Facial paralysis in children is a complex condition. It may involve functional issues and always involves esthetic issues. Significant psychosocial problems may arise and family support systems are often necessary. In this brief article the etiology of facial paralysis in children is discussed and the common types described. The philosophical approach to the child and his or her family is emphasized. The timing of surgical intervention is addressed as well as a brief outline of the surgical techniques of cross-face nerve grafting and muscle transplantation. Although these latter procedures have added enormously to our capabilities to deal with this condition, further progress will be necessary through research and clinical ingenuity if we are to restore these children to normality.