From the Guidelines
Facial and neck motor tics in a child are typically part of a tic disorder, which may include transient tic disorder or Tourette syndrome, as stated in the most recent guidelines 1. These involuntary, sudden movements often involve eye blinking, facial grimacing, head jerking, or shoulder shrugging. The causes of these tics can be attributed to various factors, including genetic predisposition, brain chemistry, and environmental factors. According to the Diagnostic and Statistical Manual of Mental Disorders IV, tic disorders are divided into three main diagnoses: transient tic disorder, chronic motor or vocal tic disorder, and Tourette disorder 1.
Key Points to Consider
- Transient tic disorder is a common pediatric condition with a prevalence of 4 to 24% in elementary school children, and it is usually self-limited, lasting for 1 year 1.
- Chronic motor or vocal tic disorder lasts for 1 year, and its prevalence is not known, while Tourette syndrome has a prevalence of about 5 to 30 per 10,000 children 1.
- The diagnosis of a habit cough or psychogenic cough is a diagnosis of exclusion, and other conditions such as upper airway cough syndrome, transient tic disorder, chronic vocal tic disorder, and Tourette syndrome must be ruled out 1.
- The American Academy of Child and Adolescent Psychiatry recommends that a trial of a stimulant could be undertaken in children with comorbid ADHD and tic disorder, with proper informed consent, and if tics worsen markedly, the physician would move to an alternative stimulant 1.
Management and Treatment
- For mild tics that don't interfere with daily functioning, education and reassurance are recommended without medication.
- If tics cause significant distress or impairment, first-line medications include alpha-2 adrenergic agonists like guanfacine or clonidine, which take 2-4 weeks to show effect and have fewer side effects than antipsychotics 1.
- Behavioral therapy, particularly Comprehensive Behavioral Intervention for Tics (CBIT), is also effective in managing tics.
- Parents should maintain a supportive environment, avoid drawing attention to tics, manage stress, and ensure adequate sleep as tics often worsen with anxiety, fatigue, and excitement.
- Most childhood tics improve or resolve by late adolescence, though some may persist into adulthood, as stated in the guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.