When one side of a child’s face suddenly droops, it’s alarming. This sudden drooping is a sign of facial palsy, which can be caused by Lyme disease or other factors, and determining the cause can be a challenge for doctors. Early Lyme tests often take days and can be falsely negative, leaving clinicians to make initial treatment decisions with limited information. This uncertainty matters because treatment differs: children with Lyme-related facial palsy need antibiotics, while idiopathic cases, facial palsy with no known cause, are often treated with corticosteroids.
To understand real-world treatment patterns, the GLA-supported Pedi Lyme Net collects data across eight pediatric hospitals. In a recent study published in the Journal of Pediatrics, researchers used this network to examine how initial treatment decisions for children with facial palsy vary and how these choices affect recovery.
Among 385 children enrolled from 2015–2023, 38% had Lyme disease and 62% had idiopathic facial palsy. Initial treatments varied, with some children receiving antibiotics, corticosteroids, both, or neither; all eventually received appropriate therapy. Notably, a small proportion of Lyme cases were initially untreated with antibiotics, while many children with idiopathic palsy received antibiotics unnecessarily, highlighting challenges in early diagnosis.
About 70% of children had follow-up visits, and facial palsy resolved in roughly nine weeks on average, regardless of cause. This study is the first to show that recovery time is similar for children with Lyme-related and idiopathic facial palsy, and that corticosteroid use while awaiting Lyme test results does not appear to be harmful. While previous studies in adults have shown mixed results regarding corticosteroid use for Lyme facial palsy, a large clinical trial now underway in Sweden may help clarify best practices for treating children.
The study does have some limitations: not all children returned for follow-up, treatment information came from medical records, and early Lyme tests may have missed some infections. Despite these caveats, the findings offer valuable insights into treatment patterns and recovery, highlighting a central problem: without rapid, accurate Lyme tests, clinicians must make critical treatment decisions in the dark. Improving diagnostics is essential to ensure children receive the right care at the right time, and networks like Pedi Lyme Net provide the evidence needed to guide these decisions.
Reference: Lederer, S. R., Neville, D. N., Balamuth, F., Chapman, L. L., Thompson, A. D., Ladell, M. M., Kharbanda, A. B., Monuteaux, M. C., Nigrovic, L. E., & for Pedi Lyme Net (2025). A Longitudinal Cohort Study of Children with Peripheral Facial Nerve Palsy in Lyme Disease Endemic Areas. The Journal of pediatrics, 289, 114879. Advance online publication. https://doi.org/10.1016/j.jpeds.2025.114879
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