“My 9-year-old keeps blinking, shrugging and making throat-clearing noises — he can’t seem to stop. Is it a habit or something serious?”

TICS are sudden, repetitive, stereotyped MOTOR (blinking, grimacing, shrugging) or VOCAL (throat-clearing, sniffing, grunting) movements/sounds that characteristically WAX AND WANE, are briefly SUPPRESSIBLE, are worse with stress/excitement/tiredness, and are often preceded by a PREMONITORY URGE. Tics are COMMON in children and often TRANSIENT/self-limiting; TOURETTE SYNDROME is diagnosed when there are multiple motor tics plus at least one vocal tic for more than a year with onset before 18 (tics for under a year are a provisional tic disorder, as for Finn after a few months) — but many tic disorders are milder/transient, don’t meet Tourette criteria, and most improve over time (often by late adolescence). Assess the IMPACT (school, social situations, self-esteem, bullying, physical discomfort) and screen the common COMORBIDITIES — ADHD, OCD and anxiety (and learning difficulties) — which often matter more than the tics themselves. Reassure (tics are common, usually not a sign of serious underlying disease, and most are mild and improve) and give psychoeducation: explain the premonitory urge and suppressibility, that drawing attention to or criticising tics can worsen them, and that managing stress/tiredness helps — for mild tics, reassurance and education are often sufficient. Refer/treat proportionately if tics are significantly impairing or comorbidities need treatment: behavioural therapy — habit-reversal training / Comprehensive Behavioural Intervention for Tics (CBIT) or exposure with response prevention — is first-line (ESSTS European clinical guidelines 2021, international), with medication specialist-only for severe tics (aripiprazole usually first choice; clonidine where ADHD co-exists; BNFC), ADHD and OCD managed per NICE NG87 and NICE CG31, school support via the SENCo (Equality Act 2010, SEND Code of Practice), and consider red flags warranting referral (sudden severe onset, abnormal neurological signs — checked face to face — developmental regression, non-tic movements, very disabling tics). The skill is recognising tics/Tourette’s, reassuring appropriately, screening impact and comorbidities, and referring proportionately — not over-medicalising a common, often benign condition.