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Bell's Palsy

What is Bell's palsy?

Bell's palsy is a weakness or paralysis of a facial nerve. Nerves on each side of your child’s face control movement of the muscles on that side. When a facial nerve is weak or paralyzed, that side of the face droops and it may be hard for your child to smile or close the eye on that side. The severity of Bell's palsy can vary from mild weakness to complete paralysis of one side of the face.

What is the cause?

Bells’ palsy happens when a nerve in the face gets swollen or irritated, which makes the facial muscle get weak. The exact reason this happens is not known. One possible cause is infection with the virus that causes cold sores. The body’s immune reaction to this virus can cause swelling or irritation that damages the facial nerve. When this happens, the nerve can no longer control the facial muscles. The muscles get weak and your child loses part or all control of the muscles for weeks or months until the nerve heals.

Lyme disease, an infection caused by the bite of an infected tick, is another possible cause.

What are the symptoms?

The first symptom may be an ache behind the ear. Then that side of the face will become weak or paralyzed.

Other symptoms may include:

  • Watery eye
  • An eyelid that won’t close completely
  • Decreased taste
  • A change in hearing
  • Trouble smiling, drinking, or chewing on one side of the mouth
  • Slurring when your child talks

Symptoms may develop within a few hours or over a couple of days. The faster the symptoms happen, the more severe the weakness or paralysis is likely to be.

Although rare in children, get help from a healthcare provider right away if your child's symptoms develop quickly such as in 30 to 60 minutes. Your provider will want to make sure that your child is not having a stroke.

How is it diagnosed?

Your healthcare provider will ask about your child’s symptoms and medical history and examine your child. Your child may have tests or scans to check for other possible causes of the symptoms, such as an infection or a tumor.

How is it treated?

Treatment depends on the cause and how severe your child’s symptoms are.

  • If your child’s symptoms are mild, your child may not need treatment. Symptoms may start to go away on their own within a few weeks even without medicine.
  • If your child’s symptoms are more severe, your provider may prescribe steroid medicine. Steroid medicines have been shown to help adults recover from Bell’s palsy. Give your child steroid medicine exactly as prescribed. Your child should not take more or less of the medicine than prescribed by your provider and should not take it longer than prescribed. Your child should not stop taking a steroid without your provider's approval. The dosage may need to be lowered slowly before stopping it.
  • If a virus is the cause, your child’s healthcare provider may also prescribe antiviral medicine.
  • Physical therapy, including exercises and massage, may help your child keep some muscle strength and keep the facial muscles flexible until the symptoms go away.
  • If your child’s eye does not close completely, it needs to be protected from problems such as dust and dryness. Patching the eye or using eye drops or eye ointments can protect the eye. If the eye is not protected, your child could lose vision in that eye.

If, despite the weakness, your child still has at least some muscle movement, your child has a good chance for a complete recovery. If your child has complete paralysis (no movement of the facial muscles at all), your child will probably not get back full muscle movement.

Bell's palsy can last several weeks even when it’s mild. It may be months before you know how much muscle control your child will get back.

It’s rare to have Bell's palsy more than once. If your child has facial paralysis again, another problem may be causing it and your child should be checked right away by your healthcare provider.

How can I take care of my child?

  • Follow the full course of treatment prescribed by your child’s healthcare provider.
  • Give your child nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen.
    • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen and naproxen, may cause stomach bleeding and other problems. Read the label and give to your child as directed.
    • Acetaminophen may cause liver damage or other problems. Read the label carefully and give your child the correct dose as directed. Do not give more doses than directed. To make sure you don’t give your child too much, check other medicines your child takes to see if they also contain acetaminophen. Unless recommended by your healthcare provider, your child should not take this medicine for more than 5 days.
  • Moist heat may help relieve pain, relax the muscles, and make it easier for your child to move the face muscles. Moist heat includes moist heating pads that you can buy at most drugstores, a warm wet washcloth, or a hot shower. To prevent burns to the skin, follow directions on the package and do not allow your child to lie on any type of hot pad. Don’t use heat if there is swelling.
  • Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the area every 3 to 4 hours, for up to 20 minutes at a time.
  • Try gentle facial massage to help your child get back more muscle movement as your child recovers.
  • If your child’s eye is not closing completely, keep it moist. Some things that might help keep the eye from getting too dry are:
    • Use artificial tears when your child is awake.
    • Use eye lubricant ointment when your child is sleeping. The ointment may be used also when your child is awake if artificial tears don’t give enough protection. However, the ointment may blur your child’s vision.
    • Wear eyeglasses or a shield to protect the eye. Use sunglasses when your child is out in the sun.
    • Take extra care to keep your child’s eye moist when your child is using a computer. People tend to blink less often while at a computer. Keep eye drops handy.
  • Ask your child’s healthcare provider:
    • How and when you will get your child’s test results
    • How long it will take your child to recover
    • If there are activities your child should avoid and when your child can return to normal activities
    • How to take care of your child at home
    • What symptoms or problems you should watch for and what to do if your child has them
  • Make sure you know when your child should come back for a checkup.
Written by Robert M. Brayden, MD, Professor of Clinical Pediatrics, University of Colorado School of Medicine.
Pediatric Advisor 2019.4 published by Change Healthcare.
Last modified: 2019-10-02
Last reviewed: 2018-05-09
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2018 Change Healthcare LLC and/or one of its subsidiaries
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