Introduction: Classical Guillain-Barré syndrome (GBS) typically presents with progressive ascending motor weakness and areflexia. However, variant forms with predominant cranial nerve involvement without characteristic limb paralysis constitute approximately 5-10% of pediatric GBS cases. Recognition of these atypical presentations is crucial for timely intervention to prevent respiratory compromise. Case presentation: A 10-year-old girl presented with acute-onset muscle pain and fatigue. Neurological examination revealed unilateral left facial nerve palsy with reduced lower extremity reflexes, while motor strength remained intact throughout all muscle groups. The typical ascending weakness pattern was notably absent. Within 48 hours, clinical deterioration occurred with rightsided facial involvement, voice changes, and tongue weakness, indicating bilateral facial and bulbar cranial nerve dysfunction. Non-contrast brain computed tomography showed normal findings. Cerebrospinal fluid analysis demonstrated isolated protein elevation (45 mg/dL) with normal cell count, confirming protein-cell dissociation. Nerve conduction studies revealed acute inflammatory demyelinating polyradiculoneuropathy pattern despite preserved clinical motor function. Intravenous immunoglobulin (2 g/kg over five days) was initiated promptly . Marked clinical improvement occurred within 72 hours, with progressive resolution of cranial nerve deficits and avoidance of respiratory complications. Conclusion: This case illustrates a rare cranial nerve-predominant GBS variant with bilateral facial palsy and bulbar involvement without ascending motor weakness. Early recognition is critical as bulbar dysfunction may rapidly progress to respiratory failure. Nerve conduction abnormalities may precede obvious clinical weakness, requiring high clinical suspicion. Prompt IVIG treatment prevents respiratory compromise in atypical presentations, emphasizing the importance of early recognition in pediatric populations.