Tics

 

This guideline is for children aged 18 years and younger
 

Introduction

• Tics (sudden, rapid and repeated body movements or sounds that serve no purpose and are difficult or impossible to control) are very common in children aged 5 years and older (peak 10-13years)
   
• Tics commonly wax and wane and may change to affect different parts of the body over time. Parents can be reassured that the overwhelming majority will resolve without any medical intervention
   
• In general tics do not require referral.

 

In scope   

• Tics   

 

Not in scope      

• Tremor

      
 

Red Flag Features

• Tics with sudden onset chorea, ataxia or dystonia or other involuntary movements.
   
• Tic after streptococcal disease could indicate PANDAS Or Sydenham Chorea.  PANDAS presents with sudden onset of abnormal movements with associated chorea, ataxia, dystonia or swallowing difficulties. 

 

Investigations required prior to referral

No investigations are required but perform a full neurological examination on all children presenting with tics.

 

Management optimisation

Management is conservative and focused on reassurance, ignoring tics as much as possible, and reducing potential stressors/triggers.  Advise parents or carers of children with a tic disorder to discuss the disorder with the child’s school, emphasising that the tic is an involuntary movement, and the child should not be reprimanded for it.

 

Advice and Guidance

Contact Paediatrics advice and guidance via eRS if a child has tics and:

• developmental regression
   
• neurological abnormality on examination
   
• very severe or frequent symptoms interfering with normal daily activities.

Please include a video (if possible) in children where there is diagnostic uncertainty.

 

Referral

Emergency and red flags

Discuss with on call Paediatrics   

• Tics with sudden onset chorea, swallowing difficulties, ataxia or dystonia or other involuntary movements for same day neurological assessment
   
• Suspected PANDAS.

 

Urgent referral criteria to General Paediatrics:

• Diagnostic uncertainty between involuntary movements and epilepsy can be difficult particularly as epilepsy is more common in children with autism.  A referral may be appropriate for investigation and management of the neurodevelopmental disorders, as well as suspected neurological conditions if epilepsy cannot be confidently excluded
   
• In the event of any abnormal findings on neurological examination.

 

Routine referral criteria:

For children with a tic disorder that has a significant impact on their quality of life, consider referring according to local pathways, as follows:

• Referral to CAMHS if the tic disorder is associated with symptoms of anxiety or obsessive compulsive behaviour or other mental health issues
   
• Referral to the neurodevelopmental team if the tic disorder is associated with symptoms suggestive of autism (tics that are repetitive or ritualistic eg body rocking, hand flapping, flickering fingers) or attention deficit hyperactivity disorder. 

 

Referral instructions

Refer via eRS for urgent and routine referrals.

 

Supporting Information

For professionals           

For patients and parents:

• Tics and Tourette's Syndrome | Common Health Issues - Child 1 to 4 years | Healthier Together
• 1374586646_Tic-tips---managing-your-TS.pdf

 

References        

• NG127 Suspected neurological conditions: recognition and referral: Full guideline 2019

  

Page Review Information

Review date	23 January 2026
Next review date	23 January 2028
Clinical editor	Dr Melanie Schick
Contributors	Dr Chris Williams, Consultant Paediatrician, RCHT