children's health Gut health gut microbiome

Nutrition Case Study: Motor tics.

Harry came to see me with his mum. She was concerned that he had developed a facial tic which involved opening his mouth wide and tilting his head to the side. It was more frequent when he was tired but it was a constant feature every day. He wasn’t able to control it, although he was aware that he did it some of the time.

Harry was generally well, he liked to play football, was doing well at school and was a popular boy with plenty of friends. However, his mum told me that he had had repeated ear infections throughout his childhood. In the last year he’d had two infections in quick succession and had taken antibiotics for them. The tics developed within 6-8 weeks of the infections. Harry’s mum had read about PANDAS (Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus) but she didn’t feel that Harry had any behavioural or personality changes following the infections, just the tics. Testing for PANDAS involves a blood draw which Harry was not keen on. With this in mind we decided to only revisit this if his tics didn’t improve on our initial programme.

Aside from the facial tics Harry also had some bloating (his stomach was slightly distended), inconsistent bowel movements (sometimes constipated and sometimes loose and unformed). He also complained of an itchy bottom, especially at night time, this prevented him from getting off to sleep.

Harry’s mum had already removed as many additives as she could from his current diet and admitted it was now much ‘cleaner’ than it had ever been but this hadn’t had an impact on his tics.

We implemented a nutrient dense diet, with very low levels of gluten and dairy. We ordered a stool test to rule out inflammatory bowel issues and take a closer look at his gut bacteria. With this test we were able to add-on an investigation for threadworms – which were found in his sample. Harry also had gut dysbiosis (low levels of beneficial bacteria) and some yeasts were present.

Harry’s mum gave him an over the counter treatment for the threadworms and we followed this up with broad spectrum probiotics and saccharomyces boulardii to help crowd out yeasts and less beneficial bacteria. We also added a good quality children’s multi vitamin and mineral complex to help support Harry’s immune system. Within 4 weeks Harry’s tics had subsided completely.

In some cases there seems to be a strong link between gut dysbiosis and the development of tics and it is only through re-establishing appropriate gut bacteria that the tics diminish and disappear.


    Sarah is a clinical nutritionist specialising in mental wellbeing and the gut-brain connection.

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