Facial palsy (Bell's palsy)

  • Facial palsy is a condition where there is weakness of facial muscles on one side of the face. While there are many different causes of facial palsy (see below), often no cause is identified (idiopathic). Idiopathic facial palsy is known as Bell's palsy, which is reasonably common in children.

    Facial palsy is thought to be a result of inflammation (swelling) of the facial nerve, which controls the muscles involved in facial expressions (e.g. frowning, smiling). The facial nerve also controls eyelid closure and is partly involved with taste sensation for the front part of the tongue. Palsy is the term used when a nerve is not working properly.

    Facial palsy can happen in children or adults. For most children, the condition usually resolves completely in time, with treatment depending on the cause of the condition.

    What causes facial palsy?

    The cause of a facial nerve palsy is not fully understood, but it may be caused by pressure or swelling of the nerve as it leaves the skull. This 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)
    • infection of the parotid gland (parotitis)
    • infection with a herpes virus – this type of facial palsy is called Ramsay-Hunt syndrome.

    Signs and symptoms of facial palsy

    Facial palsy usually develops over hours or days. If your child has facial palsy, they will have trouble smiling, chewing their food or raising their eyebrow. Your child may also:

    • be unable to close their affected eye properly – this can make the eye feel irritated and dry, and tears are often reduced
    • have mild facial pain or pain behind the ear
    • find that things taste different to usual
    • be more sensitive to sound.

    Usually children with Bell's palsy are otherwise well. They should not have any severe pain, problems with seeing or weakness elsewhere in the face or body.

    If there are vesicles (small fluid-filled blisters) in the ear canal, or on the tongue or roof of the mouth, this may indicate your child has Ramsay-Hunt syndrome. You should avoid touching the vesicles, and take your child to the GP immediately.

    If your child has symptoms of facial palsy, take them to the GP. The doctor will be able to rule out other serious conditions, and determine if any treatment is needed.

    If your child develops a very sudden facial droop within seconds or minutes – with or without difficulties speaking – call an ambulance immediately, as this may represent a stroke.

    Treatment for facial palsy

    More than 95 per cent of children with Bell's palsy recover fully without treatment. Children tend to recover better than adults.

    Your doctor may prescribe steroids (prednisolone) to reduce the inflammation along the facial nerve. However, often no treatment is needed for Bell's palsy. Studies are not clear if steroid medicines are useful for children with this type of facial palsy.

    Your child's Bell's palsy 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. A few children may have mild, ongoing weakness in their facial muscles. In a very small number of children, the nerve does not recover and they have permanent muscle weakness.

    Facial palsy requires treatment in the following cases:

    • If your child has difficulty closing their affected eye it is important that they have lubricating eye drops 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.
    • Your doctor may prescribe antiviral medicine (e.g. aciclovir) if they think a herpes virus is causing the nerve inflammation (Ramsay-Hunt syndrome).
    • 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 or parotitis, your child will probably need to stay in hospital and have intravenous (IV) antibiotics.

    Key points to remember

    • Facial palsy is a reasonably common condition where there is relatively quick onset (over hours to days) of weakness of the muscles, usually on one side of the face.
    • The cause is not fully understood, but it may be due pressure or swelling of the nerve, which may be caused by an infection or trauma.
    • Facial palsy with no known cause is called Bell's palsy.
    • Treatment depends on the cause of the facial palsy, and may include steroids. Bell's palsy usually requires no medication.
    • If your child develops a very sudden facial droop call an ambulance immediately.

    For more information

    • See your GP or paediatrician.

    Common questions our doctors are asked

    Is facial palsy contagious?

    Facial palsy is not contagious and cannot be passed onto other people. However, if the cause of a person's facial palsy was a virus (e.g. herpes, Ramsay Hunt syndrome), then this underlying illness may be contagious. If you see vesicles, avoid touching them and speak with your doctor.

    Is there anything I can do to speed up my child's recovery, like massaging her facial muscles or getting her to do exercises?

    Most children with facial palsy make a full recovery, especially if the symptoms begin to improve within the first three weeks. Other than your child taking any medications that may have been prescribed, there is little you can do to speed up the process and exercises will usually not help.

    I'm worried that it looks like my child has had a stroke. What is the difference between facial palsy and stroke?

    Facial palsy is a fairly common condition in childhood, whereas childhood stroke is far less common. Stroke is a much more serious condition, which happens when the blood supply to the brain is interrupted. Stroke requires emergency medical treatment. Signs of a stroke will develop quickly, usually with a very sudden onset. The signs of Bell's palsy, develop over several hours to days.

    Developed by The Royal Children's Hospital Neurology and General Medicine departments, and Clinical Practice Guidelines group. We acknowledge the input of RCH consumers and carers.

    Reviewed June 2018.

    This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.


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