If your child is suddenly refusing food, fears choking, or becomes extremely picky, you're not imagining it — and you're not alone. While these changes may look like a typical eating disorder, they could be signs of a PANS/PANDAS eating disorder, an immune-triggered condition that affects the brain. Understanding what's going on in their brains is the 1st step towards helping them get the nutrition they need.
What is PANDAS and How Does It Affect Eating?
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is a condition where strep triggers an autoimmune response that attacks the brain. This causes sudden changes in behavior, mood, and even disordered eating.
Eating struggles in PANDAS are neurological, not psychological.
- PANDAS affects the basal ganglia, a brain region involved in motor control, emotion, and rituals.
- Food rituals, fears of choking, or intense food restriction may appear overnight.
- These symptoms are not typical picky eating, they are intense, abrupt, and emotionally charged.
Can PANDAS Cause Sudden Food Refusal or Restriction?
Yes. This is one of the lesser-known symptoms of PANDAS but also one of the most distressing for families. Parents often describe their child going from eating normally to:
- Refusing food entirely
- Only eating a limited number of foods
- Panicking over choking or contamination
- Weighing or measuring food
Take it from this mom’s experience: Sherry, a mom of a 9-year-old named Owen, shared that one day her son simply refused dinner. Within a week, he had cut out all solid food and was terrified of choking. Before this, he had no food issues whatsoever.
What Are the Symptoms of a PANDAS-Triggered Eating Issue?
While every child is different, there are several common behaviors associated with PANDAS-related disordered eating:
Watch for these symptoms:
- Sudden food restriction or refusal
- Fear of choking, vomiting, or contamination
- Obsession with calories or health
- Rituals around food (e.g., cutting it a certain way)
- Rage or panic around mealtimes
- Extreme picky eating with no prior history
Is It Picky Eating, Anorexia, ARFID, or PANDAS? Understanding the Differences
It’s important to distinguish between picky eating, clinical eating disorders, and PANDAS-related disordered eating. Many children experience picky eating at some stage of development—but when picky eating becomes extreme, sudden, or fear-based, it may point to something deeper like PANS/PANDAS.
Picky Eating is developmentally typical in many children. However, in PANS/PANDAS, picky eating can become extreme, involving refusal of entire food groups, rituals, or fears, and often coincides with other neuropsychiatric symptoms.
Anorexia Nervosa typically involves body image issues and intentional restriction for weight loss.
ARFID (Avoidant Restrictive Food Intake Disorder) includes extreme food avoidance but without body image issues—often based on texture, taste, or fear.
PANDAS-related eating issues:
- Have sudden onset (vs gradual)
- Are tied to infection or immune issues
- Often coexist with OCD, tics, or anxiety
- Include fear-based avoidance or rituals (not calorie-focused)
- May look like extreme picky eating but with medical and behavioral roots
| Type | Sudden Onset | Body Image Concern | Linked to Infection | Rituals, Fear, or OCD-like Behavior |
|---|---|---|---|---|
| Picky Eating (Typical) | No | No | No | Rare |
| Anorexia | No | Yes | No | Sometimes |
| ARFID | Gradual or Sudden | Yes | No | Sometimes |
| PANDAS | Yes | Rare or Absent | Yes | Very Often |
What Triggers PANDAS-Related Disordered Eating?
Disordered eating symptoms in PANDAS are usually triggered by an infection (like strep) that causes the immune system to attack brain tissue by mistake.
Other triggers include:
- Viral infections
- Lyme disease or tick-borne illness
- Mold or environmental toxins
- Chronic inflammation
What Treatments Help Children With PANDAS and Food Issues?
Effective treatment addresses both the underlying immune dysfunction and symptoms like food fears or rituals.
Common Treatments:
- Anti-inflammatory support (e.g., omega-3s, magnesium)
- Antibiotics or antivirals (as guided by a physician)
- Neurofeedback therapy and PEMF therapy to calm the brain
- Psychotherapy with a PANS-literate provider
The BrainBehaviorReset™ Program provides a customized, step-by-step plan to calm the brain and reduce behaviors using natural and science-backed methods.
How Can I Support My Child at Home?
Start with creating a calm, structured environment that reduces stress on the nervous system. At home, you can:
- Stick to predictable routines
- Offer gentle encouragement to eat without pressure
- Avoid focusing on food during conversations
- Use calming techniques like heart hugs or deep pressure
- Model calm behavior around mealtimes
Parent Tip: When Charlotte’s son became afraid of food, they started having him help prepare meals. It gave him some control and reduced his panic.
Parent Action Steps:
When Should I Seek Help and From Whom?
If your child’s eating has changed suddenly or drastically, and especially if other behaviors have also changed, don’t wait.
Seek help from:
- A PANS/PANDAS specialist (not just a general pediatrician)
- Functional medicine providers
- Licensed therapists familiar with OCD and PANS
Early intervention makes a big difference in reversing disordered eating and calming the brain.
It’s not your fault. And your child isn’t broken—they just need the right support.
Not sure what your child needs right now?
Take our FREE Brain & Behavior Solution Matcher: a quick, research-backed tool to help you reach the right next step for your child’s unique needs.
What if my child loses a lot of weight?
Always involve a medical provider. Malnutrition can become dangerous quickly, and treatment may need to happen in tandem with a feeding plan.
Does every child with PANDAS develop eating issues?
No. But when they do, it’s often sudden and intense.
Is medication necessary?
Not always. Many children improve with targeted natural support and nervous system regulation strategies.
Can picky eating be a sign of PANDAS?
Yes, in PANS/PANDAS picky eating may suddenly intensify and become ritualistic or fear-driven, unlike typical developmental picky eating.
How long does it take to improve?
Improvement depends on early detection, calming the brain, and consistent support—but change is absolutely possible.
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:
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- Parade Want to Know How to Overcome Social Anxiety? We've got Help!.
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Disclaimer: This article is not intended to give health advice and it is recommended to consult with a physician before beginning any new wellness regime. *The effectiveness of diagnosis and treatment vary by patient and condition. Dr. Roseann Capanna-Hodge, LLC does not guarantee certain results.
