One page summary: Facial nerve palsy in newborns

In two sentences

Facial nerve palsy means the nerve that moves one side of the face is not working. The affected side does not move when the baby cries, so the mouth pulls to the unaffected side and the eye on the affected side may not close. ¹

Most newborn facial palsy comes from pressure on the nerve during birth, and most recovers completely within weeks. The urgent job while it recovers is protecting the eye, because an eye that will not close dries out and can be damaged. ¹

The numbers, with their sources

• What is affected. The facial nerve, the seventh cranial nerve, which controls the muscles of facial expression on one side ¹
• The usual cause after birth. Pressure on the nerve where it passes near the surface in front of the ear, from the maternal pelvis or from forceps ²
• The usual course. Most cases from pressure recover completely, typically within days to a few weeks ¹
• The most urgent care. Protecting the eye on the affected side with lubricating drops or ointment and, where advised, taping it closed for sleep ¹
• The key distinction. A nerve compressed during birth recovers. A facial nerve or muscle that did not develop does not, and it is managed differently ¹
• The clue on examination. In a pressure injury the forehead is usually affected too. Where the forehead still moves, the problem is more likely to be in the brain than in the nerve itself ¹

What to do this week

1. Ask exactly how to protect the eye, and get the drops and ointment before discharge.
2. Ask whether the forehead moves on the affected side. It changes what this is.
3. Ask whether feeding is being assessed.
4. Ask what recovery should look like and by when, so you know if it is off track.
5. If forceps were used, ask where they were placed and how many attempts. Request the operative note.
6. Report eye redness, discharge or cloudiness the same day.
7. Book a re-evaluation at around 3 months if recovery has not started.

Questions to take with you

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the pediatrician or neonatologist

• Does the forehead move on that side?
• Is the whole side affected, or only the lower lip?
• How do I protect the eye, and what should I watch for?
• What recovery should I expect, and by when?
• What happens if it has not improved by 3 months?

For the obstetric team

• Were forceps used, and where were the blades placed?
• How many attempts?
• What was the indication for the assisted delivery?

For the feeding team

• How do we get a better seal for feeding?
• Would a different bottle or position help?
• Is my baby getting enough, and how will we know?

You can also build a printable list with the question generator.

Where to read more

The full page on this condition covers how it happens, causes split into what happens even with perfect care and what is associated with gaps in care, signs by age, diagnosis, treatment, outlook, daily life and lifetime cost.

Read the full page on Facial nerve palsy in newborns

Related pages are listed at the bottom of it, including the events that can lead to this condition and the guides that cover therapy, school and money.