Why Has My Child Suddenly Developed a Tic?
Written by Kate Shore
The sudden onset of tics in children can be a confusing and concerning experience for parents. Tics, characterised by sudden, repetitive movements or sounds, can vary in intensity and duration, adding to the uncertainty surrounding their emergence. While conditions like Tourette's and Functional Neurological Disorder (FND) include tics, research shows that various infections and traumas can also cause an immune reaction leading to tics, as seen in conditions like PANS. Understanding why these tics appear, potential triggers and how to support your child is crucial for their wellbeing.
What Are Tics?
First of all, it is important to be clear on what exactly is a tic. Tics are fast, repetitive muscle movements that manifest as sudden and challenging-to-control body twitches, jolts or sounds. These sudden and involuntary movements or sounds are performed repeatedly, and kids with tics cannot stop their bodies from doing these things. While they often improve with time, they can be a source of frustration that disrupts everyday activities.
Commonly affecting school-aged children, tics often start in early primary school years. Approximately one in eight school-aged children experience tics temporarily, known as provisional tic disorder, whereas chronic tic disorder, lasting more than a year, occurs in about one in 100 children (1). Although tics can be more troublesome around the ages of 10 to 12, they typically show improvement in the later teenage years or early adulthood.
Types of Tics
There are many different types of tics, that can be categorised in a couple of different ways:
Motor Tics
Eye tics such as blinking or eye rolling
Facial grimacing or mouth movements
Other sudden facial tics such as nose twitching
Head tics or jerking
Shoulder shrugging
Physical tics and full body movement
Muscle spasms
Vocal Tics
Throat clearing and other throat noises
Grunting
Sniffing
Coughing
Coprolalia - involuntary outburst of obscene or socially inappropriate words
Palilallia - involuntary repetition of syllables, words, or phrases
Tics can also be categorised by the type of movement and complexity of the tic.
Simple Tics: Simple tics are those that involve a single muscle group or sound, such as:
Blinking
Throat clearing
Shoulder shrugging
Motor Tics: Involves coordinated movements or a sequence of sounds, often with different parts of the body.
Shrugging, while moving the head and then lifting an arm
Jumping or repeating words/phrases
Full body tics
What Causes Tics in Children?
While science is always learning more about what part of the brain causes tics, the understanding is that the areas involved include a part of the brain known as the basal ganglia and its related wiring. This wiring involves the structures in the brain that control a range of cognitive, motor and emotional functions (2). The basal ganglia also play a key role in suppressing unwanted thoughts, actions and emotions It is also understood that an excess of dopamine within these areas leads to the activation of these circuits, producing tics (3).
Several conditions can include the presence of tics with the most common being Tourettes and Functional Neurological Disorder (FND). Still, each condition has distinct differences, such as age of onset and relapsing and remitting pattern. It is important to see an experienced practitioner including your GP and refer to a neurologist if appropriate, for a full case history and testing to consider all potential causes, as different conditions will require different treatment approaches.
Sudden Onset
But what about sudden onset tics and those tics that fall outside the typical Tourette’s or FND diagnosis? For parents with children whose tics started overnight, or had a sudden development following a high fever or a period of illness it can be surprising and confusing. What causes sudden onset of tics in otherwise healthy children?
Recent research shows that various infections and traumas can trigger an immune reaction that results in the sudden onset of tics in children (4). This response can lead to ongoing dysregulated immune function that results in neurological inflammation and the development of neuropsychiatric symptoms like tics (5).
Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS), and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) are two such examples of this dysregulated immune function. These relatively unknown, yet increasingly recognised conditions, refer to a set of neuropsychiatric symptoms in children such as tics, obsessive-compulsive behaviours, and other emotional, behavioural, and cognitive issues. PANDAS, specifically, is linked to the onset of these symptoms following a streptococcal infection. Initially identified by Susan Swedo in the late 1990s, the early research primarily focused on the relationship with strep infections, however, current understanding indicates that this brain inflammation in PANS can stem from various other triggers beyond strep infection (6, 7)
What Can Trigger Tics?
Infectious Triggers
Strep Throat (8)
Viral Infection
Other bacterial infections
Non-Infectious Triggers
Traumatic Brain Injury (TBI)
Head injuries can affect the brain's functioning and contribute to the development of tics.
Emotional stress and trauma (6)
Environmental triggers
Disruption to the oral microbiome
Worsening tics with dental work, orthodontics or oral dysbiosis
Associated Behavioral Symptoms
Some children with a sudden onset of tics also experience other symptoms that were not typical previously (13):
Deterioration in school performance
Regression or sudden deterioration in handwriting
Bedwetting or increased need for urination
Mood swings or depression
Irritability, aggression or oppositional behaviours
Behavioural or developmental regression
When to Worry About Childhood Tics
Tics are not usually serious, and they do not cause damage to the brain, which can be reassuring for many parents to learn. If they are mild, and not causing problems you don’t necessarily need to get support, and they can sometimes go away all on their own.
Seek the advice of your GP or a trusted health practitioner if you are concerned about your child’s tics or they are:
occurring more regularly
interfering with daily activities
becoming more severe
painful
causing embarrassment, or other emotional or social problems
Treatment and Testing
Diagnostic Testing
Accurate diagnosis is important for creating a successful treatment plan, as there are many possible reasons for the development of tics. Usually, diagnosis involves seeing a GP or a neurologist, who might request various tests like neurological exams, blood tests, and imaging to determine the cause.
Medication
In some cases, medication may be recommended to manage the type and severity of tics. However, it's important to engage in thorough discussions with healthcare professionals to tailor a treatment plan that best suits the individual needs of the child.
Where there is an infection involved, like in PANS, treatment focuses on anti-inflammatory and immune-modulating therapies, in addition to psychotropic and cognitive-behavioural support. Antibiotics may be recommended if there is a clear bacterial infection, or to prevent future exacerbations (6).
Naturopathic Approach
The naturopathic approach to treating sudden tics in kids involves:
Addressing symptoms with nutritional and antimicrobial interventions to reduce neuroinflammation
Supporting the gut-brain connection and neurotransmitter function
Eliminating the source of inflammation with targeted antimicrobial support
Decreasing immune dysregulation by supporting the interplay between the intestinal microbiome, gut barrier, and immune cells located in the gut environment
Working with the child’s broader healthcare team, such as psychologists, pediatricians, and neurologists, to ensure a comprehensive and coordinated treatment approach.
After getting a detailed history, each child receives a personalised treatment plan. This plan considers things like antioxidant levels, potential for nutritional deficiencies, immune resilience, neurotransmitter function, and gut health. Useful tests often include microbiome testing and nutrigenomic assessment.
It is also important to identify and determine what makes tics worse for each child. This may include looking into nutritional deficiencies, stress, illness, and infection as potential triggers, to effectively reduce these triggers and minimise the frequency of tic flares. Gaining an understanding of these triggers, and creating a trigger checklist, helps manage tics and recognise their come and go patterns.
Navigating your child's sudden tics can be challenging and overwhelming for any parent. Understanding the condition and seeking professional help can greatly support your child's overall well-being. It's essential to consult healthcare professionals who can provide personalised advice and treatment options that are specifically tailored to your child's unique needs. By gaining a deeper understanding of the various types of tics and their underlying causes, you can effectively manage their impact and enhance your child's quality of life.
Disclaimer: This article is for educational purposes and does not constitute individual health advice. It is important to seek the advice of a practitioner to assess what is right for your child. If you have questions, speak with your primary health care practitioner or book a free chat here.
More about Kate Shore - Paediatric Naturopath:
Kate Shore is a paediatric naturopath with an interest and clinical focus on gut health, behaviour, and mental health. Kate received her Bachelor of Health Science from Torrens University and has established her practice in North Warrandyte, Melbourne, where she sees clients both locally and all over the world. Her approach draws heavily on supporting the gut brain axis via nutrigenomics, microbiome testing, nutritional foundations, and lifestyle support. She works with a range conditions, from anxiety and depression, ADHD and ASD, OCD tic disorders, and PANS/PANDAS.
If you want to get in touch or have any more questions about the above, you are welcome to get in contact here or make an time for a free chat here.
If you want to keep learning, keep reading the research here:
Eapen, V. & Usherwood, T. (2022) ‘Assessing tics in children’, BMJ [Preprint]. doi:10.1136/bmj-2021-069346
Lamanna, J. et al. (2023) ‘The dysfunctional mechanisms throwing tics: Structural and functional changes in tourette syndrome’, Behavioral Sciences, 13(8), p. 668 doi: 10.3390/bs13080668
Leisman, G. & Sheldon, D. (2022) ‘Tics and emotions’, Brain Sciences, 12(2), p. 242. doi:10.3390/brainsci12020242 doi: 10.3390/brainsci12020242
L. Krause, D. (2012) ‘The relationship between Tourette’s syndrome and infections’, The Open Neurology Journal, 6(1), pp. 124–128. doi:10.2174/1874205x01206010124
Martino, D., Johnson, I. & Leckman, J.F. (2020) ‘What does immunology have to do with normal brain development and the pathophysiology underlying Tourette syndrome and related neuropsychiatric disorders?’, Frontiers in Neurology, 11. doi:10.3389/fneur.2020.567407.
Gagliano, A. et al. (2023) ‘Pediatric acute-onset neuropsychiatric syndrome: Current perspectives’, Neuropsychiatric Disease and Treatment, Volume 19, pp. 1221–1250. doi:10.2147/ndt.s362202.
Swedo, S., Rose, N. & Leckman, J. (2012) ‘From research subgroup to clinical syndrome: Modifying the pandas criteria to describe pans (pediatric acute-onset neuropsychiatric syndrome)’, Pediatrics & Therapeutics, 02(02). doi:10.4172/2161-0665.1000113.
Mell, L.K., Davis, R.L. & Owens, D. (2005) ‘Association between streptococcal infection and obsessive-compulsive disorder, Tourette’s syndrome, and tic disorder’, Pediatrics, 116(1), pp. 56–60. doi:10.1542/peds.2004-2058
Tsai, C.-S. et al. (2016) ‘Association of TIC disorders and enterovirus infection’, Medicine, 95(15). doi:10.1097/md.0000000000003347
Riedel, M. et al. (1998) ‘Lyme disease presenting as Tourette’s syndrome’, The Lancet, 351(9100), pp. 418–419. doi:10.1016/s0140-6736(05)78357-4.
Delaney, S.L., Murray, L.A. & Fallon, B.A. (2022) ‘Neuropsychiatric symptoms and tick-borne diseases’, Microorganisms and Mental Health, pp. 279–302. doi:10.1007/7854_2022_406.
Moore, K. (2018) ‘N-acetyl cysteine and curcumin in pediatric acute-onset neuropsychiatric syndrome’, Journal of Child and Adolescent Psychopharmacology, 28(4), pp. 293–294. doi:10.1089/cap.2017.0165
Chang, K. et al. (2015) ‘Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): Recommendations from the 2013 pans consensus conference’, Journal of Child and Adolescent Psychopharmacology, 25(1), pp. 3–13. doi:10.1089/cap.2014.0084