Estimated reading time: 6 minutes
When your child suddenly starts struggling with rage, food refusal, obsessive thoughts, or anxiety, it’s heartbreaking and confusing. People around you may brush it off as “just behavior” – but deep down, you know this isn’t typical.
PANS and PANDAS are two conditions that can trigger these dramatic shifts, and while they share similarities, they’re not the same.
What Are PANS and PANDAS?
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) are conditions where a child’s immune system mistakenly attacks the brain, causing sudden changes in behavior, mood, and function.
- PANDAS is triggered by the strep bacteria.
- PANS may be triggered by other infections like Lyme disease, flu, Mycoplasma, or even mold and toxins.
What’s the Difference Between PANS and PANDAS?
- PANDAS = strep (must have documented recent strep infection)
- PANS = other infections or triggers (Lyme disease, viruses, environmental toxins)
Common Ground:
- Sudden, dramatic behavioral or mood changes
- OCD, tics, rage, eating restriction, and more
- Symptoms often begin overnight or within days
| Feature | PANS | PANDAS |
|---|---|---|
| Trigger | Any infection/inflammation (e.g., Lyme disease) | Group A strep bacteria |
| Age range | Any age | Onset before puberty |
| Diagnosis | Clinical, no single test | Requires proof of strep infection |
How Do You Know If It’s PANS, PANDAS, or Something Else?
When you see your child go from being a thriving, regulated and happy kid to suddenly developing OCD, rage, or severe anxiety, it’s a red flag, it’s heartbreaking. Especially if it happens overnight or after an illness.
Look for these signs, in such cases:
- New, intense fears or rituals
- Sudden tics or compulsions
- Major mood swings or aggression
- Refusal to eat or extreme food preferences
- Regression in behavior or school performance
These signs point to something deeper, often immune or neurological, and towards PANS/ PANDAS.
What Are the Most Common Symptoms of PANS and PANDAS?
In more than 90% of the cases, symptoms often appear suddenly and feel extreme. Here’s what to watch for:
Top Symptoms:
- Obsessive thoughts or compulsive rituals
- Motor or vocal tics
- Severe separation anxiety
- Explosive anger or rages
- Handwriting deterioration
- Emotional swings or irrational fears
- Restricted eating or sudden food aversions
How Are PANS and PANDAS Diagnosed?
There are no definitive tests for PANDAS and PANS, and diagnosis relies on clinical history and the symptoms experienced by the individual.
To diagnose PANDAS:
- Sudden onset of OCD or tics
- History of recent strep infection (confirmed by throat culture or bloodwork)
To diagnose PANS:
- Sudden OCD or eating restrictions
- At least two additional neurological or behavioral symptoms
What Treatments Help Kids with PANS or PANDAS?
When it comes to supporting kids with PANDAS or PANS, there’s no one-size-fits-all solution. A multi-pronged approach works best, because treating the immune system and calming the nervous system often need to happen at the same time. They go hand in hand.
Some of the treatment options that might be part of a care plan include:
- Antibiotics (especially when strep is confirmed as the trigger)
- Anti-inflammatories like ibuprofen, turmeric, or low-dose naltrexon
- Immune therapies such as IVIG, steroids, or dietary support
- Brain-based therapies like neurofeedback, PEMF, or psychotherapy
Parent Action Steps
Can Kids with PANS or PANDAS Get Better?
Yes. With the right interventions, many children and teens improve dramatically. But it takes time, the right approach, and parent advocacy.
Key steps:
- Work with a root-cause-focused provider
- Calm the nervous system first
- Use consistent, supportive strategies at home
- Focus on immune and brain healing
That’s why I created the BrainBehaviorReset™ (BBR) Program to guide families through this process with a clear, step-by-step approach that supports both the brain and body for real, lasting change.
Paul's Story: From Rage to Regulation
Paul was a bright, happy 9-year-old until a series of illnesses, including strep – sent his behavior spiraling. One day, he was laughing at breakfast. That night, he had his first rage outburst. Within a week, Paul was experiencing obsessive fears, food refusal, and intense separation anxiety.
His parents were told it was anxiety and to try therapy, but nothing worked. When they discovered PANDAS and had him tested for strep and inflammatory markers, everything clicked.
With the help of the QEEG Brain map, it was evident that Paul had inflammation and infection in his brain with the clear patterns of depression and anxiety. HIs mom’s decision to work with us proved to be the most helpful for Paul. After starting our BrainBehaviorResetTM program, Paul gradually improved. Today, he’s thriving again, with support, understanding, and regulation tools.
Why Is PANS or PANDAS So Hard to Diagnose?
While many clinicians and researchers support the existence of PANS and PANDAS, there is ongoing debate in the medical field.
- Lack of universal diagnostic tests
- Overlap with psychiatric disorders like OCD, anxiety, or ADHD
- Disagreement about the role of strep bacteria or Lyme disease as consistent triggers
Despite this, thousands of families report dramatic improvements when these conditions are addressed.
“Whether it’s called PANS, PANDAS, or post-infectious encephalitis, we must listen to families and treat the whole child.”
— Dr. Elisa Song, pediatric integrative medicine expert
As a parent, you have the right to seek answers and trust your instincts. You know your child best.
FAQ: Quick Answers for Parents
What age do PANS and PANDAS typically appear?
PANDAS typically appears between ages 3–12. PANS can appear at any age.
Can my child still go to school with these symptoms?
Yes, but support and understanding from school staff is crucial. Accommodations may be needed.
Do all kids with strep get PANDAS?
No, only a subset of children with genetic susceptibility develop autoimmune brain inflammation.
Will my child need long-term treatment?
Not always. Early, effective intervention can reduce the duration and severity of symptoms.
Can PANS/PANDAS look like other diagnoses?
Yes, many children are misdiagnosed with OCD, bipolar disorder, or ADHD before a proper evaluation.
Citations
Swedo, S. E., Leonard, H. L., Garvey, M., Mittleman, B., Allen, A. J., Perlmutter, S., … & Rapoport, J. L. (1998). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: Clinical description of the first 50 cases. American Journal of Psychiatry, 155(2), 264–271. https://doi.org/10.1176/ajp.155.2.264
O’Hara, N. (2020). Demystifying PANS & PANDAS: A functional medicine approach. Lecture presented at PANS/PANDAS Parent Symposium. Retrieved from https://www.drnancyohara.com
Song, E. (2021). Understanding neuroinflammation in kids: How PANS and PANDAS affect the body and brain. Healthy Kids Happy Kids Blog. Retrieved from https://healthykidshappykids.com/2021/02/16/pans-pandas/
Dr. Roseann Capanna-Hodge is a licensed mental health expert that is frequently cited in the media:
- CBS2 New York (Article) Experts Offer Tips On How To Help Children Deal With Anxiety.
- Parade Want to Know How to Overcome Social Anxiety? We've got Help!.
Are you looking for SOLUTIONS for your struggling child or teen?
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