From the Guidelines
For pediatric patients with Bell's palsy, the use of prednisone is not strongly supported by evidence, and its benefits are inconclusive, therefore, it should not be recommended as a standard treatment. When considering treatment, it's essential to weigh the potential benefits and harms, and in the case of pediatric patients with Bell's palsy, the evidence is limited, and the prognosis is generally better than in adults, with higher rates of spontaneous recovery 1. The current evidence does not support the routine use of steroids in children with new-onset Bell's palsy, and any decision to use oral steroids should be made on a case-by-case basis, with significant involvement from caregivers in the decision-making process 1. Some key points to consider when treating pediatric patients with Bell's palsy include:
- The lack of controlled trials on the use of steroids in children with Bell's palsy 1
- The limited evidence supporting the use of antiviral therapy alone or in combination with steroids 1
- The importance of monitoring for potential side effects if steroids are used, such as mood changes, increased appetite, or sleep disturbances
- The excellent prognosis for most pediatric patients with Bell's palsy, with approximately 85-90% achieving complete recovery within 3-6 months, even with partial or complete facial paralysis initially. Given the limited evidence and the potential for spontaneous recovery, a conservative approach to treatment may be the most appropriate, focusing on supportive care and monitoring for any potential complications.
From the Research
Recommended Dose of Prednisone for Bell's Palsy in Pediatric Patients
- The recommended dose of prednisone for the treatment of Bell's palsy in pediatric patients is approximately 1 mg/kg body weight for up to 70 or 80 mg/day 2.
- Another study suggests that prednisolone can be prescribed for 9 days at around 1 mg/kg/day, with tapering 3.
- A specific regimen of 50 to 60 mg per day for five days followed by a five-day taper is also recommended for the treatment of Bell's palsy, although this is not specific to pediatric patients 4.
- In a randomized, double-blind, placebo-controlled, multicenter trial, prednisolone was administered at a dose of approximately 1 mg/kg for 10 days 5.
Considerations for Treatment
- The effectiveness of prednisolone in improving complete recovery in pediatric patients with Bell's palsy is uncertain 5.
- Early treatment with corticosteroids, such as prednisone, may improve outcomes in patients with Bell's palsy, especially if administered within 72 hours of symptom onset 2, 6.
- The use of prednisolone in pediatric patients with Bell's palsy is common in Australasian emergency departments, despite the lack of high-level pediatric evidence 3.