Pediatric Bell’s Palsy Paralysis Treatments

Pediatric Bell’s palsy causes facial paralysis in children from infancy to adolescence. This condition affects a child’s ability to make facial expressions, which can impact speech, eating, and overall quality of life. 

Dr. Babak Azizzadeh of The Facial Paralysis Institute specializes in treating Bell’s palsy in children. He offers non-surgical and surgical treatments, including Botox and facial reanimation surgery, to help restore function and facial symmetry.

What Is Bell’s Palsy?

Understanding Bell’s Palsy and Facial Nerve Paralysis

Bell’s palsy is one of the most common causes of facial paralysis. It is named after Sir Charles Bell, a neurologist who first described the condition.

Each year, about 40,000 Americans develop Bell’s palsy, but it is less common in children under 15 and adults over 60. The condition leads to sudden weakness or paralysis of the facial muscles, usually on one side of the face.

Most cases are temporary, with about 85% of patients recovering fully. However, in some cases, Bell’s palsy leads to long-term complications like synkinesis, which causes involuntary facial movements.

Facial paralysis can be emotionally and socially challenging for children. Since facial expressions play a key role in communication, children with Bell’s palsy may experience frustration or self-consciousness. Encouraging emotional support and therapy can help them adjust as they recover.

Related: What is Bell’s Palsy? Here’s Everything You Need to Know

The Facial Nerve: A Detailed Look

The facial nerve, or the seventh cranial nerve, is a complex network that originates in the brainstem and travels through a narrow bony canal within the skull. Its intricate branching structure allows it to control a multitude of functions within the face. 

This includes the motor control of facial expression, enabling us to smile, frown, and raise our eyebrows. Beyond expression, it also carries taste sensations from the anterior two-thirds of the tongue and regulates the production of tears and saliva.

Demyelination and Inflammation: The Disruptive Processes

In Bell’s palsy, the disruption of nerve signals can stem from two primary mechanisms: demyelination and direct inflammation. Demyelination involves the loss of the protective myelin sheath that surrounds nerve fibers, hindering the efficient transmission of electrical signals. 

Direct inflammation causes swelling and compression of the nerve, similarly impeding its function. These processes interrupt the communication between the facial nerve and the muscles it controls, leading to the characteristic weakness or paralysis.

Causes of Bell’s Palsy in Children

Why Do Kids Develop Bell’s Palsy?

Bell’s palsy in children can be congenital (present at birth) or acquired (developed later due to infection or trauma).  The exact cause of Bell’s palsy remains unknown, but several factors are believed to contribute to its onset.

• Salivary gland inflammation
• Viral or bacterial infections
• Trauma during birth or later in childhood
• Tumors affecting the facial nerve

Causes of Bell’s palsy vary by case, and a thorough medical evaluation is required to determine the underlying issue.

Certain viruses, including herpes simplex and Epstein-Barr, have been linked to Bell’s palsy. These viruses cause inflammation around the facial nerve, leading to temporary paralysis. Identifying underlying infections can help guide treatment.

Viral and Bacterial Culprits: A Closer Examination

Several viral and bacterial infections are closely linked to Bell’s palsy. Herpes simplex virus (HSV) and Epstein-Barr virus (EBV) are common viral culprits, causing inflammation around the facial nerve.

Lyme disease, caused by the bacterium Borrelia burgdorferi, can also lead to facial paralysis, sometimes affecting both sides of the face.

Ramsay Hunt syndrome, a more severe form associated with the varicella-zoster virus (VZV), often presents with a painful rash and hearing impairments. Understanding the specific infectious agents involved is vital for targeted treatment.

Trauma, Genetics, and Autoimmune Factors

Facial nerve trauma can occur during birth, especially with difficult deliveries involving forceps or prolonged labor. Later in childhood, accidents or surgical procedures can also damage the nerve.

Furthermore, research is exploring the role of genetic predisposition in Bell’s palsy. While not fully understood, some individuals may have a higher susceptibility due to genetic factors.

In rare instances, autoimmune disorders, such as Guillain-Barré syndrome, can trigger facial nerve inflammation, as the body’s immune system mistakenly attacks its own nerves.

Ramsay Hunt Syndrome: A Specific Cause

Ramsay Hunt syndrome deserves specific attention. Caused by the reactivation of the varicella-zoster virus (VZV), the same virus responsible for chickenpox and shingles, this condition is characterized by facial paralysis accompanied by a painful rash, often in or around the ear.

It can also lead to hearing loss and dizziness. Due to the potential for more severe and lasting effects, prompt diagnosis and treatment are crucial.

Related: Bell’s Palsy: Expert-approved Facial Exercises

Pediatric Bell’s Palsy vs. Congenital Facial Paralysis

How Does Pediatric Bell’s Palsy Differ from Congenital Facial Paralysis?

Pediatric Bell’s palsy develops suddenly, leading to temporary facial paralysis. Symptoms often improve within weeks or months, though some children experience recurrences over time.

Congenital facial paralysis, on the other hand, is present at birth. It is a rare condition that may affect feeding, speech, and emotional expression. Children with congenital paralysis may struggle to nurse properly or completely close their eyes.

Some children with congenital facial paralysis also have other conditions, such as:

• Cleft palate
• Deformed extremities
• Microtia (underdeveloped ear structure)

Any child with sudden or ongoing facial paralysis should be evaluated by a specialist to determine the cause and best course of treatment.

A child who experiences sudden facial paralysis should go to the emergency room for immediate diagnosis. Most facial paralysis symptoms in kids will disappear on their own within a few days or weeks.

If a child experiences facial paralysis symptoms that last for eight months or longer, meet with Dr. Azizzadeh. Dr. Azizzadeh is a world-renowned facial plastic and reconstructive surgeon with many years of experience. He can evaluate facial paralysis patients and treat their symptoms.

 Associated Congenital Anomalies

Congenital facial paralysis can occur alongside other congenital anomalies, such as cleft palate, deformed extremities, and microtia.

These conditions may indicate broader developmental issues and require a multidisciplinary approach to care.

Moebius syndrome, a rare neurological disorder, is another significant condition associated with congenital facial paralysis, affecting eye movement and potentially other cranial nerves.

Impact on Infant Development

Infants with congenital facial paralysis may face challenges with feeding, as impaired lip closure and sucking ability can lead to nutritional deficiencies.

Furthermore, facial paralysis can affect speech development, as children may struggle with articulation and producing certain sounds. Early intervention and specialized care are essential to support these infants’ development.

Recognizing Symptoms of Bell’s Palsy in Kids

Common Signs of Facial Paralysis in Children

Bell’s palsy symptoms in children range from mild weakness to complete facial paralysis. Common signs include:

• Inability to close one eye
• Weakness or drooping on one side of the face
• Loss of the nasolabial fold
• Difficulty smiling, frowning, or making other expressions
• Ear pain, ringing in the ears, or headache
• Loss of taste or sensitivity to sound
• Slurred speech and difficulty eating or drinking

Parents who notice these symptoms should seek immediate medical attention. Early diagnosis helps determine whether the condition is temporary or requires long-term care.

In some cases, Bell’s palsy symptoms may be mistaken for a stroke. While Bell’s palsy affects only the facial muscles, a stroke often involves additional neurological issues, such as weakness in the arms or legs. If there is any uncertainty, immediate medical evaluation is necessary.

Physiological Basis of Symptoms

Each symptom of Bell’s palsy has a physiological explanation. The inability to close the eye results from paralysis of the orbicularis oculi muscle.

Loss of taste sensation occurs due to damage to the chorda tympani nerve. Hyperacusis, or increased sensitivity to sound, can result from paralysis of the stapedius muscle.

Understanding these underlying mechanisms helps in recognizing the specific manifestations of the condition.

Differentiating from Stroke: A Critical Distinction

It is crucial to distinguish Bell’s palsy from stroke, as they require vastly different medical interventions. 

While Bell’s palsy primarily affects facial muscles, stroke often presents with additional neurological deficits, such as weakness or paralysis on one side of the body, slurred speech, and vision changes. 

Any suspicion of stroke necessitates immediate emergency medical evaluation.

Diagnosing Bell’s Palsy in Children

How Is Bell’s Palsy Diagnosed in Pediatric Patients?

Doctors diagnose Bell’s palsy based on a child’s medical history and a physical exam. In some cases, imaging tests such as MRIs or CT scans help rule out other conditions like tumors or stroke.

If symptoms persist beyond eight months, further evaluation is needed. Dr. Azizzadeh specializes in diagnosing and treating facial paralysis in children, ensuring they receive appropriate care.

 Imaging and Nerve Studies

Diagnostic procedures play a vital role in confirming Bell’s palsy and ruling out other potential causes. MRI and CT scans provide detailed images of the facial nerve and surrounding structures, helping to identify tumors, fractures, or other abnormalities.

Electromyography (EMG) and nerve conduction studies assess the electrical activity of the facial nerve and muscles, providing valuable information about the extent of nerve damage and muscle involvement.

Treatment Options for Pediatric Bell’s Palsy

How Is Facial Nerve Palsy Treated in Children?

Treatment depends on severity and duration. Dr. Azizzadeh offers a range of treatments, including:

• Medications – Corticosteroids help reduce inflammation and swelling around the facial nerve.
• Physical therapy – Exercises improve muscle strength and coordination.
• Botox injections – Helps manage synkinesis and relax tight muscles.
• Surgical options – Used for long-term paralysis cases that do not improve with other treatments.

Dr. Azizzadeh works closely with families to determine the best course of action for each child.

Surgical intervention is rarely needed but may be considered in cases where facial function does not return. Procedures such as nerve grafting or muscle transfers can restore movement in children with permanent paralysis.

Collaborative Care for Optimal Outcomes

Effective management of pediatric Bell’s palsy requires a multidisciplinary approach, involving collaboration between physicians, therapists, and other healthcare professionals.

This team approach ensures comprehensive care, addressing the diverse needs of children with the condition.

Physicians, including pediatricians, neurologists, and facial plastic surgeons, work alongside physical therapists, speech therapists, and occupational therapists to provide tailored treatment plans and support.

Alternative and Complementary Therapies

In addition to conventional medical treatments, some families explore alternative and complementary therapies. Acupuncture, for example, has been reported by some to alleviate symptoms and promote nerve regeneration.

While scientific evidence supporting these therapies is often limited, they can be considered as part of a holistic approach to care.

It’s crucial, however, to discuss any alternative treatments with a healthcare provider to ensure safety and avoid potential interactions with prescribed medications.

Biofeedback is another option that can help children gain better control of their muscles.

Furthermore, it’s important to discuss the importance of eye care. Because the eye can’t close, it can dry out and become damaged. The importance of eye drops, and eye patches should be stressed.

The Psychological Impact and Support Strategies

The emotional and social challenges posed by facial paralysis can be significant for children. Synkinesis, with its involuntary facial movements, can amplify these challenges, leading to self-consciousness and social anxiety.

A holistic approach to care involves not just medical treatment, but also emotional support. Cognitive behavioral therapy (CBT) can equip children with coping mechanisms for managing anxiety and building self-esteem.

Parental support, open communication, and fostering a positive self-image are equally crucial. In addition, speech therapy can assist with articulation and communication difficulties.

Frequently Asked Questions

Can Bell’s palsy affect both sides of a child’s face?

In rare cases, Bell’s palsy can cause bilateral facial paralysis. This is often associated with conditions like Guillain-Barré syndrome or Lyme disease.

Does Bell’s palsy always require treatment?

Most cases improve on their own without medical intervention. However, some children may need treatment if symptoms persist beyond three months.

Is Bell’s palsy contagious?

Bell’s palsy itself is not contagious, but some viral infections that cause it can spread from person to person.

Can Bell’s palsy cause permanent facial weakness?

While most children recover fully, some may experience mild weakness or muscle tightness long-term.

Getting Help for Pediatric Bell’s Palsy

Schedule a Consultation with Dr. Babak Azizzadeh

If your child has persistent facial paralysis, early intervention is key. Dr. Azizzadeh specializes in pediatric Bell’s palsy treatment, helping children regain facial function and confidence.

To schedule an appointment, contact us online or call (310) 657-2203 today.