Follow-up

If no other cause of acute facial paralysis is identified, in the absence of risk factors for underlying malignancy or other causes, the patient may be discharged from the ED with a suitable follow-up plan:

GP

• Ideally, the child should be seen within 3 weeks by their GP or a doctor in the ED for review.
• If, at this stage, there are any signs of progression or any other worrying features have become apparent, then referral to a specialist should be made and arrangements made for further testing (electro/neurophysiology testing).

Follow-up

• If there are signs of recovery by 1 month, routine follow-up at 3, 6 and 9 months is recommended [1]
• Monitoring should be for a minimum of 1 year (risk of missing long term sequelae if not done) [3]

Prognosis

• Examination to determine if paresis (incomplete paralysis) or complete paralysis is present is the most important prognostic test at the outset
• Paresis at onset can be followed up clinically, because prognosis is invariably good
• Further testing is recommended in cases of complete paralysis or if no signs of recovery within 3 weeks of disease onset [1]
• In patients who recover without treatment, major improvement occurs within 3 weeks in most cases. [3]

Natural history of Bell’s palsy in children states that [15]:

“True Bell’s palsy is thought to be more benign, with a tendency toward complete resolution in many cases within 2 months of onset of facial paralysis and by 6 months in most cases.”

Discharge Advice

Discharge advice needs to contain information on worrying features so that parents/patients themselves can return early if such features develop. [9]

Upon discharge, the following should be explained:

• Administer analgesia for pain as needed (paracetamol)
• Child may experience sensitivity to sounds during acute stages
• Child may initially worsen before improving
• Most children recover fully by 6 weeks, although may take up to 1 year
• <10% will get some continuing weakness or the nerve may grow back to the wrong area
• Medical advice should be sought if any concerning symptoms occur

Concerning symptoms

• Red/painful eye
• Progression of weakness after 48 hours
• Different or new symptoms such as:
  • Headache
  • Vomiting
  • Temperature
  • Disturbed vision
  • Weakness
  • Abnormal sensation in another area of the body or head or neck
•  No improvement in facial paralysis after 1 month.