A school-age child with a recent URI develops unilateral facial sagging; cannot close eye or mouth on affected side but no limb weakness; management?

A school-age child with a recent URI develops unilateral facial sagging; cannot close eye or mouth on affected side but no limb weakness; management?

• A. Initiate a short course of antibiotic therapy.
• B. Prescribe oral prednisone 1 mg/kg/day initially.
• C. Diagnostic testing to rule out serious causes.
• D. Prepare the parents for lifelong complications.

Answer: (B)

Unilateral facial nerve palsy after a recent URI in a school-age child, with an inability to close the eye or mouth on the affected side and no limb weakness, is most consistent with acute peripheral facial nerve palsy (Bell’s palsy). The best initial management is to start corticosteroids promptly to reduce inflammation of the facial nerve as it travels through the facial canal; prednisone at about 1 mg/kg per day is standard and has the strongest evidence for improving recovery when begun early. In addition, protect the affected eye to prevent corneal injury—use lubricating drops during the day and ointment at night, possibly with an eye shield. Routine diagnostic testing or imaging isn’t needed in an otherwise healthy child with classic Bell’s palsy unless red flags appear (such as bilateral involvement, vesicular rash suggesting Ramsay Hunt, or signs pointing to a central or infectious process). Antibiotics aren’t indicated here, and most children recover fully, so lifelong complications are unlikely.

Unilateral facial nerve palsy after a recent URI in a school-age child, with an inability to close the eye or mouth on the affected side and no limb weakness, is most consistent with acute peripheral facial nerve palsy (Bell’s palsy). The best initial management is to start corticosteroids promptly to reduce inflammation of the facial nerve as it travels through the facial canal; prednisone at about 1 mg/kg per day is standard and has the strongest evidence for improving recovery when begun early. In addition, protect the affected eye to prevent corneal injury—use lubricating drops during the day and ointment at night, possibly with an eye shield. Routine diagnostic testing or imaging isn’t needed in an otherwise healthy child with classic Bell’s palsy unless red flags appear (such as bilateral involvement, vesicular rash suggesting Ramsay Hunt, or signs pointing to a central or infectious process). Antibiotics aren’t indicated here, and most children recover fully, so lifelong complications are unlikely.