Should we use steroids to treat children with Bell's palsy?

QUESTION: A healthy 6-year-old boy came to my office with severe Bell's palsy that had lasted for 24 hours following an upper respiratory tract infection he had had a little over a week ago. Should I treat him with steroids?

ANSWER: While there is currently no definitive answer, the risk that Bell's palsy will become permanent seems exceptionally small in children (even smaller than in adults), and the best evidence demonstrates no benefit from steroids. Until a large randomized controlled trial can prove benefit, these patients should not be treated with steroids. The vast majority will recover fully without treatment.