723 Bell's Palsy: To Treat or not to Treat

Objective: To audit management of children presenting with Bell's Palsy to a paediatric Emergency Department (ED) in a tertiary referral centre. Methods: Retrospective chart review of children presenting with Bell's palsy from October 2006 to February 2009. Information was gathered on investigations carried out, treatment prescribed, referral to neurology and follow up. Results: In total 46 children presented with Bell's palsy from Oct 06 to Feb 09, F:M, 1.7:1. The median age was 9.29 with an interquartile range of 6.26 - 12.2. Of interest median weight was 39.2Kg which at 9.29 years is > 91st centile for both boys and girls. 16 of 46 (34%) patients received prednisolone. The duration of treatment varied from 3 days to two weeks. Four children received acyclovir. An MRI brain was carried out in seven children. All MRIs were normal. Three children were referred to neurology, in two instances referral was sent for recurrent episodes, the third child had torticollis associated with facial palsy. Follow up telephone contact with 35 of 46 parents revealed that in all of these patients the condition had resolved, including the 3 children referred to neurology. However interestingly 7 parents can still notice slight facial asymmetry particularly when the child is tired. Conclusion: In uncomplicated Bell's Palsy in a child with a normal examination, further investigations are generally not necessary. From our experience steroids and aciclovir are not required for Bell's Palsy in children.