From the November 2018 issue

When Tics in Children Are Signs of Typical Development

Many children develop tics, such as compulsive throat-clearing or nose-twitching. Find out if you should let them slide or call them out.

Tics in children

It can be worrisome to notice your child making repetitive noises or involuntary jerky movements. You may be thinking the worst, minutes away from driving to the hospital to see what’s going on. But your child is probably just experiencing a tic.

Tics are fairly common, says Dr. Stefani Hines, M.D., a developmental-behavioral pediatrician and medical director at the Beaumont Children’s Center for Human Development in Royal Oak. In fact, 25 percent of all children experience them, usually beginning around preschool age.

What is a tic?

Tics are separated into two categories: motor and vocal. Motor tics have to do with the muscles, whether in the face or the body, while vocal tics are associated with noises made by the mouth or nose.

Common motor tics include shoulder-shrugging, eye-blinking, a nose twitch or opening the mouth. Vocal tics can include sniffing, throat-clearing or grunting. Complex tics, meanwhile, are things like flicking of the wrists, leg-kicking or abdominal-tensing.

The tic that involves involuntary swearing, called coprolalia, is very rare, Hines notes. It’s most often associated with Tourette syndrome, a neurological disorder characterized by vocal or motor tics that last longer than a year.

Why they start

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Tics can be hereditary or can begin during times of anxiety, excitement or frustration.

“Tics can change characteristics over time,” Hines points out. “Eye-blinking can turn into a shoulder shrug,” for example.

Fortunately, most tics are transient and will last less than a month. But be mindful of a “waxing and waning” period, Hines adds, in which a child may experience several tics for a period of time before they calm down for a while.

How to respond

Many parents feel the urge to step in and even ask their child to stop their motor or vocal tics. This isn’t necessarily the best route, though. “Tics bother parents more than they bother the children,” Hines says.

If your child is preschool-age, just let it go, she advises. With older kids, consider bringing it up gently with something like, “I noticed you’re blinking your eyes a lot. Are you stressed out or excited?”

“The more that they are aware, the more they can work on it and bring it under control,” Hines explains.

When to seek help

There’s usually no need to call your child’s pediatrician about tics right away. But if your child’s tics are interfering with their ability to function at home or school, it’s time to seek help. A child could have trouble eating due to an involuntary wrist-flicking tic, for example, or teasing due to tics could damage a child’s self-esteem or interfere with concentration at school.

Also watch for signs that a tic is affecting your child’s physical health, like a tense neck or sore eye muscles, Hines says.

If tics continue for longer than a month or two, consider an evaluation to check for tic disorders. These are very treatable, Hines says, with primary treatments including cognitive behavioral intervention therapy or medications. With the right treatment, kids will be able to recognize their tics, find out what triggers them and learn to keep them under control.

But remember that sometimes, a tic is just a tic, Hines emphasizes. “Let it be if the child isn’t bothered.”

Illustration by Brent Mossner

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