Has your child suddenly developed tics? The causes and course of blinking, sniffing and throat-clearing tics, how parents can help and when to seek advice.
You notice it in the first weeks after the schools open: your seven-year-old son keeps blinking hard, again and again, while watching television. At first you put it down to tiredness, then you think something has got into his eye. A few weeks later the blinking eases, but now he starts sniffing and clearing his throat frequently. The more you say "stop it", the more the movement seems to increase. And when a relative asks during a holiday visit "What's wrong with this child's eyes?", you become even more uneasy. Tics in children are quite common at school age and usually run a harmless course; but understandably, they cause families a great deal of worry. In this article we will look at what a tic is, why it starts, when it tends to fade on its own and how parents should respond during this time.
What Are Tics in Children?
A tic is a sudden, rapid, repetitive, non-rhythmic movement or sound. The child does not "do" it on purpose; a tic is mostly involuntary. Yet it is not entirely involuntary either: somewhat older children can describe feeling a tension, an itch or a sense of "I won't feel settled unless I do it" in their body just before a tic. This feeling is called a premonitory urge. When the tic is performed, the feeling passes briefly, then builds up again.
This feature also explains a common misconception among families. A child can suppress a tic for a while; for example, in front of the teacher or when visiting others the tic is hardly seen at all, and then it increases once they get home. This is interpreted as "so if he wanted to, he wouldn't do it". In reality, suppressing places considerable effort and strain on the child; like holding in a sneeze for a while, sooner or later it comes out.
Tics mostly begin between the ages of five and ten and are more common in boys. A significant proportion of school-age children may have temporary tics for at least one period. So you are not alone, and it may still be too early to conclude that your child has a "disorder".
Types and Signs of Tics in Children
Tics are generally divided into two main groups:
Motor tics (movement tics):
- Eye blinking, squeezing the eyes shut or rolling them upwards
- Wrinkling the nose, grimacing, opening the mouth
- Head shaking, neck jerking, shoulder shrugging
- Tensing the stomach muscles, hand or finger movements
Vocal tics (sound tics):
- Throat clearing, making cough-like sounds
- Sniffing
- Grunting, humming, short yelp-like sounds
- More rarely, repeating words or syllables
Tics can be simple or complex. Simple tics involve a single muscle group and are very brief, such as blinking. Complex tics are made up of several movements in sequence, for example touching an object and then jumping.
The most typical feature of tics is that they change location and form over time. A child who blinks one month shrugs their shoulders the next; throat clearing passes and sniffing takes its place. This variability surprises families, but it is part of the natural course of tics.
Why Do Tics Start? Stress or Neurology?
This is the question families ask most: "Did we cause this? Is my child too stressed?" The short answer is: tics are not born of stress, but they are affected by it.
Tics are thought to be rooted in a developmental and largely biological predisposition related to the brain networks that regulate movement. The fact that they are more common in children with a family history of tics shows that genetic factors play a role. In other words, your child's tic is not the result of a parenting mistake on your part.
Nevertheless, some situations can noticeably increase tics:
- Stress and anxiety: Schools reopening, exam periods, moving house, the birth of a sibling, tension between parents
- Excitement: A birthday, a religious holiday, watching a match or playing a much-loved game; positive excitement can also increase tics
- Tiredness and lack of sleep: Holiday periods with late bedtimes, a heavy timetable
- Long screen time: Especially hours spent with fast-paced, stimulating content
- Drawing attention to the tic: Remarks such as "Are you doing it again?"
When a child concentrates on a task, on the other hand, tics often decrease. You may notice that tics almost disappear while they are building Lego, drawing or playing an instrument. Tics usually stop during sleep too.
When symptoms such as eye blinking or throat clearing first appear, it is important to rule out physical causes. A vision problem, dry eyes or allergic conjunctivitis can cause frequent blinking; allergies, sinusitis or reflux can cause throat clearing. That is why the first step is often an assessment by a paediatrician and, if necessary, an eye doctor.
The Difference Between Provisional Tics and Tourette Syndrome
The word families fear most when searching online is "Tourette". Knowing the distinction can ease this anxiety.
Provisional tic: One or more tics that last less than a year. The great majority of tics in school-age children fall into this group.
Persistent motor or vocal tic: Only motor tics or only vocal tics lasting longer than a year.
Tourette syndrome: Defined by both multiple motor tics and at least one vocal tic lasting longer than a year, even if they wax and wane. The swearing that comes to mind when people hear "Tourette" is in fact a rare symptom; most children diagnosed with Tourette syndrome do not have it.
Making these diagnoses is the job of a specialist; usually an assessment by paediatric neurology or child and adolescent psychiatry is needed. What matters here is that, whatever the tic picture is called, in many children tics decrease markedly with adolescence.
When Do Tics in Children Go Away? Course and Fluctuation
The course of tics is fluctuating. Tics that are very noticeable for weeks suddenly ease; months later they may return in a different form. This fluctuation does not mean treatment has failed or that the condition is getting worse.
A significant proportion of provisional tics fade or disappear completely on their own within a few weeks to a few months. With longer-lasting tics, too, there is usually a peak around the age of ten, followed by a decline through adolescence. In many young adults, tics either disappear completely or become mild enough not to affect daily life.
Let's say an eight-year-old girl develops a throat-clearing tic during a winter when tension at home rises because her older sister is preparing for the LGS (Turkey's national high-school entrance exam). Every time the family hears the sound they say "Are you ill? Drink some water"; the tic increases. After the paediatrician finds no physical cause, the family decides not to comment on the tic at all, to talk about the older sister's exam stress and to make the evenings at home calmer. Within a few months the sound becomes less frequent, and during the summer holidays it is hardly heard at all. When exam season comes round it briefly reappears; this time the family does not panic.
The Family's Approach: What to Do and Not Do When You Notice a Tic
The family's approach plays a very important role in the course of tics. The aim is not to "stop" the tic, but to reduce the tension surrounding it.
Don't comment on the tic
Warnings such as "Don't", "You've started again" or "Stop blinking like that" draw the child's attention to the tic and increase their anxiety. As anxiety increases, so do tics. The most helpful approach is to behave as if the tic were not there; neither criticise it nor watch it closely.
Don't punish, and don't allow teasing
A tic is something outside the child's control; punishment or scolding only creates shame and efforts to hide it. Set a gentle but clear limit on siblings or cousins imitating it, and on relatives' jokes.
Talk to your child in an age-appropriate way
If your child has noticed their tic and is asking about it, you can give a calm explanation: "Sometimes your body makes small movements on its own. It isn't your fault; it happens to lots of children and it usually gets less over time." This explanation stops the child from feeling "weird".
Put a steady daily rhythm in place
Regular sleep, keeping screen time reasonable, time for movement and play during the day and a calm evening routine can indirectly soften the intensity of tics.
Review sources of stress
What has changed in your child's life recently? School, friendships, arguments at home, a busy schedule of courses... The answers to these questions guide you not only on the tic but on your child's overall wellbeing. To recognise anxiety in children, you can also take a look at our article on anxiety in children.
Let the teacher know
If the teacher is aware of the tic, they won't reprimand the child in class and will be more alert to classmates making fun of them. Knowing that tics may increase during tests also helps the teacher approach the child with more understanding.
Manage your own anxiety too
Counting your child's every blink and searching online for new information every evening is a natural parental reaction; but this state of alert is passed on to the child as well. Keeping an observation diary and reviewing the tics only once a week gives both you and your child room to breathe.
A tic is like a brief hiccup of the child's body; the less attention it draws, the more easily it passes.
Tics are different from habit behaviours such as nail biting or hair pulling; however, families often confuse the two. For information about habit behaviours, you can look at our article on nail biting.
When Should You Seek Professional Support?
It is helpful to see a specialist in the following situations:
- If tics last longer than a year, or if both movement and vocal tics are present together
- If tics cause pain, injury or marked difficulty with daily tasks (for example neck pain, or hand movements that make writing difficult)
- If the child is being teased because of tics, does not want to go to school or is withdrawing from friends
- If tics are accompanied by marked attention problems, obsessive thoughts, repetitive checking behaviours or intense anxiety
- If tics started very suddenly and severely, or are accompanied by a rapid change in behaviour
Tics are frequently seen together with attention deficit, obsessive-compulsive symptoms or anxiety. Sometimes what troubles the child most is not the tic itself but these accompanying conditions. That is why an assessment looks at the child as a whole. These signs do not by themselves mean a diagnosis; making a diagnosis requires an assessment by a specialist in paediatric neurology or child and adolescent psychiatry. Only a physician can decide whether medication is needed.
How Are Tics Addressed in Therapy?
With mild and provisional tics, informing the family and changing the approach at home is often enough. If tics are causing the child significant difficulty, behavioural approaches are among the effective options.
One of the most extensively researched methods in this area is the approach known as Comprehensive Behavioural Intervention for Tics (CBIT). At its heart is habit reversal training. The child first learns to notice their tic and the premonitory urge that comes just before it. Then a competing response is practised: a movement that cannot be done at the same time as the tic and is not noticeable from the outside; for example gently pressing the shoulders down for a shoulder-shrugging tic, or breathing slowly through the nose for throat clearing. When the urge comes, the child applies this competing response for a short time and experiences the urge fading on its own. The method is generally suitable for children aged around eight to ten and older; it is important for parents to take part in the process too.
In addition, within the cognitive behavioural approach, we work with the sources of stress and the anxiety that increase tics, and help the child build relaxation and calming skills. With younger children, play therapy helps the child express the shame or anger they feel because of their tics and work through their anxiety through play. For information about this approach, you can visit the child and play therapy page.
Frequently Asked Questions
Are tics caused by the evil eye or by a fright?
Tics stem from a largely biological predisposition related to the brain's regulation of movement. Fear or stress can increase tics, but cannot start them on their own. Rather than pressing the child with questions like "What scared you?", providing a calm environment is more helpful.
Is my child doing the tic on purpose?
No. A child can suppress a tic for a short time, but this does not mean they are doing it deliberately. Suppressing is tiring, and tics usually increase afterwards. That is why the idea that "if he wanted to, he wouldn't do it" is both wrong and unfair to the child.
Will banning screens completely make the tics go away?
Banning screens entirely is usually unnecessary and can create extra tension for the child. However, long screen time with fast, stimulating content has been observed to increase tics in some children. Keeping screen time reasonable and spending the hour before bed screen-free is a balanced approach.
Their sibling has started doing tics too; is it contagious?
Tics are not contagious; but siblings sometimes imitate each other, or may share the same family predisposition. Movements that start through imitation usually fade quickly when they receive no attention. If you think a real tic has started in the sibling too, you can keep up the same calm approach.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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