Pediatric Bell’s palsy

What is pediatric Bell’s palsy?

Bell’s palsy refers to drooping and weakness on one side of the face. It happens when there is a problem in one of the two facial nerves that go from the brainstem to the face.

The classic sign of Bell’s palsy is drooping of one side of your child’s face. Your child may also experience pain or discomfort on the side of the face that’s affected. Because of its symptoms and sudden appearance, Bell’s palsy often raises worries about stroke. Though strokes are rare in children, you should have your child checked by a doctor if weakness on one side of their face suddenly appears.

In most cases, your primary care provider or an emergency room doctor will be able to tell pretty quickly if it’s Bell’s palsy.

Bell's palsy was named after Sir Charles Bell in the early 19th century.

Risk factors

Bell’s palsy can happen at any age. It is fairly common in adults but not common in very young children. For three of four people, Bell’s palsy will completely or mostly go away. But it can take up to six months and that can feel like a long time, especially to a child.

What are the signs and symptoms of pediatric Bell’s palsy?

Drooping on one side of the face is the most common sign of Bell’s palsy.

Some things you might see on the affected side include:

• The mouth on the affected side won’t move as much when your child speaks, smiles or eats.

• The eyelid may not close well.

• The eyebrow might not raise as well as the eyebrow on the other side.

• The eye may not tear well.

• Saliva may not be produced well and/or drooling may occur.

Less common signs and symptoms include:

• Not being able to taste well

• Pain or a sensation of fullness in the ear

How is pediatric Bell’s palsy diagnosed?

Bell’s palsy is usually diagnosed by a doctor who will give your child a physical exam and ask you about your child’s symptoms, including how and when they started (this is known as a health history). The doctor will pay special attention to how your child’s face is moving.

Usually, diagnosing Bell’s palsy is pretty simple. But sometimes it’s not. We may do tests, like blood work or an MRI, to make sure there isn’t something else causing the weakness. Those tests will usually come back normal if your child has Bell’s palsy.

Most of the time, additional tests aren’t needed. Your doctor can tell if it’s Bell’s palsy from a physical exam and a health history.

What causes pediatric Bell’s palsy?

We don’t know what causes Bell’s palsy. In some cases, it may be due to swelling of the facial nerve related to a common virus (for example, cold sores or chickenpox), but not always.

How is pediatric Bell’s palsy treated?

Steroids are the most common treatment for Bell’s palsy. Sometimes your child may also receive an antiviral medicine because Bell’s palsy can be associated with a virus. These treatments are most helpful if they are started within a few days of the symptoms beginning. Protecting the eye with a patch or ointment may be needed if your child is having trouble closing their eye or producing enough tears. However, many people get better over time without any treatment.

Depending on your child’s symptoms, your doctor may refer you to one of the following specialists:

• An eye specialist (ophthalmologist) - Will help your child if they are having trouble with their tear ducts or closing their eye

• Physical therapist (PT) - Will help your child relearn to use the muscles in their face

• Surgeon - This is sometimes needed for people who continue to have a lot of symptoms over time. But this is rare.