A Normative Dataset of the Balance Error Scoring System in Children Aged Between 5 and 14

Abstract

Objective: 

Pediatric head injuries occur commonly and are being reported in increasing numbers. Balance testing is a key component in the evaluation of suspected concussion, and the balance error scoring system (BESS) is likely the most well-known and widely used measure. To date, normative BESS scores for adults have been reported but not for children.

Design: 

Normative data for BESS scores and modified BESS scores were created in a cohort of healthy children. Potential variables were analyzed as predictors of BESS performance.

Setting: 

Local elementary and junior high schools.

Participants: 

A total of 373 healthy children between the ages of 5 and 14.

Interventions: 

The BESS was performed on all children.

Assessment of Risk Factors: 

Gender, body mass index percentile, previous concussions, athletic participation, age, and the parental opinion of child's balance ability were examined as factors associated with the BESS score.

Main Outcome Measures: 

BESS scores.

Results: 

Normative data are reported, stratified by age groups of 5 to 7 years, 8 to 10 years, and 11 to 14 years of age, for both BESS and modified BESS. Median BESS scores are 23 for children aged 5 to 7, 18 for children aged 8 to 10, and 16 for children aged 11 to 14. Median modified BESS scores are 8 for children age 5 to 7, 5 for children age 8 to 10, and 4 for children age 11 to 14. Increasing age and positive parental opinion regarding their child's balance ability were independently correlated with decreasing BESS scores (P < 0.01).

Conclusions: 

The normative data on BESS scores for healthy children reported here provide age-stratified reference values for suspected balance alterations.