Alice in Wonderland Syndrome Signs Symptoms and Treatment in Children

Does your child sometimes see objects as unusually big or small? Or feel that their body doesn’t match the space around them? This could be a sign of Alice in Wonderland Syndrome (AIWS) in children, a rare condition that affects a child’s perception of their body, surroundings, and time. In this Daleely Medical article, we’ll explain the causes, types, and symptoms of the syndrome, as well as how it’s diagnosed and treated, in a simple and easy-to-understand way. We’ll also share practical tips for parents to help their child adapt and protect their daily life.

What is Alice in Wonderland Syndrome (AIWS)?
Alice in Wonderland Syndrome is a rare neurological disorder in children that makes them feel that their body or objects around them are changing in size. Sometimes, they may also experience dizziness or visual distortions, especially during or after a migraine.

Is the syndrome dangerous?
Generally, no. AIWS is not life-threatening, but it can cause anxiety in children and parents due to the unusual perception of reality.

What causes it?

Often linked to migraines in children.
Sometimes triggered by viral infections or temporary neurological issues.
Genetic factors or mild neurological sensitivities may play a minor role.

What are the main symptoms?

Feeling that the body or objects are larger or smaller than normal.
Temporary dizziness or loss of balance.
Visual distortions or strange perceptions of colors and shapes.
Sometimes accompanied by migraines.

Are tests needed?
Diagnosis is usually clinical, based on the child’s description and the doctor’s observations. Occasionally, doctors may request a brain MRI or EEG if symptoms are severe or unusual.

Is there a definitive treatment?

There is no cure for the syndrome itself.
Most cases improve over time.
Controlling migraines helps reduce episodes of AIWS.
Psychological support and teaching the child coping strategies are very important.

Can the child live a normal life?
Yes, most children live a completely normal life with simple monitoring. Some may need psychological support if symptoms cause anxiety or fear.

Is AIWS the same as schizophrenia?
No, AIWS and schizophrenia are separate conditions. Symptoms of AIWS may appear in some people with schizophrenia, but this is rare. Other conditions can also cause similar symptoms.

Why is it named after a fictional character?
The syndrome was first described in 1955 by English psychiatrist John Todd, who named it after Alice in Wonderland.
The name comes from the story “Alice’s Adventures in Wonderland” by Lewis Carroll, where Alice experiences strange changes in the size of objects and herself.
Some experts believe Carroll (real name Charles Dodgson) may have experienced similar symptoms, though there is no confirmed evidence.

Who is affected by this syndrome?

Most cases occur in children, with about two-thirds of cases under 18 years old.
Sometimes it affects people with certain brain or neurological disorders.

Is it contagious?
No, AIWS is not contagious. It may occasionally appear after infections like influenza, but the infection itself is not the direct cause.

How long does it last?
Episodes are usually temporary, lasting minutes or hours. Certain causes or conditions may extend the duration. Doctors can best estimate how long symptoms might last in each case.

What is the prognosis?
AIWS rarely poses a threat to life. Most children improve over time and do not require direct medical care, though severe cases may vary.

How common is it?
AIWS is very rare, partly due to limited research. Some studies suggest up to 30% of adolescents experience brief episodes of AIWS symptoms, usually temporary.
Between 1955 and 2016, only 200 cases were serious enough to need direct medical care.
There are no precise diagnostic criteria, so AIWS is often misdiagnosed or underdiagnosed.

How does AIWS affect a child’s body?
AIWS affects the brain’s perception of the body and surroundings, not the body itself. Experts divide symptoms into three types:

Self-perception disturbances

The child may feel that their body or parts of it are larger or smaller than normal.
Affects sense of reality, body connection, emotions, and even perception of time.
Rare, about 9% of cases.

Visual processing disturbances

The child sees objects abnormally, as if they are bigger or smaller.
Most common, about 75% of cases.

Combined symptoms

The child experiences both self-perception and visual processing disturbances simultaneously.

Causes of AIWS in children:

Migraine: Most children with AIWS have a history of migraines, which can cause temporary changes in perception.
Viral infections: Some cases are linked to viruses like Epstein-Barr (EBV) or common colds, which may temporarily affect the brain.
Brain disorders: Changes or issues in the brain, especially the temporal or occipital lobes, can cause distorted perception of body or objects.
Psychological stress or anxiety: High stress may trigger AIWS-like symptoms, particularly sensory and visual distortions.
Rare genetic or neurological factors: Some studies suggest a genetic predisposition or neurological abnormality that increases the likelihood of AIWS.

Types of AIWS in children:

Visual type: Most common; child sees objects as larger, smaller, closer, or farther than they really are.
Somesthetic/body type: Child feels body parts are unusually large or small, or not proportionate.
Temporal type: Distorted perception of time, feeling it passes too quickly, too slowly, or frozen.
Mixed type: Combination of visual, body, and temporal symptoms; rare and more complex, requiring careful monitoring.

Symptoms in children:
1. Self-perception symptoms:

Body size distortions: hands, head, or body feel bigger or smaller.
Feeling detached from reality or observing oneself from outside the body.
Sense of splitting: feeling the body is divided into two halves.
Time perception changes: time seems to pass faster or slower.

2. Visual perception symptoms:

Objects appear bigger or smaller.
Objects appear closer or farther away.
Shape distortions: straight lines or objects appear bent or slanted.
Lilliputian: people or objects appear much smaller than normal.

3. Other associated symptoms:

Balance and movement problems: dizziness or poor hand-eye coordination.
Migraine symptoms: light sensitivity, nausea, or vomiting.
Temporary neurological symptoms: numbness or tingling, strange distance perception.

Most symptoms of Alice in Wonderland Syndrome (AIWS) in children are temporary, lasting minutes to hours, but they may recur depending on the child and the underlying cause.

Diagnosing AIWS in children
Diagnosing Alice in Wonderland Syndrome requires careful evaluation, as its symptoms can resemble other neurological or visual problems. Key steps include:

Clinical examination and medical history

The doctor asks parents about the child’s symptoms, such as distortions in size, shape, or time perception.
Monitors the duration and frequency of episodes and checks if they are related to headaches, fever, or other conditions.
Reviews family history for migraines or neurological disorders.

Neurological examination

Checks brain and nerve function, vision, movement, and coordination.
Observes cognitive changes during episodes.

Eye examinations

Ensures that symptoms are not caused by vision problems such as nearsightedness, farsightedness, or retinal diseases.

Neuroimaging

MRI or CT scans may be performed if symptoms are severe or frequent.

Laboratory tests

Blood tests may be ordered to rule out viral infections or metabolic disorders.

Excluding similar conditions

Differentiates AIWS from other disorders such as:
- Pediatric migraines
- Anxiety or hallucination-related disorders
- Eye or inner ear problems affecting balance and perception

Early diagnosis and regular medical monitoring help understand the child’s condition and manage symptoms more effectively.

Tests used to diagnose AIWS in children
Several tests can help confirm that symptoms are not caused by other conditions:

Imaging tests: MRI or CT scans to detect structural changes or issues in the brain.
Lumbar puncture (spinal tap): Examines cerebrospinal fluid for infections that could affect the brain.
Electroencephalogram (EEG): Measures brain electrical activity, useful for diagnosing seizures or neurological issues.
Visual evoked potential (VEP): Tests the ability of the eyes and optic nerve to send signals correctly to the brain.

Medication treatment for AIWS in children
There is no cure for AIWS itself, but medications help control symptoms and reduce the impact on the child:

Migraine medications
- Simple pain relievers such as acetaminophen or ibuprofen.
- Sometimes specialized migraine medications if episodes are severe or frequent.
Anti-seizure medications
- For children who experience seizures or neurological episodes related to AIWS.
Anxiety or sleep disorder medications
- Helps reduce stress or improve sleep if symptoms cause fear or anxiety.
Nutritional supplements and general support
- Vitamin B and other nerve-supporting supplements.
- Healthy diet, regular sleep, and stress reduction can help reduce AIWS episodes.