Dealing with a preschooler’s nervous tics

Every time my son, Ari, scratched his nose I cringed. At five, he had somehow developed a nose-scratching nervous tic. He scratched his nose obsessively, to the point that the skin turned thin and pink. If he didn’t stop soon, I feared he’d reach the bone.

It was both alarming and painful to watch. Why was he doing this? Why couldn’t he stop? The more I thought about it, I realized that Ari wasn’t the only one. I clearly remember my brother twitching his nose like a bunny when he was little.

As it turns out, tics are very common. “Twenty percent of school-aged kids have tics,” says Dr. Sandra Mendlowitz, a psychologist in the anxiety disorders program at Toronto’s Sick Kids Hospital and an assistant professor of child psychiatry at the University of Toronto.

“Some researchers say it is as high as 25 percent, and we know it is more common in boys than girls,” she says. Reported in kids as young as two, tics are most common between ages seven and nine. Occasionally kids 12 and older get them.

There are different types of tics. Most common are motor tics – the jerking of the shoulders, a hand, eye blinking, a facial grimace or a head twitch. These jerky movements are repetitive and can be very difficult to control. Tics can also be vocal, in which a child may shout, cough, or make throat-clearing sounds.

“Nobody knows what causes it, but we know that anxiety and stress can exacerbate tics or play a role in it,” says Dr. Mendlowitz.

What would a preschooler be anxious about, I wondered? “Leaving mom and dad, not understanding what’s going on, not doing things right,” suggests Dr. Mendlowitz. “If a child is shy he or she can be anxious. Although most anxious children do not have tics, I’ve seen quite a few five-year-olds who do.”

With anxiety-related tic issues, it may become more noticeable when a child enters school. “Kids are away from their parents, a teacher is constantly observing them, and they are in more situations where they have to perform. This can cause stress in kids who are a bit rigid,” Dr. Mendlowitz says.

Hunger, lack of sleep and certain types of medication can play a role. “Keep kids on a regular routine of healthy foods and make sure they get enough sleep. Preschoolers need 11 to 12 hours a night,” she says.

Tics often go away or disappear on their own – especially when developed at a young age. The concern is when a tic lasts longer than a year. “Then they are called chronic,” says Dr. Mendlowitz. “Transient tics go away, but they might be present or worsen with anxiety and sleep deprivation.” When tics persist, it could indicate Tourette’s syndrome, says Dr. Mendlowitz.

What to do

• If you’re concerned, see your family doctor.
• There are treatments, such as the “competing response,” method that can be taught to block the tic or prevent the child from engaging in the tic. For instance, if the tic involves a cough or throat clearing, the therapist would teach the child to identify the urge associated with the cough. When the urge to cough was noticed, the child could engage in some deep breathing to block the tic.
• Don’t yell or demand your child stop the tic, says Dr. Mendlowitz. “This can cause tics to increase. They aren’t doing it on purpose, so you can’t punish them.”
• If the tic is worsened by anxiety, deal with the underlying cause. With the help of a child psychologist, that’s what we did. Ari’s tic disappeared within a couple of weeks, and the skin on his nose has finally grown back.

Originally published in ParentsCanada magazine, April 2015.