Tics

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KEY POINTS

• Tics are muscle movements or sounds that your child makes without meaning to do so.
• Tics may happen more often when your child is tired, tense, or stressed. Many tics are not harmful and get better on their own.
• Tics that don’t go away can be treated with relaxation techniques or biofeedback.

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What are tics?

Tics are muscle movements or sounds that a child makes without meaning to do so. Tics are hard to stop or control. Some children are able to hold back their tics briefly, but usually not for long. If tics are severe, or happen often, they can affect a child's life in many ways. The tics may go away after a time or children may keep having the tics into adulthood.

There are different kinds of tics.

• Motor tics are brief, rapid movements of the face, hands, or legs that happen over and over.
• Vocal tics can be words, throat clearing, or other sounds that are not made on purpose.

Tics may involve just a single muscle group, such as eye blinking or sticking out the tongue. Or they may include multiple muscle groups in a coordinated movement such as jumping, head shaking, or throwing an object.

Tourette syndrome (TS) is a type of tic disorder that can cause both motor and vocal tics. It usually starts in early childhood and is usually lifelong, though the symptoms may decrease as your child grows older.

What is the cause?

The exact cause of tics is not known. They tend to run in families. Tics may be caused by:

• Caffeine
• Head injury
• Damage to a nerve in the face
• A seizure disorder
• A brain disease, tumor, or stroke
• Carbon monoxide poisoning
• Low birth weight
• Not enough magnesium in the diet
• Pain in the face or teeth
• Some stimulant medicines
• Stress, fatigue, or anxiety

Some tic problems may start or get worse after a strep infection.

Boys are much more likely to have tics than girls. As many as 1 in every 4 children develops a short-term tic. This is fairly common in school-aged children as they adjust to new routines, new schools, and new friendships.

What are the symptoms?

Symptoms may include:

• Eye twitches or very fast eye blinks
• Wrinkling the nose
• Sticking out or biting the tongue
• Shoulder shrugging
• Head jerks
• Kicking
• Grunting, throat clearing, or sniffling

A child may have one type of tic or many different tics. The tic may start in one body part and spread to other body parts. Between tics, your child may have a feeling of relief until he feels the need to have another tic. Children often have trouble paying attention and concentrating because they are distracted by their tics.

How are they diagnosed?

Your child’s healthcare provider will ask about your child’s symptoms and medical history and examine your child. Your child may have tests or scans to check for possible causes of the symptoms, such as a seizure disorder.

How are they treated?

With simple tics, very little treatment may be needed. Typically, a child will have more tics when tense or stressed and fewer tics when asleep, relaxed, or focused on a task. The use of relaxation techniques or biofeedback may help your child deal with stress.

Complex tic disorders may be treated with medicine. Comprehensive Behavioral Intervention for Tics (CBIT), which includes habit reversal training and other therapies, may also help. With habit reversal training, your child does something instead of the tic. The new action should use muscles in a way that makes it impossible to do the old habit. For example, instead of an eye blink tic, your child could very gently close his eyelids and hold them closed for 10 seconds.

How can I help take care of my child?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Take care of your child’s health. Make sure your child eats a healthy diet and gets enough sleep and exercise every day. Teach your child to avoid alcohol, caffeine, nicotine, and drugs.
• Help your child learn to manage stress. Teach your child to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax. For example, your child may take up a hobby, listen to music, play, watch movies, or take walks.
• Never punish or shame a child for tic behaviors. There is very little that your child can do to control or stop the tics. Telling your child to stop does not solve the problem. In fact, it may make tics worse. Don’t make a big deal out of the behavior.

Ask your provider:

• How and when you will get your child’s test results
• If there are activities your child should avoid and when he can return to his normal activities
• How to take care of your child at home

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests.