Objective To analyze the clinical manifestations and influencing factors of Tourette syndrome (TS) in children. Methods 50 children with TS in the hospital from February 2019 to February 2024 were selected as study group, and 105 healthy children who came to the hospital for physical examination during the same period were included in control group. The clinical manifestations of children with TS were recorded. The general data[gender, age, family history of tic disorder, bad eating habits, recurrent respiratory tract infection within 1 year, education level of guardians, history of perinatal abnormal diseases, family education mode]and laboratory indicators[blood lead (Pb), blood zinc (Zn), blood selenium (Se), 25-hydroxyvitamin D]were collected and compared between groups. The family relationship was evaluated by the three dimensions of intimacy, emotional expression and contradiction of Family Environment Scale - Chinese Version (FES-CV). Variables with P<0.05 in univariate analysis were included in a binary logistic regression model with sex and age forced as control variables to identify factors independently associated with TS. Results The clinical manifestations of 50 children with TS were complicated, including frowning and blinking (84.00%), followed by throat noise (68.00%), head shaking and shoulder shrug (58.00%), mouth opening and grin (46.00%), sniffing (36.00%), shoulder twisting (30.00%) and abdominal muscle twitching (6.00%). There were no statistical differences in gender, age, bad eating habits, education level of guardians, per capita monthly family income, domicile, residence, Pb, Zn, Se and 25-hydroxyvitamin D levels between the two groups (P>0.05). The proportions of family history of tic disorder, recurrent respiratory tract infection within 1 year, history of perinatal abnormal diseases and strict family education mode in study group were higher than those in control group (P<0.05), and the scores of intimacy and emotion expression of family relationship were lower (P<0.05) while the score of contradiction was higher compared with the control group (P<0.05). Regression analysis results showed that family history of tic disorder (OR=3.431, 95%CI: 1.642-7.170), recurrent respiratory tract infection within 1 year (OR=2.903, 95%CI: 1.488-5.665), history of perinatal abnormal diseases (OR=2.601, 95%CI: 1.346-5.026), strict family education mode (OR=3.656, 95%CI: 1.801-7.415), low intimacy score (OR=2.581, 95%CI: 1.336-4.986), low emotional expression score (OR=2.927, 95%CI: 1.477-5.801) and high contradiction score (OR=2.646, 95%CI: 1.353-5.172) were independent risk factors for TS occurrence (P<0.05). Conclusion The clinical manifestations of children with TS are complex and diverse, including frowning and blinking, throat noise, head shaking and shoulder shrug, mouth opening and grin, sniffing, shoulder twisting and abdominal muscle twitching. Children with family history of tic disorder, recurrent respiratory tract infection within 1 year, history of abnormal perinatal diseases, strict family education mode, and discordant family relationship show higher detection rates of TS, and these factors may serve as references for high-risk screening. Clinical interventions should focus on modifiable family environmental factors, with family history used as a risk marker to strengthen early identification however, the causal direction and intervention efficacy require further validation through prospective studies.