Dear Editor,

Bell's palsy is an acute lower motor neuron paralysis or weakness of facial musculature. Recent evidence-based reviews have reported acyclovir to be ineffective in terms of recovery of function in Bell's palsy, whereas corticosteroids conferred significant benefit in adults.[1, 2] Paediatric treatment data are very limited, with only one small randomised trial on steroid use which was not placebo controlled.[3] Studies often describe outcome in terms of motor recovery, but Bell's palsy has also been shown to have important functional and psychosocial effects in adults while nerve function is impaired.[4] There are no previous data on the psychosocial effects of Bell's palsy in children. We set out to assess the use of steroids at an Australian centre and determine the emotional impact of Bell's palsy on children and their parents.

In a prospective observational study, we identified children with Bell's palsy presenting to the emergency department at Royal Children's Hospital, Melbourne. We assessed demographics and steroid use. Patients were followed up by phone at 6 months to assess recovery and whether there was a negative emotional impact, embarrassment, or change in societal attitude towards the child or parent.

Twenty-nine children were diagnosed with Bell's palsy over the 17-month study period. Mean age was 8.5 ± 5.3 years (range 5.3 months to 16.8 years). Median time from symptom onset to ED presentation was 3 days (interquartile range of 1 to 6.5 days). All had lower motor neuron facial weakness; 21% also described headache, and 14% had subjective facial sensory disturbance or dysarthria. Twelve (36%) were prescribed corticosteroids. Twenty-six families (90%) were contactable by phone following presentation; 69% reported complete and 31% partial recovery. Some recovery of motor function was observed within a mean of 26.5 days (range 1 day to 5 months). Twenty-one of 26 parents (81%) and 19 of 21 verbal children (90%) reported being distressed, and 9 children (43%) were embarrassed by their condition. Problems included embarrassment (2 parents, 9 children), noticing a change in people's attitude (2 parents, 9 children) and being treated differently because of the children's condition (2 parents, 4 children).

While treatment with steroids is well supported by evidence in adults,[2] only a minority of children with Bell's palsy in this series were treated in this manner. Bell's palsy has unrecognised emotional impacts on children and parents. A placebo-controlled RCT is warranted to address the utility of corticosteroids in children.


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