Why Has One Side of My Child’s Face Suddenly Dropped? A Parent’s Guide to Facial Palsy
Perhaps you first notice it while your child is eating breakfast.
Their smile looks different.
One corner of the mouth does not move as well as the other.
Perhaps they cannot puff out one cheek properly.
Or you notice something even more unexpected:
One eye does not completely close when they blink.
For a parent, suddenly seeing one side of a child’s face move differently can be frightening.
You may immediately search:
“Why is my child’s face drooping?”
“Can children get Bell’s palsy?”
or
“Is this coming from the ear?”
One possible explanation is facial nerve palsy.
Bell’s palsy is one type of facial palsy, but don't assume every child with a suddenly uneven face has Bell’s palsy.
New facial weakness in a child needs prompt medical assessment.
Current NHS guidance advises urgent medical assessment for symptoms suggestive of Bell’s palsy because treatment, where appropriate, is more useful when started early. nhs.uk
What is facial palsy?
Our facial expressions are controlled mainly by the facial nerve, also called the seventh cranial nerve.
Each side has one facial nerve.
The nerve controls muscles that help your child:
- smile
- raise the eyebrow
- close the eyelid
- wrinkle the nose
- move the lips
- keep food and drink inside the mouth.
It also has functions related to taste and other structures around the ear and face.
If one facial nerve is not working normally, the muscles on that side may become weak.
That is facial palsy.
Oxford University Hospitals NHS Foundation Trust describes facial palsy as weakness of the facial muscles following temporary or permanent impairment of the facial nerve. Oxford University Hospitals
What does facial palsy look like in a child?
The appearance varies according to the degree of weakness.
Parents may notice:
an uneven smile
one corner of the mouth drooping
difficulty closing one eye
a flatter forehead on one side
difficulty raising one eyebrow
dribbling from one side of the mouth
or
difficulty keeping food inside the cheek.
Some children also experience pain around the ear, altered taste, a dry or watering eye or increased sensitivity to loud sounds. Paediatric NHS guidance lists these among the recognised features of facial nerve palsy. Leeds Teaching Hospitals NHS Trust
What is Bell’s palsy?
Bell’s palsy is facial nerve weakness where another specific cause has not been identified.
It usually affects one side of the face.
The weakness typically develops relatively quickly—over hours or a few days rather than gradually over many months. nhs.uk
Children can develop Bell’s palsy, although facial weakness in a child needs proper assessment before that diagnosis.
In other words:
Bell’s palsy is a diagnosis of exclusion—not simply another name for every drooping face.
Can children really get Bell’s palsy?
Yes.
Bell’s palsy occurs in children and adults.
The reassuring point is that recovery in children is often very good.
A Leeds Teaching Hospitals paediatric information resource, reviewed in June 2025, states that around 95% of children with Bell’s palsy make a full recovery within 12 months, often much earlier. Leeds Teaching Hospitals NHS Trust
That figure should not be interpreted as a guarantee for an individual child because prognosis depends partly on the cause and severity of the facial weakness.
Why does Bell’s palsy happen?
The exact reason is not always known.
The facial nerve becomes temporarily dysfunctional, likely due to inflammation or swelling around the nerve.
But when a clinician assesses a child, the important question is not simply:
“Could this be Bell’s palsy?”
It is also:
“Is there another reason for this facial weakness?”
That is why examination matters.
What else can cause facial weakness in a child?
There are several possibilities.
These include facial nerve problems associated with:
- infections
- ear disease
- trauma
- inflammation
- congenital facial weakness
- neurological conditions
- other much less common disorders.
The NHS describes Bell’s palsy as the most common cause of facial paralysis overall but emphasises that there are other forms of facial palsy. nhs.uk
A clinician therefore looks at the whole picture rather than diagnosing from the smile alone.
Can an ear problem affect the facial nerve?
Yes, although this is uncommon.
The facial nerve travels through the temporal bone very close to structures within the ear.
Certain significant ear diseases can therefore affect facial nerve function.
For example, the NHS lists facial nerve damage among the possible complications of Cholesteatoma. nhs.uk
This does not mean that an ordinary childhood ear infection will usually cause facial weakness.
It means that facial weakness combined with significant ear symptoms deserves careful assessment.
What if my child has facial weakness and ear discharge?
A child with new facial weakness plus:
persistent ear discharge
significant ear pain
hearing change
swelling around the ear
or a history of significant chronic ear disease
needs prompt medical assessment.
Do not assume that the facial weakness is simply an unrelated Bell’s palsy.
The ear should be examined.
Why can’t my child close one eye?
The facial nerve powers the muscles that close the eyelids.
If those muscles become weak, the child may be able to open the eye normally but not fully close it.
This matters because blinking protects the surface of the eye.
If the eyelid cannot close properly, tears may not spread normally across the cornea.
The eye can become:
dry • sore • red • irritated
and, in more significant cases, the cornea can be damaged.
Eye protection is therefore one of the most important early aspects of facial-palsy care.
Paediatric NHS guidance specifically emphasises protecting the affected eye when closure is incomplete. Leeds Teaching Hospitals NHS Trust
What should parents do about the eye?
If your child cannot completely close one eye, seek medical advice promptly.
Treatment may include lubricating eye drops or ointment, and clinicians may advise ways to protect the eye during sleep.
Do not improvise by tightly taping the eyelid without being shown how to do this appropriately.
If the eye becomes painful, increasingly red, very light-sensitive or vision seems affected, the child needs urgent eye assessment.
Does Bell’s palsy need steroids?
Steroids may be considered when Bell’s palsy is diagnosed, and treatment can be started early.
The NHS advises that treatment is more effective when started within 72 hours of symptom onset. nhs.uk
Paediatric NHS resources similarly describe prednisolone as a treatment that may be considered when symptoms have started within the previous three days. Leeds Teaching Hospitals NHS Trust
However, the clinician assessing the child should make treatment decisions.
Parents should not use leftover steroid medication at home.
The diagnosis needs to be considered first.
Will my child need antiviral medication?
Sometimes antiviral treatment may be considered depending on the clinical circumstances.
Parents should not decide this themselves.
The more important step is getting a new facial palsy assessed promptly so clinicians can decide whether time-sensitive treatment is appropriate.
Will my child need a scan?
Not every child with a typical facial palsy requires a scan.
Bell’s palsy is primarily a clinical diagnosis after considering other causes.
Further investigations may become appropriate if the presentation is unusual—for example:
gradual rather than sudden weakness
recurrent facial palsy
weakness on both sides
other neurological signs
significant ear disease
or failure to recover as expected.
Paediatric NHS guidance describes additional investigation when recovery does not progress as expected. Barnsley Hospital
Why might my child say sounds are suddenly too loud?
The facial nerve has a small branch involved with a tiny muscle inside the middle ear.
When facial nerve function is affected, some children can develop unusual sensitivity to sound on the affected side.
Both Leeds and Barnsley paediatric guidance list difficulty tolerating loud sounds among possible facial-palsy symptoms. Leeds Teaching Hospitals NHS Trust
This is different from the broader childhood hyperacusis discussed in yesterday’s article because here the sound sensitivity appears as part of an acute facial nerve problem.
Can facial palsy affect eating?
Yes.
Weakness around the lips and cheek can make it harder to:
keep liquids inside the mouth
move food around the cheek
chew efficiently
or articulate certain speech sounds.
Food may collect between the cheek and teeth on the weaker side.
Paediatric guidance therefore recommends paying attention to oral hygiene and clearing food debris after meals. Leeds Teaching Hospitals NHS Trust
If your child is unable to eat or drink safely or is becoming dehydrated, seek medical advice.
Should my child do facial exercises?
Parents understandably want to “exercise” the weak side immediately.
However, management should be individualised.
Gentle facial movement may be advised during recovery, and specialist facial rehabilitation can be valuable for selected patients. Leeds paediatric guidance describes gentle exercises as movement returns, while specialist facial-palsy services use multidisciplinary rehabilitation where appropriate. Oxford University Hospitals
Avoid aggressive or repetitive exercises without professional guidance.
How quickly will Bell’s palsy improve?
Recovery varies.
Some children begin improving within weeks.
Others take longer.
The general prognosis for childhood Bell’s palsy is reassuring, but recovery should be monitored rather than assumed.
If there is no improvement, the weakness is worsening, new symptoms develop, or the diagnosis remains uncertain, the child should be reassessed.
Is a drooping face in a child ever an emergency?
Yes.
This is the most important safety section.
A new drooping face should not automatically be labelled Bell’s palsy at home.
The NHS advises calling 999 when facial drooping occurs together with inability to raise both arms normally or difficulty speaking, because these can indicate a serious neurological emergency. nhs.uk
Although stroke is much less common in children than adults, sudden neurological symptoms in a child still require emergency assessment.
Call 999 for facial weakness accompanied by:
- weakness of an arm or leg
- new significant difficulty speaking
- collapse or reduced consciousness
- seizure
- sudden severe neurological symptoms.
Seek prompt medical assessment for new isolated facial weakness as well, particularly because treatment for Bell’s palsy may be time-sensitive.
When else should parents seek urgent help?
Seek urgent assessment if facial weakness occurs with:
- severe headache
- persistent vomiting
- significant balance difficulty
- severe ear pain or discharge
- swelling behind or around the ear
- significant hearing deterioration
- a painful or damaged-looking eye
- inability to close the eye
- recent significant head injury
- rapidly worsening weakness
- weakness affecting more than the face.
The appropriate urgency depends on the accompanying symptoms, but a newly asymmetric face in a child should not simply be watched for several days without advice.
Facial palsy in children across London and Essex
A useful parent rule is:
NEW UNEVEN SMILE → get it assessed promptly
EYE WON’T CLOSE → eye protection matters
EAR SYMPTOMS + FACIAL WEAKNESS → ear examination matters
ARM/LEG WEAKNESS OR MAJOR SPEECH CHANGE → 999
Mr Gaurav Kumar, Consultant ENT Surgeon, assesses children with ear, facial-nerve and other paediatric ENT problems across London, East London, Romford, Ilford, Redbridge, Woodford, Brentwood, Chelmsford and surrounding areas of Essex.
However, a new facial palsy should first be assessed through the appropriate urgent healthcare pathway rather than waiting for a routine ENT appointment.
The key message for parents
Seeing one side of your child’s face suddenly become weak can be alarming.
Bell’s palsy is one possible cause, and the outlook for children is often very good.
But Bell’s palsy should not be self-diagnosed.
New facial weakness needs prompt assessment because other causes need to be considered and treatment may be time-sensitive.
And remember the eye:
If your child cannot close it properly, protecting the eye surface is an immediate priority.
Frequently asked questions
Disclaimer: This information is intended for general educational and regional SEO purposes only and does not replace personalised clinical advice. For a definitive structural evaluation, you need a face-to-face consultation with a registered specialist.
Call 07494914140
