Tics In Children: Causes, Symptoms And Treatment Methods

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Nat was staring at the teacher and continuously blinking her right eye. Her teacher just thought she was being silly and didn’t pay much attention. Another time, the teacher saw Nat constantly grimacing at another student. This time, she was worried as that was not normal behavior for Nat, who is usually friendly and polite with everyone in the class.

Nat was not silly or rude. She had a repetitive muscle-spasm or movement, also referred to as the Tic syndrome. Here, MomJunction explains twitches and tics in children, why they happen and how they can be treated.

What Are Tics?

Tics are involuntary muscle or vocal spasms that are sudden, repetitive, and last for a specific duration. Tics usually occur in children under 18 years, and studies reveal that 20% of school-going children are affected by it (1).

The severity of tics varies from one child to another.

Tics increase in severity when the child is around 11-12 years old and decrease during adolescence. These do disappear eventually, but in some cases, the child experiences them in adulthood as well (2).

Comorbidities are common among children who suffer from tics Children with tics may also have attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), separation anxiety disorder or learning disorders.

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Symptoms Of Tics

The frequency, intensity, and duration of the spasm or tic may vary from one person to another. The symptoms may also vary between simple tics and complex tics.

Simple tics are short-term and could be either vocal or motor. Simple vocal tics in children could be:

  • Sighing
  • Coughing
  • Grunting
  • Other vocal sounds such as hooting or shouting

Simple motor tics could include:

  • Blinking
  • Nose twitching
  • Shoulder shrugging
  • Head jerking
  • Jaw movements

[ Read: Muscular Dystrophy In Children ]

Complex tics last longer and are often a combination of multiple tics. Complex vocal tics could involve repetitive use of words or phrases that have no relevance to the conversation. The child may repeat his or her own words or repeat something said by another person. These words may be spoken in a specific manner or just grunted in between.

Complex motor tics could be a combination of blinking, head jerking, and shoulder shrugging in a specific order. They could also involve evident physical movements such as jumping, hopping, or an obscene gesture, and could seem like a deliberate or voluntary action. In some cases, complex motor tics in children could just be an imitation of another person’s actions.

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Causes Of Transient Tic Disorder:

There is no known cause of tics in children. Studies suggest that there could be more than one contributing factor. Researchers believe that a combination of environmental and biological factors can develop the tic syndrome in a child. Environmental factors such as allergens, chemicals in cleaning products and even exposure to violence in movies or video games can trigger a tic (

Some researchers suggest that tic disorder in children is genetic, while others suggest that abnormalities in the brain or with the neurotransmitters could result in a tic syndrome. Tic syndromes could also be the result of certain medical conditions such as stroke, toxins in the body, head trauma, surgery or infection, but these are uncommon.

Neurodegenerative conditions such as Huntington’s disease, neuroacanthocytosis and Creutzfeldt-Jakob could also contribute to development of tics in kids.

Tic syndrome in children could also develop if:

  • there were complications during his birth
  • the mother had consumed alcohol or smoked during pregnancy
  • The child’s birth weight was low
  • The child had group A ß-hemolytic streptococcal (“strep”) infection (this is still being studied)

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Diagnosis of tics is not easy, as a few symptoms such as nose twitching, sniffing, or throat clearing could also occur due to an allergic reaction. Diagnosis of tics begins with a complete physical and neurological evaluation, followed by a study of the child’s medical history to determine if an underlying medical condition is causing the tics.

During the diagnosis, doctors would check for:

  1. Age when the tic symptoms have manifested; ideally it must be before the child turns 18
  2. Severity of tics
  3. Duration of tics
  4. Type of tics: vocal or motor

[ Read: Anxiety Disorders In Children ]

If the child has had short-term vocal or motor tics for at least a month but less than a year, it is transient tic syndrome. If the tics are vocal or motor and are more long-lasting, and persist for a year or more, it is chronic tic disorder. Tics are often confused with Tourette syndrome, which is the persistence of both motor and vocal spasms or tics for at least one year (3).

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Tics usually do not require treatment unless they affect the child’s everyday activities or are very severe. Treatment options for tic syndromes could include:

1. Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is one of the best treatments and most recommended options for tic disorders. Psychologists use a form of CBT called habit reversal training that focuses on the emotion preceding a tic. Once the events or situations that may trigger the tic are identified, the therapist helps the child learn a less visible motor reaction.

For instance, facial tics in children such as nose twitching or blinking, the therapist may help replace that with a less obvious one such as deep breathing or closing the eyes for a few seconds. Behavioral therapy may also help in reducing the frequency of the tics through breathing and relaxation techniques.

2. Medication

Depending on the reason behind the tic, the doctor may prescribe:

  • Neuroleptics or antipsychotics such as pimozide, risperidone, and aripiprazole are the main medicines for tics in children (4). They work on altering the chemicals that control the motor abilities. However, they may have side-effects such as blurred vision, weight gain, constipation, and dry mouth.
  • Clonidine helps minimize the symptoms of tics as well as ADHD.
  • Botulinum toxin helps in relaxing specific muscles and in preventing tics. The effect of this medication, however, lasts only for three months.
  • Clonazepam also alters the production of chemicals in the brain to reduce the severity and frequency of tics.

Note that these are prescription medications and come with a few side-effects. So speak to your doctor to determine what’s best for your child. It must be noted that very few simple tics that is not due to an underlying condition ever need medication as the potential side-effects usually outweigh the benefit.

[ Read: OCD In Children ]

3. Treatment of underlying medical condition

If the diagnosis reveals that tics are a result of an underlying condition, treatment of that condition will help eliminate tics in children.

Besides these, there are a few homeopathic remedies. However, Where possible, the trigger must be identified and removed or minimized.

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Home Care And Management Of Tics

In most cases, you can manage the tic syndrome without any medication or treatment. Remember that tics are involuntary or no-fault neurological symptoms, which means that the child is not doing them on purpose. A little bit of care on how you react to the tics can go a long way in minimizing the problem or even preventing it.

Here are a few home care tips to deal with tics in children.

  • Stress and anxiety are perhaps the most common triggers of tics in a kid. So try to keep the child in a stress-free environment.
  • Sometimes, tics could indicate a food allergy. . If indicated, then et your kid tested for food allergy and avoid dairy, foods with artificial colors, flavors or preservatives, processed foods, corn syrups, and other gluten foods for a while. Discuss this with your healthcare provider first.
  • Ensure that the child rests well in the night. They should get at least ten hours of sleep.
  • If the tics are not severe, ignore them. Paying too much attention to it can stress out the child, and make it worse.
  • Tics can be embarrassing. Reassuring the child that nothing is wrong with them can help reduce the frequency of tics.
  • A study found that 72% of children having ADHD had a magnesium deficiency (5). Given the link between ADHD and tic syndrome, giving the child magnesium-rich foods and supplements can be a good idea.

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[ Read: How To Manage Stress In Children ]

A healthy diet, lifestyle, and a positive environment can help the child stay healthy and relaxed, which can minimize tics and also aid in their treatment. Tics can be frustrating, especially because they are involuntary and present themselves at the worst of times. The best way to handle them is to stay calm and let the child be stress-free about it. Also, make a note of the events before the tics manifest. This will help you identify the triggers, which make treating the tics or preventing them easy.

In general, if the tic does not bother your child, then it shouldn’t bother you. Your child’s healthcare provider will just have to rule out other causes to be safe.

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Dr. Ritika Shah

Dr. Ritika Shah is a dental surgeon with more than seven years of clinical experience across various cities in India. During her clinical practice, pediatric dentistry was her particular area of interest, and she constantly thrived to inculcate the latest advancements in the field of dentistry into her practice. Dr. Shah's deep interest in the well-being of babies and children made her take up writing. In addition to dental-related topics, she writes on the general health and well-being of children. A first-time mother to a nine-month-old, Dr. Shah understands the struggles and joys of parenting. In addition to research-backed evidence, she tries to include her own experiences and that makes her articles personalized for the readers. In her free time, she takes up gardening, driving, and playing strategy board games.

Dr. Wayne Hough

(MBChB, MMed, FC Paeds)
Dr. Wayne Hough is a pediatrician currently based in the Northern Suburbs of Cape Town in South Africa. He got his medical degree from the University of Stellenbosch. He then worked at the Tygerberg Children's Hospital before completing his pediatric training and qualification from the South African College of Medicine. Dr. Hough also holds a MMed degree in pediatrics from... more