That feeling that “something doesn’t fit”…
As professionals in child development, we’ve all experienced that moment.
The baby seems healthy. Neurological tests are within expectations. But something doesn’t fit:
- Why can’t they hold their head steady?
- Why don’t they tolerate prone position?
- Why do they startle so easily?
- Why can’t they organize their movement, even in supportive environments?
And then comes the question that can make the difference in your approach:
Am I taking the vestibular system into account in my evaluation?
A primitive but key system
The vestibular system is the first functional sensory system in intrauterine life, active from the 8th week of gestation. It is deeply involved in the organization of tone, balance, posture, visual coordination, and emotional regulation.
However, it remains one of the most overlooked systems in the clinical evaluation of babies.
How many times do we dismiss the vestibular system because there is no visible injury or an established vestibular diagnosis?
How many times do we assume its function is preserved… simply because the baby does not present spontaneous nystagmus or an obvious balance alteration?
What the evidence (and the clinic) tells us
Recent studies show that early signs of vestibular dysfunction in babies may be present even in the absence of structural lesions. These signs include:
- Alterations in axial and cervical tone.
- Difficulties in verticalization.
- Inadequate postural reactions.
- Disorganization of head control.
- Hypersensitivity to visual or movement stimuli.
In a quasi-experimental study on babies with neurological risk, early vestibular stimulation significantly improved head control, visual fixation, and postural tolerance (Trejo-Torres et al., 2019).
On the other hand, research such as that of Rine et al. (2024) emphasizes that early vestibular rehabilitation in pediatrics improves not only balance but also overall coordination, even in populations without an established vestibular diagnosis.
The risk of not looking
Not integrating vestibular evaluation in babies entails a significant clinical risk:
- We may interpret as “slow maturity” what is actually an underlying sensory dysfunction.
- We may delay key interventions during a critical window of neurodevelopment.
- We may design therapeutic plans without activating the fundamental systems of tonic and postural regulation.
And above all: we may lose the opportunity to offer the baby a more organized, stable, and harmonious development.
How to start looking?
At TMPI, we propose an integrative sensory-motor approach from the very first contact with the baby:
- Clinical observation of cervical tone and head support.
- Postural and protective reactions in different planes.
- Tolerance to changes in position and to gentle vestibular stimuli.
- Integration of head, eyes, and body in space.
- Coherence between the postural, visual, and auditory profile.
A paradigm shift
We can no longer wait for the baby to “mature on their own.”
The vestibular system is not just a channel for balance.
It is a central organizing system for motor, sensory, and emotional development.
And you, as a physiotherapist, occupational therapist, optometrist, or speech therapist, can make a difference if you integrate it from the start.
Scientific references:
- Božanić Urbančič, V., et al. (2023). Meaningful movement and targeted vestibular stimulation in child development.
- Hadders-Algra, M. (2010). Variability and stereotypy of general movements in infants. Early Human Development, 86(11), 787-794.
- Lobo, M. A., Harbourne, R. T., Dusing, S. C., et al. (2014). Grounding Early Intervention: Physical Therapy Cannot Just Be About Motor Skills Anymore. Pediatric Physical Therapy, 31(4), 277–284. https://doi.org/10.1097/PEP.0000000000000630
- Molloy, A., et al. (2018). Subtle signs of vestibular dysfunction in hypotonic infants. Journal of Pediatric Rehabilitation Medicine, 11(4), 297–305.
- Rine, R. M., Braswell, J., & Sabo, D. (2024). Pediatric Vestibular Rehabilitation: Efficacy and Clinical Applications. Revista de Fisioterapia Pediátrica, 12(3), 115–130.
- Trejo-Torres, A., et al. (2019). Estimulación vestibular en bebés con riesgo neurológico. Universidad Autónoma de Querétaro. RI-UAQ Repository.
- Wiener-Vacher, S. R., et al. (2013). Vestibular function and its impact on cognition and learning in children. Frontiers in Integrative Neuroscience, 7, 104. https://doi.org/10.3389/fnint.2013.00104
- Zelazo, P. R., & Kolb, B. (2012). Developmental Plasticity and the Neural Bases of Behavior. In Neuropsychology of Developmental Disorders.
Are you part of the change?
At PIMT we train professionals who know how to see beyond the diagnosis.
Who know how to listen with the body, with the eyes… and with science.
Are you interested in training in sensory evaluation from the first months of life?
Do you want to deepen your knowledge of vestibular function from real clinical practice?
Then this is your place.
Because when you start to look differently, you also start to intervene differently.
Comments are closed.