Blinking tics in children
Causes, Contributing Factors, and Treatments
What is a facial tic disorder?
Facial tics are uncontrollable spasms in the face, such as rapid eye blinking or nose scrunching. They may also be called mimic spasms. Although facial tics are usually involuntary, they may be suppressed temporarily.
A number of different disorders can cause facial tics. They occur most often in children, but they can affect adults as well. Tics are much more common in boys than in girls.
Facial tics usually don’t indicate a serious medical condition, and most children outgrow them within a few months.
Facial tics are a symptom of several different disorders. The severity and frequency of the tics can help determine which disorder is causing them.
Transient tic disorder
Transient tic disorder is diagnosed when facial tics last for a short period of time. They may occur nearly every day for more than a month but less than a year. They generally resolve without any treatment. This disorder is most common in children and is believed to be a mild form of Tourette syndrome.
People with transient tic disorder tend to experience an overwhelming urge to make a certain movement or sound. Tics may include:
- blinking eyes
- flaring nostrils
- raising eyebrows
- opening the mouth
- clicking the tongue
- clearing the throat
Transient tic disorder doesn’t usually require any treatment.
Chronic motor tic disorder
Chronic motor tic disorder is less common than transient tic disorder, but more common than Tourette syndrome. To be diagnosed with chronic motor tic disorder, you must experience tics for more than a year and for more than 3 months at a time.
Excessive blinking, grimacing, and twitching are common tics associated with chronic motor tic disorder. Unlike transient tic disorder, these tics may occur during sleep.
Children who are diagnosed with chronic motor tic disorder between the ages of 6 and 8 don’t typically require treatment. At that point, the symptoms may be manageable and can even subside on their own.
People who are diagnosed with the disorder later in life may need treatment. The specific treatment will depend on the severity of the tics.
Tourette syndrome, also known as Tourette disorder, typically begins in childhood. On average, it appears at age 7. Children with this disorder may experience spasms in the face, head, and arms.
The tics can intensify and spread to other areas of the body as the disorder progresses. However, the tics usually become less severe in adulthood.
Tics associated with Tourette syndrome include:
- flapping arms
- sticking the tongue out
- shrugging shoulders
- inappropriate touching
- vocalizing of curse words
- obscene gestures
To be diagnosed with Tourette syndrome, you must experience vocal tics in addition to physical tics. Vocal tics include excessive hiccupping, throat clearing, and yelling. Some people may also frequently use expletives or repeat words and phrases.
Tourette syndrome can usually be managed with behavioral treatment. Some cases may also require medication.
Other conditions may result in facial spasms that mimic facial tics. They include:
- hemifacial spasms, which are twitches that affect only one side of the face
- blepharospasms, which affect the eyelids
- facial dystonia, a disorder that leads to involuntary movement of facial muscles
If facial tics start in adulthood, your doctor may suspect hemifacial spasms.
Several factors contribute to facial tic disorders. These factors tend to increase the frequency and severity of tics.
Contributing factors include:
- stimulant medications
- attention deficit hyperactivity disorder (ADHD)
- obsessive-compulsive disorder (OCD)
Your doctor can usually diagnose a facial tic disorder by discussing the symptoms with you. They may also refer you to a mental health professional who can assess your psychological status.
It’s important to rule out physical causes of facial tics. Your doctor may ask about other symptoms to decide whether you need further testing.
They may order an electroencephalogram (EEG) to measure the electrical activity in your brain. This test can help determine whether a seizure disorder is causing your symptoms.
Your doctor might also want to perform an electromyography (EMG), a test that evaluates muscle or nerve problems. This is to check for conditions that cause muscle twitching.
Most facial tic disorders don’t require treatment. If your child develops facial tics, avoid drawing attention to them or scolding them for making involuntary movements or sounds. Help your child understand what tics are so they can explain them to their friends and classmates.
Treatment may be needed if the tics interfere with social interactions, schoolwork, or job performance. Treatment options often don’t completely eliminate tics but help reduce tics. Treatment options can include:
- stress reduction programs
- behavioral therapy, comprehensive behavioral intervention for tics (CBIT)
- dopamine blocker medications
- antipsychotic medications like haloperidol (Haldol), risperidone (Risperdal), aripiprazole (Abilify)
- anticonvulsant topiramate (Topamax)
- alpha-agonists like clonidine and guanfacine
- medications to treat underlying conditions, such as ADHD and OCD
- botulinum toxin (Botox) injections to temporarily paralyze facial muscles
Recent studies have shown that deep brain stimulation may help treat Tourette syndrome. Deep brain stimulation is a surgical procedure that places electrodes in the brain. The electrodes send electrical impulses through the brain to restore the brain circuitry to more normal patterns.
This type of treatment can help relieve symptoms of Tourette syndrome. However, more research is needed to determine the best area of the brain to stimulate for improvement of Tourette syndrome symptoms.
Cannabis-based medications might also be effective in helping reduce tics. However, the evidence to support this is limited. Cannabis-based medications should not be prescribed to children and adolescents, or to pregnant or nursing women.
While facial tics usually aren’t the result of a serious condition, you may need treatment if they interfere with your everyday life. If you’re concerned you may have a facial tic disorder, talk to your doctor about treatment options.
What Makes a Child Tic?
Frequent eye blinking, facial grimacing, shoulder shrugging, sniffling, repetitive throat clearing or uncontrolled vocalization – these are all symptoms of a tic. For a parent, seeing or hearing your child exhibit these unexpected movements or sounds can be extremely worrisome.
There are likely a ton of questions going through your head: Is my child having a seizure? What is causing this? Should I take them to the doctor? Will they have this tic forever?
These questions are completely normal. In fact, pediatric neurologist, Marina Khrizman, D.O. of K. Hovnanian Children’s Hospital, informs that you are not alone in your concerns. “Tics are incredibly common, as many as one in five children have a tic during their school years, and most tics go away on their own in less than a year, usually even shorter,” shares Dr. Khrizman.
Dr. Khrizman provided some of the most common questions parents ask surrounding their child’s tic.
What exactly is a tic?
“Tics are sudden, brief, stereotyped motor movements or vocalizations. Although they are involuntary, children will report what’s called a premonitory ‘urge’ to do the tic, and will feel a release of tension once it is done,” says Dr. Khrizman.
“If the child is able to concentrate on the movement, they may be able to suppress it for a short period of time; however it will have to be released later on. This is why many parents will see these movements after they pick their child up from school,” notes Dr. Khrizman.
Are tics related to Tourette syndrome?
“Most tics will go away on their own – tics that go away in less than a year are known as transient tics, meaning they are only temporary. When a patient has both vocal tics and motor tics for more than a year, that’s identified as Tourette syndrome,” mentions Dr. Khrizman.
What causes a tic? Are there any preventative measures?
“Unfortunately, there is no way to prevent a tic,” Dr. Khrizman says. “Tics typically start to appear around 5 to 10 years of age, and we don’t fully understand the cause. However, it’s believed that there are neurochemical changes in the neurons that produce dopamine and serotonin, impacting several parts of the brain including the thalamus, cerebral cortex and striatum.”
How can I help my child manage his or her tics?
“The best way to manage a tic is to ignore it – more often than not, families are more bothered by the tic than the child themselves,” advises Dr. Khrizman. “When you draw attention to the tic, it can exacerbate the child’s anxiety, and anxiety can make tics worse.”
Dr. Khrizman recommends trying breathing exercises with the child to help reduce anxiety or stress.
Parents should also be aware of the emotional impact this may have on a child’s self-esteem. It’s important to make sure the child feels supported through this, particularly when they are of schooling age. Reassure them that everything is okay, and that there is no need to be self-conscious.
When should I consult a doctor?
Dr. Khrizman advises that parents should always bring up their concerns to their pediatrician, who can further evaluate to determine if the symptom is a tic or something different.
“Tics are usually diagnosed based on the symptoms the parent or the child describes, and a pediatrician will generally be able to identify a tic – usually, no other tests are necessary,” mentions Dr. Khrizman. “If the diagnosis is not clear, the tics start to bother the child, cause pain or significant disruption in learning, we recommend the child be evaluated by a neurologist. Also, if there are any other abnormal movements or concerns on the neurological examination, this is also definitely a reason for further investigation with a neurologist.”
Attention deficit hyperactivity disorder (ADHD), anxiety and obsessive compulsive disorder (OCD) can occur in children who have tics, and specifically those who have Tourette syndrome. “A doctor should certainly be involved at that point because treating those disorders is as important, if not more important, than treating the tics themselves,” shares Dr. Khrizman.
What treatment options are available for my child?
Most of the time, treatment is not necessary. Effective behavioral based and medication options do exist. “We really only consider treatment if the tic is disrupting daily activities, such as causing pain or learning difficulties” says Dr. Khrizman.
“There is a type of therapy called habit reversal therapy which teaches the child how to address the tics. This essentially trains the child to perform a competing response, which can eventually offset the tic movement,” adds Dr. Khrizman.
Next Steps & Resources:
- Meet our clinical contributor: Marina Khrizman, D.O.
- To make an appointment with Dr. Khrizman or a doctor near you, call 800-822-8905 or visit our website.
- Kurlan et al., 2001. Kurlan R., McDermott M.P., Deeley C., Como P.G., Brower C., Eapen S., et al: Prevalence of tics in schoolchildren and association with placement in special education. Neurology 2001; 57: pp. 1383-1388
- Centers for Disease Control and Prevention (CDC)
- National Institute of Neurological Disorders and Stroke (NIH)
- NJ Center for Tourette Syndrome (NJCTS)
The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.
Children's tics: symptoms, causes, treatment
Have you noticed that your child blinks more than usual, twitches his shoulders and coughs? Perhaps these are manifestations of tics. Why they arise and how to treat them correctly, Galina Anatolyevna Zueva, chief pediatric neurologist of the Ministry of Health of the Tver Region, will tell.
What are tics?
Tics are involuntary violent movements that occur in certain muscle groups.
Tics are most common in children aged 4 to 6 years . This is due to the maturation of the subcortical parts of the brain, which most often ends by the age of seven or eight.
If, for some reason, a little more activating (or, conversely, fewer inhibitory) neurons are produced in the child's body than required, and the mode of motor and other load is not observed, then he starts having problems. It can be attention deficit hyperactivity disorder, or sleep disturbances, or tics. nine0003
From the age of three or four, your baby begins to grow very actively and explore the world. In order for the cognitive function to be fast, for it to absorb a large amount of information, and for the brain to mature, the child needs a lot of activating neurotransmitters. He must have time to climb everywhere, jump, look, speak, speak, ask a bunch of questions, understand and assimilate everything he hears. If activating neurotransmitters are used correctly, then the child develops harmoniously: he is smart, but at the same time he can control himself, follow the rules, and show perseverance during kindergarten classes. It's perfectly normal that your child is active, inquisitive, fast. When a baby does not use these neurotransmitters for movement, communication, learning (for example, he sits at home all day, he is not allowed to walk outside), then various problems may arise: hyperactivity syndrome, sleep disturbance, behavior problems.
So, in order for a child to develop properly, he must run a lot, climb, talk, learn about the world around him, experience various emotions. This forms spatial-figurative thinking, motor skills, synchrony of the work of the two hemispheres, develops the brain and at the same time correctly wastes all the developed neurotransmitters of activity. nine0009 At the age of 3-5 years, the child is smart, he quickly switches, but at the same time copes with his tasks: if he needs to sit, he will sit normally, study, do something. This is the standard development of the child, which should be.
Types of tics in children
Most often, children aged 3-6 years have motor and vocal tics.
Motor are movement-related tics: blinking, blinking, squinting, nose twitching, pulling clothes, shouldering, etc. nine0003
Vocal - tics associated with breathing. These are all kinds of huffing, sniffing, coughing, whistling. By the way, a frequent case in my practice: a child coughs for a long time, they take him to the doctors, looking for the cause, but in fact he has a vocal tic, which needs to be treated by a neurologist. It doesn't have to be a tick, but it also happens and needs to be taken into account.
Quite often there are combinations of several ticks. For example, blinking, twitching the corners of the nose and the behavior of the shoulders at the same time. Tics can be more pronounced when certain muscle groups, the so-called segmental tics . There may be a combination of motor and vocal tics - for example, blinking eyes and grunting at the same time. At the same time, he can independently delay the manifestation of a tick for some time (up to several seconds) and repeat it on request. This is the so-called duplication, which is a distinctive feature of tics from other types of obsessive movements - hyperkinesis.
A separate, most complex, case of generalized tics is Tourette's syndrome , when tic manifestations occur in multiple muscle groups, when the same child has several varieties of vocal tics. They are very pronounced and cause great inconvenience to the child. In this case, examination and treatment by a neurologist is strictly required. nine0003
Tics can be transient, i. e. appeared, were observed for some time in the child, and then passed. But if the tics continue for more than a year, then these are already chronic tics , so examination and treatment are required.
Causes of tics in children
As we have already said, this is a lesion of the subcortical formations in the child's brain. It may be due to the peculiarities of the development of the brain or be damaged by some factor.
A sedentary lifestyle is one of the most common triggers for tics. When a child is not active enough, he does not consume all the neurotransmitters of activity. Muscles need to move, but they don't get it. As a result, tics occur. The child must definitely run, and it’s better not along a flat asphalt path, but along a forest path, where you need to crawl under a tree somewhere, run along a log, turn away from the root. All this better forms the nervous system, helps to develop spatial-figurative thinking. Can't go to the forest? In the park, get off the flat path and walk along the dirt path, just dress appropriately so that both you and your baby feel comfortable. nine0009 This is one of the most common mistakes parents make: they spend hours walking in parks, dressed up on paths, but this is of little use. It is much more useful for the child to be closer to nature, to study, to learn. And a lot of emotions that he receives at the same time correctly spend the energy inherent in him. When a child sits at home all day with a tablet, this energy accumulates in him, and then it pours out into fights, disobedience and tics as well.
Particularly susceptible to tics attention-deficit children . Due to illness, they already have a failure in the formation of neurotransmitters, and when we do not allow them to fully use all this energy, various problems appear: headaches, insomnia, tics.
Unfavorable psycho-emotional environment is another common cause of tics in children. For example, if a child really does not like going to kindergarten, which causes negative emotions in him and creates a lot of stress, and parents do not have time to discuss this situation with him, explain it, and agree. In this case, the child's nervousness can also get a side effect in the form of a tick. nine0003
Some difficult situation in the family can also lead to stress , for example, when parents demand high results from a child in all subjects, forming the so-called excellent student syndrome. The kid is afraid not to cope, he has a great responsibility, as a result, neuroses, tics, most often vocal ones, arise. Moreover, they can persist for a long time, manifesting themselves in stressful situations.
A common cause of tics is divergence of views on raising a child in one family . When, for example, parents treat him strictly, and grandparents, on the contrary, indulge all whims. The child ceases to understand how to behave, and this leads to neurosis.
This is all about common tics in children aged 4 to 6 years. But there are also more difficult cases. If tics appear in children older than seven years , then the reason is no longer in the usual maturation of the body, but in some kind of pathology.
This may be a consequence of frequent angina, streptococcus , when an autoimmune process occurs that damages subcortical formations and malfunctions in the form of various tics or hyperkinesis. They must be treated.
Also the cause may be the effects of frequent mononucleosis , this virus also often affects the subcortical nuclei.
There are a number of hereditary diseases that cause tics. They are rare, but nonetheless. For example, diseases associated with a violation of the proper breakdown of copper and iron. Among them is Wilson-Konovalov's disease, in which copper begins to be deposited in the liver and other internal organs, including in the subcortical formations of the brain, and leads to various types of hyperkinesis, tics. These diseases are necessarily excluded in children with tics. nine0003
When should tics be treated in children?
If these are single simple motor tics in a child aged 4 to 6 years, they are rare and do not interfere with the baby's life, then most likely this is due to a slight overabundance of neurotransmitters. Such tics can be left untreated , they will go away on their own in a year or two.
However, if the tics are frequent and prevent the child from concentrating, then, of course, this should be examined and treated .
Pay special attention to tics that appear in a child after 7-8 years . They must be examined and found out the cause of the occurrence.
I must say that tics are well treated . There are a lot of quality products out there now. It is important here that the doctor correctly selects the right medicine and dosage. For the treatment of tics, a special drug regimen is used, the dosage here is slightly higher than usual, but you should not worry about this - the drugs are well tolerated and will not harm the health of the child. Sometimes for chronic tics, medicines are given for the entire school year. nine0003
Prevention of tics in children
Follow these simple guidelines and your child will grow up healthy and happy.
Walk with your child as much as possible. It’s good if he runs not only around the yard or a flat path, but also along earthen paths with some small obstacles. To do this, it is enough to get off the main alley in the park and go to explore the lawns.
Study natural phenomena. Listen to the sounds of nature, teach your child to distinguish them, learn with him the laws of the world around him. All this will not only develop the baby's brain, but also help him use neurotransmitters to good use and cope with stress. nine0003
Play active games with your child. It is normal for a child between the ages of 2 and 5 to spend about 10 hours a day in active movement. Let's say he worked out, drew, then ran in the yard, played with the dog, went down the hill, explored something, met someone on the playground, talked, then rested and ran to play again. Then the neurotransmitters will be spent correctly and the child will not have problems with sleep, or with nervousness, or with behavior. nine0003
Talk to your child. And this is a very important point. Something that many parents often forget about. Meanwhile, it is conversations with the baby that can solve many neurological problems. It is important not only to talk to the child, but also to listen to what he says to you in response. From the age of two, the baby has every right to make some decisions, to choose something - for example, in which T-shirt to go for a walk or what color to take a toy. Give him the opportunity to participate in family life, listen to his opinion. You need to understand that this opinion should be reasoned, that is, not just “I want”, but “I want, because ...” This will not only help you create and maintain a trusting relationship with your child, but also keep him healthy and save him from many behavioral problems. nine0003
Good luck to you and your children!
Nervous tics in children: main causes and treatments
Nervous tics or, as they are commonly called in medicine, tic disorders are common. Transient tics occur in 10-24% of children, and chronic tics in 1.6%. At the same time, they can be both independent and enter the structure of other disorders.
Tics are stereotyped, repetitive movements. Usually first appear in children aged 3-5 years. Tics are characterized by an undulating course: periods of exacerbations, which usually last about 1.5 months, are replaced by periods of remission. nine0003
What can be called tics?
Usually these are simple actions: blinking, blinking, grimacing, neck twitching, shrugging, coughing, hissing, snorting, sniffing and others.
Sometimes, more difficult actions: hitting oneself, jumping on one leg, jumping up and down, repeating one's own words and sounds, shouting curses.
What are the reasons?
Various stress factors (for example, fear) play a certain role in the occurrence of tics. At the same time, positive and negative experiences can lead to increased tics. Although there are other reasons (for example, Gilles de la Tourette's syndrome is genetically determined). nine0003
Parents often associate childhood tics with stress and emotional upheaval. In fact, tics are caused by a change in metabolism (dopamine and norepinephrine) in the subcortical structures of the brain. A person is born with similar predispositions and is often inherited.
Tics are not always stressful. There is not always a connection between the occurrence of tics and the experience of stress. A child can grow up in a prosperous and happy family, but one day, without external reasons, due to the peculiarities of brain development, the mechanism turns on and clinical symptoms appear. nine0003
How is it treated?
Treatment of tics is carried out on an outpatient basis, and it should combine not only drug treatment (depending on the severity of symptoms and many other factors), but also:
- Psychotherapy, including family, behavioral and play.