In this section
Acute otitis media
Facial weakness in children may be idiopathic, or caused by infection, inflammation, tumour, trauma or a vascular event. Bell's palsy is an isolated lower motor neuron lesion of the whole facial nerve. The cause is usually unknown. Most children recover completely. Assessment of Bell's palsy is aimed at confirming the diagnosis and excluding the other important causes of facial weakness.
Idiopathic or post-viral facial palsy is uncommon in very young children, especially infants.
<2 years of age, or with atypical features on history or examination, should be discussed with a neurologist and admission considered for further workup including possible neuroimaging
Eye care: All children with any inability to completely close their eye should have eye care:
Steroids: The role in treatment of Bell's palsy in children is unclear, however streroids appear to benefit adults, particularly if given within 72 hours of onset and if complete palsy present. Prednisolone (1 mg/kg/day PO daily for 10 days) may be considered for Bell's palsy presenting within 72 hours of onset.
Antivirals: aciclovir may only be considered if vesicular rash present.
to a neurologist is suggested for children
<2 years of age (see above), atypical features on history or examination or in the absence of any recovery by 4 weeksReferral to ENT should occur if evidence of otitis media, mastoiditis or parotitis
For the other cases, a paediatrician or general practitioner should review in 3-5 days, then as needed to monitor for corneal ulceration