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:


  • 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)


  • 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]


  • 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 [17]:
“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.”

Post a comment

Leave a Comment