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

Clin J Sport Med. 2016 Nov;26(6):497-501. doi: 10.1097/JSM.0000000000000285.


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.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Brain Concussion / diagnosis*
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Physical Examination / methods
  • Physical Examination / standards*
  • Prospective Studies
  • Reference Values