Kids Health Info

Bells palsy

  • Bell's palsy is a reasonably common condition where there is sudden weakness of facial muscles one side of the face. It is thought to be caused by the inflammation (swelling) of the facial nerve that affects the muscles that control facial expressions. The affected side of the face does not move properly and the smile may appear lopsided. Affected individuals also have difficulty raising their eyebrow and the eye may not close properly.

    It is named after Charles Bell, the physician who first described it. Palsy is the term given to a nerve which is not working.

    For most children, the condition usually gets completely better in time.

    Causes

    The facial nerve is a nerve which controls the muscles of facial expressions such as smiling, frowning, etc. It also controls eyelid closure and is also partly involved with taste sensation. It has its origins deep in the brain, and leaves the skull close to the ear and parotid (salivary) gland. From there it branches into several divisions to supply the various facial muscles.  

    The cause of Bell's palsy is not fully understood, but it may be caused by pressure or swelling of the nerve as it leaves the skull. Pressure may be caused by trauma (e.g. a bang to the head), ear infections, infection of the skull bone close to the ear (mastoiditis) or infection of the parotid (salivary) gland. However, there is often no cause to be found.

    Symptoms

    • Bell's palsy usually only affects one side of the face.
    • It can happen in children or adults.
    • Affected individuals may have trouble smiling, chewing their food or raising their eyebrow.
    • The affected eye may not be able to close properly. This can make the eye feel irritated and dry.
    • Usually people with Bell's palsy are otherwise well. They sometimes get mild facial pain or pain behind the ear.
    • Sometimes things may taste different to usual and the person may be more sensitive to sound. However, they should not have any severe pain, problems with seeing or weakness elsewhere in the face or body.

    Treatment

    Almost all children (more than 95 children in every 100) with Bell's palsy recover fully without treatment. Children tend to recover better than adults. A few children may have mild, ongoing weakness.  In a very small number of children, the nerve does not recover and they have life-long weakness.

    If your child has difficulty closing the affected eye, it is important that they have lubricating eye drops prescribed and that you use them often (several times per day).  Your doctor or pharmacist can advise you. The eye should also be patched shut at night or when your child goes to sleep.

    Sometimes your doctor will prescribe medicines for Bell's palsy. These include steroids (prednisolone) and an antiviral medicine (aciclovir). However, studies are not clear if these medicines are useful for children with Bell's palsy. Steroids (e.g. prednisolone) are sometimes prescribed to reduce the inflammation of the facial nerve. However, the use of prednisolone in children is controversial. You and your doctor should discuss treatment decisions.

    Your doctor may prescribe antiviral medicine (e.g. aciclovir) if they think a herpes virus (e.g. shingles) is causing the nerve inflammation. Usually, these children would also have a blistering rash in or around the ear.

    If your child also has an ear infection, your doctor will prescribe antibiotics and may recommend surgical drainage of the ear infection.

    If there are signs of mastoiditis (infection of the bone underneath the ear) or parotitis (infection of the salivary gland), your child will probably need to stay in hospital and have intravenous (IV) antibiotics.

    How long before it gets better?

    Bell's palsy is usually an acute problem, meaning it happens suddenly. It may get worse before you see any signs of improvement. There are usually signs of improvement in about six weeks. It may be a year before the facial weakness has gone away completely. In a very small number of children the facial muscle weakness is permanent.

    Key points to remember

    • Bell's palsy is a reasonably common condition where there is sudden weakness of the muscles, usually on one side of the face.
    • Children nearly always completely recover within 12 months.
    • The cause is not fully understood, but it may be caused by pressure or swelling of the nerve.
    • Your doctor may recommend antibiotics or ear drainage if your child also has an ear infection.
    • Treatment with steroids or antiviral medicine is sometimes used but has not been proven to help speed up recovery for most children.

    For more information

    • Talk to your family doctor or paediatrician.

     

    Developed by the RCH Clinical Practice Guidelines group with the Departments of Neurology and General Paediatrics. First published in Feb 2007. Updated in September 2012.



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Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.