Facial Nerve Damage at Birth
The short answer
Facial nerve palsy in a newborn causes one side of the face to droop or not move as well, especially noticeable when the baby cries. It can result from pressure on the nerve during delivery (from forceps or passage through the birth canal) or, rarely, from developmental causes. Most cases from birth pressure resolve completely within a few weeks to months.
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By Age
What to expect by age
Facial nerve palsy is typically noticed at birth or soon after when the baby cries and one side of the face does not move symmetrically. On the affected side, the forehead may not wrinkle, the eye may not close completely, and the mouth may droop. If caused by pressure during delivery, the prognosis is excellent, with most cases resolving within 2-3 weeks as the nerve recovers from compression. If the eye does not close fully, protecting the eye with lubricating drops or ointment may be recommended to prevent drying.
Most pressure-related facial nerve palsies have resolved or are improving significantly by this time. If there is no improvement by 4-6 weeks, further evaluation may be warranted to determine whether the injury is more severe. Developmental (congenital) facial nerve palsy, which is present from birth but not caused by delivery trauma, may not improve and may require specialist evaluation.
Nearly all delivery-related facial nerve palsies have resolved by this time. If facial asymmetry persists, your pediatrician may refer to a pediatric neurologist or ENT specialist. Congenital facial palsy may require different management depending on the underlying cause.
Persistent facial nerve palsy at this age is likely either congenital or the result of more severe nerve injury. Specialist evaluation can determine whether any intervention would be beneficial.
What Should You Do?
When to take action
- Mild facial asymmetry only visible during crying that gradually improves over weeks
- Baby can close both eyes and feed without difficulty
- Progressive improvement in facial movement over the first few weeks
- You notice your baby's face looks asymmetric, especially during crying
- One eye does not seem to close fully
- There is no improvement in facial movement after 3-4 weeks
- The affected eye cannot close and appears dry or irritated, requiring immediate eye protection
- Facial palsy appears alongside other neurological symptoms such as difficulty swallowing, poor feeding, or limb weakness
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
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Related Medical Concerns
Bruising From Forceps Delivery
Red marks or bruising on a baby's face or head from forceps delivery are common and temporary. These marks are caused by pressure from the forceps blades during delivery and typically fade within a few days to 2 weeks. They do not cause lasting marks or scars and do not affect brain development.
Erb's Palsy (Brachial Plexus Birth Injury)
A brachial plexus injury (Erb's palsy) occurs when the nerves controlling the arm are stretched during delivery, most often during shoulder dystocia. The affected arm may appear limp or have limited movement. The good news is that 80-90% of cases resolve within the first 3-6 months with conservative management and physical therapy.
Bruising After Difficult Delivery
Bruising from delivery is common, especially after difficult or prolonged labors, vacuum-assisted deliveries, or forceps deliveries. The bruising typically appears on the face, scalp, or body and resolves on its own within 1-2 weeks. Birth-related bruising can contribute to newborn jaundice as the blood breaks down, so your baby's bilirubin levels may be monitored.
My Baby's Head Shape Looks Abnormal
Many babies develop temporary head shape irregularities that are completely normal. A cone-shaped head from vaginal delivery reshapes within days. Mild positional flattening (plagiocephaly) from sleeping on the back is very common and usually improves with repositioning and tummy time. However, head shape changes involving ridges, a persistently bulging fontanelle, or rapid head growth changes should be evaluated to rule out craniosynostosis.
Achondroplasia (Dwarfism) in Babies
Achondroplasia is the most common form of short-limbed dwarfism, affecting about 1 in 15,000 to 40,000 births. It is caused by a mutation in the FGFR3 gene and is usually apparent at birth with characteristic features including short limbs, a larger head, and a prominent forehead. Intelligence is normal. With monitoring for specific complications and supportive care, children with achondroplasia lead full, active, and independent lives.
Adenoid Hypertrophy and Breathing
Adenoids are lymphoid tissue located behind the nose that help fight infection in young children. When adenoids become enlarged (adenoid hypertrophy), they can block the nasal airway, causing chronic mouth breathing, snoring, nasal speech, and sleep-disordered breathing. Enlarged adenoids are most common between ages 2-7 and are a leading cause of obstructive sleep apnea in young children. Treatment ranges from watchful waiting and nasal steroids to surgical removal (adenoidectomy) if breathing or sleep is significantly affected.