Best practices for managing children's nervous tics

For most kids tics are a temporary thing, and they're also essentially out of their control.
Let's talk about tics. Not the crawling, creepy ticks that suck your blood, but the kind that involve twitchy muscle movements, like eye blinking, or little squeaks or clearing of the throat.

Tics are very common and may occur briefly and subtly for some, but can be more persistent and pronounced for others. For most, tics are first noticed between the ages 4 and 12 and they affect boys four times more often than girls. They're also more common in kids who tend to be a bit more anxious or "Type A" — more Felix Unger types than Oscar Madison.

Often, the tic movement or sound follows a sensation or irritant: dry eyes leading to frequent blinking, dry lips leading to lip licking or a grimace, tight muscles leading to shoulder shrugging, an itchy nose causing a rabbit-like nose scrunching or post-nasal drip leading to a recurrent throat clearing or cough.

Tics can vary considerably in quality and severity from simple motor movements or simple vocalizations, to complex clusters of movements and sounds, such as twirling when walking, contorting the face, hopping or repeating one's own words multiple times. However, unlike what Bill Murray, aka Bob Wiley, depicts in What About Bob?, very few individuals with Tourette's syndrome demonstrate "coprolalia," a symptom where they are unable to control their use of profanity.

For most kids, these sounds and movements last less than a year, often less than a few months, and are considered "provisional tics." Less often, the tics can persist longer than a year, and for a rare few (between one and eight cases per 1,000 kids) tics can persist for more than a year and involve both motor movements and a vocal sound — these individuals meet the criteria for Tourette's syndrome.

Tics tend to drive parents and teachers crazy, but the more the parent or teacher encourages the child not to make the movement or sound, the more frequently they seem to do so: That's because stress and anxiety tend to result in more tics. Sleep deprivation also definitely drives more tics.

Usually tics can be temporarily suppressed, only to happen more than ever once allowed to freely occur. Like an itch that needs to be scratched, if the tension builds it can become very uncomfortable for the individual if they can't address the sensation and make the movement or sound that brings them relief.

With that in mind, here are a few tips for dealing with tics:

1. Focus on relieving underlying tension and stressors that may be exacerbating tics, especially sleep deprivation.

2. Learning to relax and distract from too much focus are usually very helpful.

3. Try not to encourage suppression of tics. Let them let it out — the tension that typically builds with suppression can be far more debilitating than the tics.

4. Consider seeking treatment for any underlying exacerbating factors, such as dry eyes, post-nasal drip, muscle tension, etc. Although they are not the sole cause of the tic, they may drive sensations that worsen the tics.

5. If tics are upsetting to the child, impairing function in learning or relationships, associated with significant anxiety, obsessive or compulsive tendencies, difficulties with focus or attention or associated with other neurological or behavioral changes, a visit to the primary care office is appropriate.

The best advice is often to give those with tics a break. For most kids tics are a temporary thing, and they're also essentially out of their control. Drawing attention to them just makes it worse.

Dr. Matt Thompson is a pediatrician at the Kids Clinic in Spokane.

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