From the Guidelines
Bell's palsy in children is characterized by a better prognosis and higher rates of spontaneous recovery compared to adults, making the benefit of corticosteroid treatment inconclusive.
Characteristics of Bell's Palsy in Children
- The prognosis of untreated Bell’s palsy in children is better than in adults, with higher rates of spontaneous recovery 1
- Children show higher rates of spontaneous recovery than adults, which makes the benefit of corticosteroid treatment unclear 1
Management of Bell's Palsy in Children
- Oral steroids may be considered in pediatric patients, but the evidence is limited, and the need for steroid treatment is unclear 1
- A 10-day course of oral steroids with at least 5 days at a high dose (either prednisolone 50 mg for 10 days or prednisone 60 mg for 5 days with a 5-day taper) initiated within 72 hours of symptom onset may be used, but the benefit of treatment after 72 hours is less clear 1
- The decision to use steroids in children should involve caregiver involvement in the decision-making process, given the presumed similar disease process of Bell’s palsy in adults and children, as well as the generally favorable benefit-harm ratio of steroid therapy 1
- Antiviral therapy alone is not recommended, as it is no better than placebo with regard to facial nerve recovery in Bell’s palsy 1
From the Research
Characteristics of Bell's Palsy in Children
- Bell's palsy is a neurological disorder characterized by sudden unilateral peripheral facial paralysis, with the etiology in children remaining largely unknown 2.
- The condition is most common in people aged 15 to 40 years, but can also occur in children, with a 1 in 60 lifetime risk 3.
- Children with Bell's palsy often have a very good prognosis, with a complete recovery rate exceeding 90% 4.
- The mean duration between onset of Bell's palsy and consultation is typically short, around 3 days 4.
Management of Bell's Palsy in Children
- The use of corticosteroids, such as prednisone, is a common treatment approach, but its effectiveness in children is still debated 2, 5, 4.
- Some studies suggest that corticosteroid therapy may not be a disease-modifying factor that ultimately influences outcomes in pediatric Bell's palsy 2.
- Antiviral treatment, such as acyclovir, may be used in combination with corticosteroids, but its effectiveness in children is also unclear 6, 4.
- Hospitalization is not typically indicated for pediatric patients with Bell's palsy, and treatment can often be managed on an outpatient basis 5, 4.
- Further large-scale studies are needed to define evidence-based protocols for managing pediatric Bell's palsy 2, 4.
Recovery Outcomes
- The recovery rate for children with Bell's palsy is generally high, with 81.8% of patients achieving complete recovery at 2-month follow-up in one study 2.
- The duration of complete recovery can vary, but is typically around 7.4 weeks 4.
- Factors such as the degree of initial paralysis, etiology, and treatment approach may influence recovery outcomes, but more research is needed to fully understand these relationships 2, 5.