Management of Facial Palsy in Children: A Narrative Review

Abstract

Background and Objective: Facial nerve palsy in children arises from diverse aetiologies, including Bell’s palsy as well as infectious, neoplastic, and neurologic conditions. Differentiating peripheral from central causes is critical, as each entails distinct management and prognostic implications. This narrative review summarizes the diagnostic criteria and management strategies of paediatric facial palsy by comparing protocols from major reference centres and reviewing the recent literature. We present four clinical cases that underscore the importance of a multidisciplinary approach, provide practical clues for timely diagnosis, and offer key messages for the management of facial palsy. Finally, we propose a management algorithm derived from these findings.   

Methods: We reviewed literature (2010–2025), reference centre protocols, and four Hôpital Universitaire de Bruxelles paediatric cases to summarize diagnosis, management, and outcomes of paediatric facial palsy, adapting adult guidelines where paediatric data were lacking.   

Key Content and Findings: Paediatric facial palsy requires a systematic diagnostic and multidisciplinary approach, as both aetiology and management vary. This review covers clinical diagnosis, indications for imaging, multidisciplinary follow-up, treatment options and prognosis. Severe cases benefit from corticosteroids; antivirals are reserved for Ramsay Hunt syndrome. Neuroborreliosis should be considered in endemic areas, even with initially negative serological tests. Early ophthalmologic care and multidisciplinary follow-up are essential to prevent complications.     

Conclusions: Early, thorough evaluation and a multidisciplinary approach are essential to identify underlying causes of paediatric facial palsy. Corticosteroid use remains debated and varies across centres; based on our review, we propose an algorithm to guide management.