Bell’s palsy is a problem that affects many children and adults at some time in their lives. In Bell’s palsy, the seventh cranial nerve, which controls the muscles on one side of the face, becomes inflamed and does not function properly. Therefore, that side of the face has no expression or muscle movement — it is temporarily paralyzed or very much weakened. Bell’s palsy almost always resolves without difficulty, but it can be terrifying for the child and very distressing to the parents, too.
The first sign of Bell’s palsy may be an ache or pain near one ear, which may be a sign that the facial nerve on that side is swollen or irritated. Hours later the child or parent may notice a crooked (asymmetric) smile and drooping facial expression. On the palsied side, the child is unable to smile, frown, grimace, close the eye tightly, purse the lips, or raise the eyebrows.
Because the seventh nerve is also responsible for the tongue’s sensation of taste, some children with Bell’s palsy will say that food has no flavor. They may be unable to drink without dripping and their speech may be slurred. Seeing these problems, parents may worry that their child is having a stroke.
There is no known, specific cause for Bell’s palsy, but it is believed to be the facial nerve’s reaction to inflammation, most likely a viral infection. Herpes simplex virus, which causes lip and mouth sores, may be a likely culprit, as well as varicella, the chickenpox virus. Rarely, Bell’s palsy occurs with Lyme disease. The bacterium Borrelia burgdorferi causes Lyme disease and deer ticks transmit it when they bite.
Your pediatrician or neurology subspecialist can diagnose Bell’s palsy by physical examination alone. A head or facial CT or MRI scan is not necessary. A blood test for Lyme disease should be performed. Some doctors do viral studies looking for signs of recent infection.
Because the cause of Bell’s palsy is not known, there is also no specific treatment. Some experts recommend several days of oral corticosteroids (prednisone), beginning within the first 24 to 48 hours of paralysis, in order to reduce the swelling and inflammation of the facial nerve.
Other experts suggest a seven to 10 day course of an oral antiviral medication, such as acyclovir, for a possible direct viral infection of the facial nerve. But nearly all patients with Bell’s palsy recover complete or nearly complete function of the facial nerve and facial muscles without medication. Drastic surgical measures to “decompress” the facial nerve in the ear canal are not recommended.
In many cases, Bell’s palsy is present two to six weeks or longer before the paralysis begins to resolve. Your daughter is likely to be upset by her facial appearance during this time, and she will need the support and understanding of her family and friends, as well as her doctor.
Reassure her that the facial muscle weakness is temporary, although it seems as if it will never go away. Suggest a straw for drinking on the normal side of her mouth. Eye drops (artificial tears) will be helpful for her eye, which will be dry because she won’t be able to blink or close it completely. Her doctor may suggest an eye patch at night to keep her eyelids closed while she sleeps.
More than 90 percent of Bell’s palsy patients have a very good recovery, and recurrences are fortunately quite rare. Stay in close contact with your daughter’s doctor during these difficult weeks, so she receives the support she needs and so her recovery can be monitored and maximized.
Tags: children, corticosteroids, stress