If your child repeatedly clears his nose and throat, don't rush to diagnose rhinitis. It may be caused by tic disorder.

Dongdong's mother has been a bit overwhelmed recently.

Every time she helped Dongdong with his homework or assigned him extracurricular tasks, he would always pinch his nose or clear his throat, even if he had no runny nose or phlegm. He would not listen to her and could not control himself. Although the child did not resist, the harsh sound seemed to be a ruthless mockery of her authority, which made her crazy.

In a situation like Dongdong’s mother’s, most parents’ first reaction is definitely that it is caused by rhinitis or pharyngitis. Many patients come to the ENT department because of this problem.

In the clinic, I first carefully examined the child's nose and throat to get a general idea of ​​the situation. Then I told the child that his nose and throat were fine and there was no problem, and then asked the grandmother who was traveling with him to take the child out to play.

Dongdong's mother asked in confusion what disease the child had.

I gave my diagnosis, "There is nothing serious wrong with the child's nose and throat. His involuntary, frequent nasal shrinking, forceful nasal inhalation, and vigorous throat clearing may be a tic disorder."

Dongdong's mother was still confused and anxious, so I quickly said, "Don't worry, your child's condition is transient tic disorder, the mildest type, and it will usually be relieved through psychological counseling and stress relief."

Then, I gave her a brief introduction to what tic disorder is.

Tic disorder (TD) is a neuropsychiatric disease that begins in childhood and is characterized by tics. It is also often called tics. According to clinical characteristics and duration of the disease, TD is divided into three types: transient TD, chronic TD and Tourette syndrome (TS).

Severe tic disorder, Tourette syndrome, is also known by another name, Tourette syndrome. The disease was first described in detail by French doctor Tourette in 1885, so it is called Tourette syndrome. Current research believes that abnormal levels of certain neurotransmitters in the brain (such as dopamine, etc.) may be related to Tourette syndrome. At the same time, the cause of the disease also involves multiple factors such as genetics, mental stress, and immune response. There is an American movie "Call Me First" with a Douban score of 8.7, which tells an inspirational story about the disease. The film is adapted from Brad Cohen's real experience. The protagonist Cohen suffers from Tourette syndrome. The movie realistically and delicately shows the scene when Cohen is ill. He will twist his neck involuntarily and make strange noises, especially when he is nervous. It is difficult to control. Unlike most people with Tourette syndrome, these symptoms did not ease even after he became an adult. He suffered many difficulties and discrimination during his growth, but he never gave up and eventually became an excellent teacher.

In fact, most of the children who are brought to our otolaryngology clinic for help because of "bad habits" such as repeatedly shrinking their noses, squinting, and clearing their throats belong to the mildest first case. Those with severe Tourette syndrome are not difficult to identify, and they are basically treated in pediatric neurology or psychiatry. However, tic disorders with short-term attacks like Dongdong are generally more hidden, and many children do not receive effective intervention or are mistakenly treated for rhinitis or pharyngitis.

I just sent the child away, mainly because I can’t emphasize this disease in front of the child. Most of the causes of transient tic disorder are tension and anxiety, especially when the child is under mental stress, and the more parents emphasize stopping it, the more they will strengthen this habit psychologically, which is a characteristic that rhinitis and pharyngitis do not have. Dongdong’s mother also said that this action is particularly obvious when the child is studying, and the more he is scolded, the more he can’t stop it. If the child is concentrating on playing games, he will completely forget to shrink his nose and clear his throat.

When a child comes to see a doctor, it is the parents who are the problem. This strange thing is not uncommon in the ENT clinic. Finally, through education to the child's mother, I gave a few suggestions:

1. Improve awareness: Parents need to have a correct understanding of tic disorders and understand that it is not a "bad habit" of their children. Downplay it in life and do not stop it repeatedly, so as not to let the child form a certain psychological reinforcement of this behavior. 2. Active communication: Maintain open and honest communication with your child, encourage him to share his feelings, and let him know that he is not abnormal. 3. Adjust yourself: Go back and watch the movie above first, and put yourself in the child's perspective. Reasonably adjust your expectations for your child to avoid additional mental stress caused by excessive demands. 4. If it gets worse or worse, go to the relevant specialist for treatment in time.

Later, I saw Dongdong's mother, and she said that after several months of adjustment, Dongdong had gradually forgotten this "bad habit" completely.

References:

1． LiuZS, CuiYH, SunD, et al. Current status, diagnosis, and treatment recommendation for tic disorders in China[J]. Front Psychiatry, 2020, 11: 774.

2. Neurology Group of the Pediatric Branch of the Chinese Medical Association. Expert consensus on the diagnosis and treatment of tic disorders in children (2017 practical version) [J]. Chinese Journal of Practical Pediatrics, 2017, 32(15): 1137-1140.