A 5-year-old develops motor and vocal tics (eye blinking, throat clearing) for the past 12 months. Tics wax and wane. There is no academic decline and the child is not bothered. OCD symptoms are absent. His tics meet criteria for Tourette syndrome. The first-line management is:

• A Haloperidol 0.025 mg/kg/day
• B Clonidine 0.1 mg/day to suppress tics
• C SSRIs to treat tic disorder
• D Comprehensive behavioral intervention for tics (CBIT) — watchful waiting initially ✓

Explanation

Tourette syndrome (both motor and vocal tics for >12 months) in a child who is not significantly impaired by tics warrants a watchful waiting approach initially — tics often wax and wane naturally and may resolve. When treatment is needed, Comprehensive Behavioral Intervention for Tics (CBIT), including habit reversal training and relaxation strategies, is now recognized as first-line treatment by AAN guidelines, with evidence equivalent or superior to medication. Pharmacotherapy (alpha-2 agonists like clonidine, or antipsychotics like fluphenazine) is initiated only when tics are functionally impairing. Haloperidol is effective but its side-effect profile makes it second or third-line. SSRIs treat co-morbid OCD/anxiety, not tics.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.