Bell's Palsy in Newborn - Hoffer & Sheremet

Bell’s palsy in newborns is a form of facial paralysis caused by injury to the seventh cranial (facial) nerve, which controls facial movements like blinking, smiling, and closing the eyelids. Unlike Bell’s palsy in adults—typically caused by viral inflammation—Bell’s palsy in infants is often related to birth trauma, particularly when excessive force is used during delivery.

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In most cases, newborn Bell’s palsy resolves over time. However, severe nerve damage may result in long-term facial weakness, asymmetry, or other complications that can affect appearance, feeding, speech, and social development.

If your child has facial paralysis after birth, it’s critical to understand what caused the injury, what treatments are available, and whether medical negligence played a role.

How Common is Bell’s Palsy in Newborns?

Bell’s palsy in newborns is relatively rare but well-documented. Studies estimate the incidence of facial nerve injury during delivery to be about 0.5–2 per 1,000 live births, with the majority related to instrument-assisted deliveries (forceps or vacuum extractors) .

While many cases improve on their own, some result in permanent deficits. According to the American Academy of Pediatrics, severe nerve injuries may require surgical evaluation or physical therapy.

Causes of Bell’s Palsy in Newborns

Bell’s palsy in infants typically results from birth trauma—physical injury during delivery. Common causes include:

Instrument-Assisted Delivery
- Forceps: Improper placement or excessive force can compress the facial nerve at the temple or jaw.
- Vacuum Extractors: Can cause soft tissue and nerve damage in the face.
Prolonged or Difficult Labor
- Long labors increase the risk of fetal head compression, especially when the baby is large (macrosomia).
Cephalopelvic Disproportion
- When the mother’s pelvis is too small for the baby’s head, more forceful extraction techniques may be used.
Breech Presentation
- Abnormal fetal positioning can increase the need for traction and manipulation during delivery.
Improper Technique
- Failure to follow standard delivery protocols, delayed decision-making for cesarean section, or misuse of instruments may all contribute.

According to Boston Children’s Hospital, most neonatal facial nerve injuries result from direct pressure on the nerve or stretching during assisted deliveries.

Recognizing Bell’s Palsy in a Newborn

Signs of Bell’s palsy are usually visible shortly after birth. Common symptoms include:

Asymmetrical facial movements – One side of the face does not move when the baby cries.
Flattened nasolabial fold – The fold between the nose and mouth is diminished on one side.
Inability to fully close the eye on the affected side.
Drooping of the mouth – Causing drooling or difficulties with feeding.
Difficulty sucking – May lead to poor feeding or inadequate weight gain.
No forehead wrinkles on the affected side when crying.

In mild cases, symptoms may be subtle and resolve within a few weeks. Severe injuries may cause long-term weakness or require specialized care.

How Is Bell’s Palsy Diagnosed in Infants?

Physical examination is typically sufficient for diagnosis. Pediatricians assess facial symmetry, eye closure, and the baby’s ability to move facial muscles.

If the cause or extent of injury is unclear, additional tests may be ordered:

Electromyography (EMG): Measures electrical activity of facial muscles to assess nerve function.
Imaging (MRI or CT): Used to rule out fractures or other causes of facial paralysis.
Neurology consultation: In severe or complex cases.

Treatment for Bell’s Palsy in Newborns

The treatment approach depends on the severity and cause of the injury.

Observation

Many infants with mild nerve compression recover spontaneously within 2–3 months . During this time, doctors may recommend simple eye protection (such as lubricating drops) to prevent corneal damage if eyelid closure is incomplete.

Physical Therapy

Early facial massage and exercises may help maintain muscle tone and prevent contractures. Pediatric physical therapists can teach parents how to safely stimulate facial muscles.

Surgical Intervention

In rare cases of severe nerve transection or non-recovery, surgical repair or nerve grafting may be necessary. Early evaluation by a pediatric plastic or craniofacial surgeon is critical.

Multidisciplinary Care

Infants with persistent facial paralysis often require a team approach involving:

Pediatric neurologists
Plastic surgeons
Speech and feeding therapists
Ophthalmologists (for eye protection)

Prognosis

The majority of infants with mild Bell’s palsy from birth trauma recover completely within weeks to months .
Prognosis depends on:

Severity of nerve injury (compression vs. transection)
Speed of diagnosis and treatment
Presence of other injuries (e.g., skull fractures, brachial plexus injury)

Children with more severe injuries may experience long-term facial asymmetry, feeding difficulties, or require corrective surgery.

When Bell’s Palsy is Caused by Medical Negligence

Not every case of Bell’s palsy is preventable, but some occur because medical providers fail to meet the standard of care. Examples include:

Improper use of forceps or vacuum extractors
Delaying a necessary C-section
Applying excessive traction or pressure on the baby’s head
Failing to monitor fetal size or positioning
Inadequate response to labor complications

When avoidable mistakes lead to facial nerve damage, families may have a valid medical malpractice claim.

How Hoffer & Sheremet Can Help

At Hoffer & Sheremet, PLC, we specialize in birth injury and medical malpractice cases. If your newborn suffered Bell’s palsy due to delivery trauma, we can:

Investigate medical records to determine whether standard care was followed.
Consult medical experts in obstetrics and neonatology.
Pursue compensation for medical care, therapy, and future needs.
Advocate for your child to ensure they get the support they need.

We handle these cases on a contingency basis—you don’t pay unless we win.

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Frequently Asked Questions

Will my baby recover from Bell’s palsy?
Many infants recover fully, especially if the injury is mild. Severe cases may need surgery or therapy.

How long does recovery take?
Mild cases often resolve within weeks to a few months. Severe injuries may take longer or result in residual weakness.

Can Bell’s palsy be prevented?
Some cases are unavoidable, but careful labor management and appropriate delivery techniques reduce the risk.

Can I file a lawsuit for my baby’s injury?
If improper delivery techniques or delayed interventions caused your baby’s facial paralysis, you may have grounds for a medical malpractice claim.

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