Facial paralysis (FP) in children is most often idiopathic, however, many diverse and identifiable etiologies exist. Twenty-five cases of children admitted consecutively to the Children's National Medical Center over 8.5 years for the evaluation of FP were reviewed retrospectively. In 21 (84%) of the patients the FP was discovered to be secondary to a specific etiology or associated with a recognizable syndrome. In 7 cases, the FP was an initial manifestation of a serious underlying disorder. Causes of the FP in this series include: otitis media, mastoiditis, temporal lobe abscess, osteopetrosis, both blunt and penetrating trauma, iatrogenic surgical injury, facial burns, cerebellar astrocytoma, leukemia rhabdomyosarcoma, intracerebral arteriovenous malformation, Goldenhar syndrome, and Melkersson-Rosenthal syndrome. Four (16%) patients were diagnosed as having Bell's palsy. Methods of management, including the use of electrodiagnostic testing are described.