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Facial paralysis: why it occurs in newborn children, and how it should be treated

Posted: 11/08/2022

This article is the next in the series covering topics relating to birth injuries. The previous article was on Erb’s palsy.

What is facial paralysis?

Facial paralysis means nerve damage that causes loss of movement in the face. It has many causes, but this summary focuses on facial paralysis in newborn children, when the nerves that control the facial muscles are inflamed or damaged during birth. It is also known as ‘facial palsy’ and one of the primary causes is birth trauma. This results in an inability to move the muscles of the face on one or both sides. The condition may present immediately after birth, and in many cases the paralysis will only be temporary. However, in more serious situations, the paralysis can be permanent.

There are three different kinds of facial nerve injury ranging from the least serious (first degree) to the most serious (third degree) injuries:

  • First degree injury – this occurs when the facial nerve is only bruised. The average recovery period for this type of injury is eight weeks.
  • Second degree injury – this occurs when the facial nerve is more seriously injured but still retains its outer layer. The nerve will slowly repair itself at a rate of around one millimetre per day and will show first signs of recovery at about four months.
  • Third degree injury – this occurs when the facial nerve is most severely damaged, and recovery is always incomplete. Sometimes the nerve is completely severed and requires surgical repair to restore facial function.

What causes facial paralysis?

If a baby is in the incorrect position prior to delivery, it is common practice for the medical team delivering the baby to use forceps to help. Although most babies delivered by forceps have no long term problems, in rare cases the forceps can cause an injury to the facial nerve.

Facial paralysis from birth trauma can also be caused as a result of:

  • large baby size.
  • long pregnancy or labour.
  • use of epidural anaesthesia.
  • induced labour.

Facial paralysis can happen despite the best efforts of the medical team assisting with the baby’s delivery. However, it can sometimes occur as a result of medical negligence, such as when forceps are used incorrectly and cause avoidable damage.

How is facial paralysis diagnosed?

Some of the symptoms of facial paralysis may appear immediately after birth, such as blinking on the affected side, drooping of the mouth and uncontrollable drooling. Other symptoms may present themselves in the hours following birth, such as difficulty feeding, problems with cooing and crying and sound sensitivity on the affected side. The most common form of facial paralysis only affects the lower part of the facial nerve and therefore it is mostly commonly diagnosed when the infant is crying.

A doctor would usually conduct a simple physical exam to diagnose the condition. In rare cases, a nerve conduction test (NCV) is needed which can ascertain the exact location of the nerve injury.

Treatment options

Most cases of facial paralysis are only temporary, and the child will be closely monitored to ensure that the paralysis goes away on its own. Sometimes an eye pad and eyedrops are used to protect the eye if the paralysis is preventing the eyelid from closing all the way. Doctors use a ‘wait and see’ approach and if there is little or no improvement, they will explore other options such as surgery and/or physiotherapy.

For the more serious forms of facial paralysis, often surgery is required to relieve pressure on the nerve. This surgery can include muscle transfer and/or nerve grafting. A common surgery to correct newborn facial paralysis is a cross facial nerve graft, where the nerve is crossed from the normal side to the affected side.

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