Tics are rapid, repeated muscle twitches of the head, face, and shoulders. They may include blinking the eyes, wrinkling the forehead, twitching the nose, opening the mouth, sticking out the tongue, licking the lips, "making faces," jerking the head, or shrugging the shoulders. They are also called habit spasms. Tics increase with stress or physical exhaustion, decrease with relaxation, and disappear during sleep. Tics occur in 20% of children, most often between 6 and 10 years of age. They are three times more common in boys than girls.

In most children, simple tics reflect the spilling over of emotional tension. They mean your child is under pressure or overly tired. Tics are involuntary, not deliberate. Since tics tend to cluster in families, there may be some genetic influence. Tics do not indicate an underlying psychological disorder. Children who have tics are usually normal, bright, and sensitive. Tics are more severe in children who are shy, overly self-conscious, or obsessive-compulsive. They can be made worse by nagging, pressing a child for achievement beyond his ability, or drawing negative comparisons with siblings.

If simple tics are ignored, they usually disappear in two months to one year. If extra effort is made to help the child relax, tics usually improve more quickly. Even if the child continues to feel stress or pressure, twitching usually improves or clears spontaneously during adolescence.

Tourette syndrome is a neurological disorder that consists of severe, frequent, multiple tics. These children also make involuntary sounds such as hissing, barking, grunting, and coughing. Tourette syndrome, which occurs in 1 in 3,000 children, should be considered in children with severe tics that last for more than one year.

The solution is to help your child to relax. Tics are a barometer of inner tension. Make sure your child has some free time and fun time every day. If your child becomes over scheduled with activities, lighten the commitments. If your child is unduly self-critical, praise him more and teach him to be a good friend to himself. Remind him that no one is perfect, that we learn from our mistakes, that you still love him when he makes mistakes, and that he needs to forgive himself.

Identify and remove specific environmental stresses. Whenever your child has a flurry of tics, write in a diary the date, time, and circumstances. This diary should help you identify the situations in which your child feels pressure. The diary can also tell you when your child is released from a stressful situation. A child may try to "hold back" tics at school, for example. When this happens, pressure builds up. The pressure is released when the child comes home, and she may display major tic activity at that time. To avoid putting added pressure on your child, do not let her know that you are keeping a diary.

In general, avoid criticizing your child about such things as grades, music lessons, sports, keeping her room clean, and table manners. Do not give her stimulant medications, such as decongestants, or soft drinks with caffeine if these substances increase the frequency of tics.

Ignore tics when they occur. When your child is having tics, don't call his attention to them. Reminders imply that they are bothering you. If your child becomes worried about tics, he'll react with tension rather than acceptance whenever they occur. The tension will trigger more tics. Your child isn't willfully defying you. He just can't help the behavior.

Also, be sure to tell relatives, friends, and teachers to ignore the tics. When tics occur, people should say nothing and reduce any pressure they may be putting on your child. Don't allow siblings or other children to tease your child about the tics. You may also need to teach your child to ignore teasing from insensitive children.

Don't talk about the tics when they are not occurring. Stop all family conversation about tics. The less said about them, the less apprehensive your child will be. If your child brings up the subject, reassure her that she will regain control over her muscles eventually and the tics will go away.

Don't punish your child for having tics. Some parents have the mistaken idea that tics are a bad habit that can be broken. This idea is absolutely false. If a child is made to practice 'controlling tics' in front of a mirror, he will just realize that he cannot control them. Likewise, facial exercises or massage should be discontinued because they only draw undue attention to the problem.

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Adapted from Schmitt BD: Your Child's Health, ed 2. New York, Bantam Books, Inc.. 1991.