Purpose <p>To evaluate the prognostic significance of inflammatory markers, computed tomography (CT)-based facial nerve measurements, and clinical parameters in pediatric patients with Bell’s palsy.</p> Methods <p>In this retrospective study, 136 patients aged 4–18 years diagnosed with Bell’s palsy were evaluated. Clinical data included age, sex, affected side, initial House-Brackmann (HB) grade, recovery grades at one month and final follow-up, presence of pain, and treatment timing. Inflammatory markers—mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein-to-albumin ratio (CAR)— were calculated from laboratory data obtained at admission. Facial nerve-to-facial canal (FN/FC) ratios were measured via CT in five regions. The control group included 70 age-matched children with normal CT scans obtained for non-specific complaints such as headache. Recovery was categorized as full (HB 1), partial (improved but not grade 1), or poor.</p> Results <p>Initial HB grade was significantly correlated with both one-month (<i>r</i> = 0.67, <i>p</i> &lt; 0.001) and final recovery (<i>r</i> = 0.33, <i>p</i> &lt; 0.001). CAR was weakly correlated with one-month recovery (<i>r</i> = 0.224, <i>p</i> = 0.0089) but not long-term outcome. MPV, NLR, and PLR showed no significant prognostic value. FN/FC ratios were significantly higher in the labyrinthine, geniculate, and tympanic regions on the paralyzed side compared to both the control group and non-paralyzed side. However, no correlations were found between FN/FC ratios and recovery. A moderate correlation was observed between initial HB grade and tympanic FN/FC ratio (<i>r</i> = 0.321, <i>p</i> = 0.001).</p> Conclusion <p>Initial clinical severity best predicts recovery in pediatric Bell’s palsy. Inflammatory and radiologic parameters offer limited prognostic value and warrant cautious interpretation.</p>