watch For

Seeing your child struggle with coordination issues or poor muscle control may prompt a visit to the pediatrician. If your normally active little one suddenly seems unusually clumsy, unsteady on their feet, or has trouble grabbing their favorite toy, a pediatrician might mention the word ataxia.

In this condition, part of the brain called the cerebellum is damaged, leading to issues with muscle coordination.

We’ll cover the causes, symptoms, and types of ataxia in children. You’ll also discover what to watch for if you think your child may have this condition, or if they’ve already been diagnosed with it.

Causes of Ataxia in Children

Ataxia in children may be caused by a wide range of conditions. There are several types of childhood ataxia, and the cause is tied to the type of ataxia.

Hereditary Ataxias

Hereditary ataxias develop due to inherited genes passed down from parents to children. Hereditary disorders that cause ataxia include:

• Friedreich ataxia — The most common type of hereditary ataxia, this condition is caused by issues with the FXN gene and may lead to heart issues, diabetes, and scoliosis (spinal curvature) as well as ataxia.
• Ataxia-telangiectasia (A-T) — This is a rare genetic condition that starts in early childhood and causes coordination issues and visible, tiny, spiderlike red blood vessels (telangiectasias) in the corners of the eyes.
• Myoclonic epilepsy ragged red fire (MERRF) syndrome — Most cases are caused by issues with the MT-TK gene, leading to jerking muscle spasms and seizures.

There are many other hereditary ataxias in addition to those listed above. For instance, one group of hereditary ataxias called spinocerebellar ataxias may be caused by about 36 different genes.

These conditions lead to uncontrolled body movements, vision problems, neuropathy (numbness and tingling), and issues with thinking and memory.

Acquired Ataxias

Ataxia isn’t always hereditary. It can also be acquired, meaning it develops as a result of external factors.

The most common ataxia type in kids is called acute cerebellar ataxia. This usually happens following a viral infection (like chickenpox, Epstein-Barr, or even a simple stomach bug), often accompanied by a fever. The body’s immune system gets a bit overexcited while fighting the virus and temporarily inflames the cerebellum.

Other types of acquired ataxias include those caused by:

• Bacterial infections — When children have brain infections, such as encephalitis or meningitis
• Ingesting toxins — When children ingest drugs or toxins such as muscle relaxants, antihistamines, or ethanol
• Head injuries — When children injure their heads, such as following a fall or during car accidents
• Autoimmune conditions — When children have immune-related conditions such as multiple sclerosis or autoimmune encephalitis
• Certain vitamin deficiencies — When children are lacking vitamins such as B12, thiamin, or vitamin E

Childhood Ataxia Symptoms

Ataxia may lead to a wide range of symptoms in children. These symptoms typically depend on the type of ataxia your child has.

The Shampoo Test: A classic sign of sensory ataxia is if your child balances perfectly fine during the day but consistently falls over or wobbles in the shower when they close their eyes to wash their hair. Without their eyes open, their brain lacks the sensory feedback to know where their body is in space.

If you notice that your child is showing any of the symptoms below, reach out to their pediatrician, a neurologist, or another healthcare provider.

Motor Symptoms

Ataxia symptoms affecting your child’s movement may include:

• Muscle tremors
• Poor muscle tone
• Difficulty walking or an unsteady gait
• Coordination problems
• Walking with a wide stance

Sensory Symptoms

Ataxia symptoms affecting your child’s senses may include:

• Difficulty walking in dim light
• Falling when their eyes are closed (for instance, when washing their hair)
• Trouble sensing vibrations
• Poor vision
• Hearing loss

Other Ataxia Symptoms

If your child has ataxia, they may also experience some or all of the symptoms below:

• Fatigue
• Headaches
• Dizziness
• Voice changes
• Slurred speech
• Vomiting
• Nausea

How Is Ataxia Diagnosed in Kids?

If your care team suspects that your child may have ataxia, they’ll perform an evaluation to determine the cause. Testing may include:

• A physical examination that includes an evaluation of eye movement and muscle control (The neurology care team might ask your child to walk on a straight line like a tightrope walker, pretend to blow out candles, or touch their nose and then touch our finger.)
• Targeted blood tests and genetic tests to look for any underlying causes
• Electromyogram (EMG) testing to evaluate unusual muscle activity
• Imaging tests, such as magnetic resonance imaging (MRI), to scan the brain for any underlying causes

If your child has an inherited form of ataxia, such as Friedreich ataxia, genetic testing may be recommended. These tests can typically help confirm the diagnosis and may help guide treatment.

Is Ataxia Permanent?

Some types of acquired ataxia are acute (short-lived) and can be cured. For instance, if the ataxia was due to an infection, symptoms may ease once the infection is gone.

Some inherited ataxias may go away by replacing a missing nutrient. For instance, if your child has inherited ataxia due to a vitamin E deficiency, their symptoms may improve by supplementing that vitamin under a doctor’s care plan.

In other cases, ataxia may be long-lasting. Ataxias due to cerebral palsy or traumatic brain injuries, for instance, are likely to continue throughout the child’s life.

Some ataxias are progressive, meaning they get worse as time passes. Friedreich ataxia, for instance, is a progressive condition. But by beginning treatment as soon as they’re detected, people with these ataxias may be able to slow progression.

Even if your child’s ataxia is permanent, your doctor can help you develop a treatment plan that aims to improve your child’s quality of life. This may include physical therapy, speech therapy, or training on how to use assistive aids like crutches or canes.

What To Watch for if Your Child Has Ataxia

Because some ataxias get worse as time passes, it’s important to take note of any new or worsening symptoms.

Your doctor will let you know what symptoms to watch for based on your child’s diagnosis. For instance, people with Friedrich ataxia may find it harder to chew and swallow. If you notice that your child is choking on their saliva, food, or drinks, reach out to your doctor right away.

In general, let your doctor know if your child has any of these symptoms along with ataxia:

• Behavioral changes
• Depression
• Dementia
• Pain
• Rigidity or stiffness
• Falls with injury
• Bladder or bowel changes
• Breathing issues
• Choking
• Loss of muscle control in your legs, arms, or hands
• Trouble eating or writing

Stay in close communication with your child’s neurology team about any changes to their symptoms. They can help you address new or changing symptoms quickly to help your child maintain their quality of life.

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