Bell’s Palsy in Children May Be Lyme Disease

Facial palsy may be the only sign
Tick bite and rash are often absent
Testing and treatment vary widely

In a retrospective review of 93 children with idiopathic facial nerve palsy at University Hospital Southampton (2010–2017), investigators found that Lyme disease was a common—and often underrecognized—cause. :contentReference[oaicite:0]{index=0}

Lyme Disease Often Present Without Classic Clues

Very few children reported typical Lyme features:

• Only 14% recalled a tick bite
• Only 5% had a rash

Yet among the 76 children who were tested, 29% were positive for Lyme disease.

These patterns are part of the broader spectrum described in our Lyme disease symptoms guide.

Testing Was Incomplete

Despite increasing awareness of Lyme disease in the region, nearly 1 in 5 children were not tested.

This suggests that Lyme disease may be underdiagnosed in children presenting with Bell’s palsy.

Neuroimaging Findings

Approximately 20% of children underwent neuroimaging.

The most common findings were consistent with inflammation or infection of the facial nerve.

Wide Variation in Treatment

Management differed significantly between patients:

• 73% received antibiotics
• Treatment duration ranged from 1 to 28 days (median: 14 days)
• 44% received corticosteroids (prednisolone)
• 17% were prescribed antiviral medications

Some children received no treatment at all.

Unanswered Clinical Questions

The study did not assess outcomes, but it raises important concerns:

• Does steroid use affect recovery in Lyme-associated facial palsy?
• What are the consequences of delayed or incomplete treatment?
• Are some children at risk for long-term complications?

These uncertainties are explored further in our Lyme disease misdiagnosis guide.

Study Conclusions

• Lyme disease is a significant cause of facial nerve palsy in endemic regions
• Facial palsy may occur without other Lyme symptoms
• Lyme testing should be considered in all children with facial palsy
• Empiric treatment may be appropriate while awaiting results

In endemic areas, Lyme disease should remain a leading consideration in children presenting with Bell’s palsy.

Why This Matters

Failure to recognize Lyme disease as a cause of facial nerve palsy may delay treatment.

Early testing and treatment can improve outcomes and reduce variability in care.

Start here: Lyme disease symptoms guide

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention