Facial nerve palsy in children

A facial nerve palsy is a weakness of one side of the face. This is due to problems with the nerve that supplies those muscles. It is called the facial nerve. There are lots of causes of a facial nerve palsy. Sometimes no cause is found in which case it is called a Bell’s Palsy.

People with facial nerve palsy develop weakness of one side of their face. In the case of Bell’s Palsy this develops over a period of hours to days. Other symptoms that your child might experience are:

• pain around their ear
• mouth problems; difficulty chewing, a dry mouth and a change in taste
• eye problems; being unable to close their eye fully, dry eyes or increased tears
• some numbness or tingling of their cheek or mouth
• dribbling and speech problems because of problems moving and closing their mouth
• being unable to tolerate loud noises

Will it improve?

How well the facial nerve palsy improves will depend on the cause of the weakness. Most children with Bell’s Palsy have an excellent recovery.

Your child will be reviewed in Ear, Nose and Throat (ENT) outpatients. If there is no improvement in the weakness after four weeks the ENT doctors may organise further investigations. This is to look for other causes of facial weakness for your child to look for other causes of the weakness.

Treatment

If your child’s symptoms started less than 3 days ago the ENT doctors may decide to treat your child with steroid medication. This is usually a drug called prednisolone, prescribed for 10 days. They may also start an anti-viral medication called acyclovir.

You may need to protect your child’s eye from damage if they cannot close it properly.

If your child is finding it difficult to eat, try using a straw for liquids and giving them soft food to eat.

The surface of your child’s eye is very vulnerable to damage if they cannot close it properly. This can cause scarring to the surface of the eye and long-term vision problems. It is really important that you help them look after their eye properly to avoid any damage.

If your child’s eye does not close fully you will be sent home with:

• Eye drops - you should put these in your child’s eye every couple of hours, up to 6 times a day, to keep the surface moist.
• Tape - you must tape your child’s eye closed overnight to avoid damage to the surface of their eye.
• Eye ointment - You should put this in your child’s eye at night time before taping their eye closed.

You should look out for pain and irritation of their eye, or any changes in their vision. These can indicate damage to their eye.

Follow up

Your child will have regular follow up with the ENT doctors. They may organise for your child to have their hearing formally assessed.

When to seek medical attention

You should seek urgent medical attention if your child:

• develops eye pain, irritation or changes in their vision
• develops worsening weakness of their face after the first 3 days
• develop headaches or severe/ worsening pain in their face
• has any swelling of their face
• develops any fevers or is unwell
• develops any weakness or change in sensation in their arms or legs
• develops any other problems affecting the nerves in their head and neck or problems with their balance

If you have any concerns you can contact your GP for advice.

Facial nerve palsy can be emotionally and physically challenging. Children may feel very upset that they look different from their friends.

Facial Palsy UK provides online information and support. The website also has details of local support groups. They also organise family days where children with facial weakness and their family members can meet with other families.

Reviewed by Dr T Shaw in October 2023, next review in October 2026.

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