Clinical Reference Systems: Pediatric Advisor 10.0
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Description

• Consist of rapid, repeated muscle twitches, such as eye blinking, facial grimacing, forehead wrinkling, head turning, or shoulder shrugging
• Most tics last only 1 second
• Increase with stress
• Decrease with relaxation and disappear during sleep
• Occur three times more often in males than females.

Causes

The cause of tics has not been clearly established. Genetics and neurochemical differences may play the largest role. Tics can be made worse through the spilling over of emotional tension. They are involuntary, not deliberate. Children who have tics are usually normal, bright, and sensitive.

Expected Course

If tics are ignored, they usually disappear in 2 months to 1 year. If extra effort is made to help your child relax, they usually improve more quickly. Even if the tics are not ignored and a child continues to feel stress or pressure, the tics usually improve or clear spontaneously during adolescence. Approximately 3% of children with tics develop incapacitating tics. They need additional behavior therapy and some require medication.

How to Help Your Child with Tics

1. Help your child relax in general and maintain self-esteem.

   Make sure your child has free time and fun time every day. If your child is overscheduled with activities, try to lighten the commitments. If your child is unduly self-critical, praise him more and remind him to be a good friend to himself.

2. Identify and remove specific environmental stresses.

   Whenever your child has a flurry of tics, write in a diary the date, time, and preceding event. From this diary, you should be able to identify when your child feels pressure. (Note: Your child should not know that you are keeping this diary.)

   In general, criticize your child less about grades, music lessons, sports, keeping his room clean, table manners, and so forth. Avoid stimulant medications (such as decongestants), which can lower the threshold for tics.

3. Ignore tics when they occur.

   When your child is having tics, don't call his attention to them. Reminders imply that they are bothering you. If your child becomes worried about the tics, then every time they occur, the child will react with tension rather than acceptance. The tension in turn will trigger more tics. Don't allow siblings or others to tease your child about the tics. Be sure that relatives, friends, and teachers also ignore the tics. When tics occur, people should focus on reducing any pressure they may be causing your child.

4. Don't talk about tics when they are not occurring.

   Stop all family conversation about tics. The less said about them, the less your child will be apprehensive of them. If your child brings up the subject, say something reassuring, such as "eventually your face muscles will learn to relax and the tics will go away."

Call Your Child's Physician During Office Hours If:

• The tics interfere with friendships or studies at school.
• The tics involve sounds, words, or profanity.
• The tics involve coughing.
• The tics involve parts of the body other than the head, face, or shoulders.
• The tics become frequent (more than 10 each day).
• The tics have lasted for more than a year.
• The tics are not better after trying this program for 1 month.
• You have other questions or concerns.