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The initial optimal assessment of the neonate born with unilateral facial paralysis should be performed as soon after birth as possible by a multidisciplinary team with the goal being to distinguish between a traumatic or developmental etiology. Electrophysiologic studies, particularly ENOG testing, are essential for this differentiation; radiologic and audiologic studies are of potential diagnostic benefit. In children determined to have a unilateral facial paralysis of developmental origin, subsequent clinical exams complemented by electrophysiologic testing facilitate prognosis. Unfortunately, in the majority of developmental etiology cases, the likelihood of spontaneous improvement is negligible. In these children, reanimation procedures will need to be considered with limited information in the current literature to dictate the optimal age of such surgical intervention.