From the Guidelines
The management of pediatric Bell's palsy in the ED is generally conservative, with a focus on supportive care and observation, as the prognosis is better in children and they show higher rates of spontaneous recovery than adults.
Key Considerations
- The use of antiviral monotherapy is not recommended, as it has been shown to be no better than placebo in terms of facial nerve recovery 1.
- The benefit of corticosteroid treatment in children is inconclusive, and compelling data are lacking to support its use in this population 1.
- However, given the similar disease process of Bell's palsy in adults and children, and the generally favorable benefit-harm ratio of steroid therapy, oral steroids may be considered in pediatric patients, with a large role for caregiver involvement in the decision-making process 1.
Treatment Approach
- Supportive care and observation are the mainstays of treatment for pediatric Bell's palsy in the ED.
- Oral steroids may be considered on a case-by-case basis, taking into account the individual patient's circumstances and the preferences of their caregivers.
From the Research
Management of Pediatric Bell's Palsy in the ED
- The management of pediatric Bell's palsy in the ED is varied, with some studies suggesting the use of corticosteroids, such as prednisolone, while others propose alternative therapies like photobiomodulation 2, 3, 4, 5, 6.
- A study published in 2018 reported a case of Bell's palsy in an adolescent successfully treated with photobiomodulation, a non-invasive approach with no side effects 2.
- Another study from 2013 found that the majority of children with Bell's palsy have complete resolution of facial weakness, regardless of treatment with prednisolone 3.
- A randomized, double-blind, placebo-controlled trial published in 2022 found no significant difference in complete recovery rates between children treated with prednisolone and those receiving a placebo 4.
- A retrospective analysis of ED medical records in Australia and New Zealand found that prednisolone is commonly used to treat Bell's palsy in children, despite a lack of high-level pediatric evidence 5.
- A recent study from 2024 suggested that corticosteroid therapy may not be a disease-modifying factor in pediatric Bell's palsy, and that further research is needed to define evidence-based protocols for management 6.
Treatment Options
- Corticosteroids, such as prednisolone, are commonly used to treat Bell's palsy in children, but their effectiveness is uncertain 3, 4, 5, 6.
- Photobiomodulation has been proposed as a potential treatment for Bell's palsy, with some studies suggesting its effectiveness in pediatric patients 2.
- Vitamin supplementation has also been explored as a potential treatment, but its impact on recovery outcomes is unclear 6.
Prognostic Factors
- The prognosis for pediatric Bell's palsy is generally good, with the majority of children achieving complete recovery 3, 6.
- Factors such as age, gender, and side of paralysis do not appear to be associated with recovery outcomes 6.
- The use of prednisone has been associated with a higher rate of incomplete recovery in some studies, with higher doses correlating with poorer outcomes 6.