Pediatric Facial Nerve Palsy: A Narrative Review of Etiology, Diagnosis, and Management

Abstract

Facial nerve palsy (FNP) in children is an uncommon but clinically relevant neurological condition with a broad and age-dependent etiological spectrum. In contrast to adults, pediatric patients present distinct diagnostic challenges related to limited cooperation, subtle clinical signs, and differences in underlying causes, particularly in neonates and young children. These factors may complicate early assessment, severity grading, and management decisions. This narrative review summarizes current evidence on pediatric FNP, focusing on age-related diagnostic considerations, etiological evaluation, severity grading, and evidence-based management. Bell’s palsy represents the most frequent cause of FNP in older children and is generally associated with a favorable prognosis. Accurate differentiation between partial and complete facial palsy at presentation is essential, as severity is a key prognostic factor and guides follow-up intensity and diagnostic workup. Routine neuroimaging and extensive investigations are not required in children with typical, isolated facial palsy and partial weakness, while targeted diagnostic evaluation should be reserved for atypical presentations, complete paralysis, associated neurological deficits, or lack of early clinical improvement. Corticosteroid therapy may be considered in moderate to severe cases of Bell’s palsy when initiated early, whereas routine antiviral treatment and surgical interventions are not supported by current pediatric evidence. Most children experience spontaneous recovery, and rehabilitation strategies should be individualized. An age-specific, severity-based, and etiology-driven approach is essential for optimal management of pediatric FNP, helping to avoid unnecessary investigations and overtreatment while ensuring appropriate follow-up and care.