PANDAS / PANS

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) are conditions where an infection or other trigger causes the immune system to attack the brain, resulting in sudden and severe neuropsychiatric symptoms.

PANDAS was first identified in the late 1990s by researchers at the National Institute of Mental Health. It specifically refers to cases triggered by a streptococcal (strep) infection, the same bacteria that cause strep throat and scarlet fever. The theory is that antibodies produced to fight the strep bacteria mistakenly attack healthy cells in the brain, particularly in the basal ganglia, leading to sudden behavioral and neurological changes.

PANS is the broader diagnostic category that encompasses PANDAS and includes cases triggered by other infections (such as Mycoplasma pneumoniae, influenza, or Lyme disease), environmental factors, or immune dysfunction where a specific trigger cannot be identified.

The defining characteristic of both conditions is the acute onset. Symptoms appear suddenly, often within 24-48 hours, in a child who was previously functioning normally. This "overnight" change is what distinguishes PANS/PANDAS from typical childhood OCD or anxiety disorders that develop gradually over time.

Did your child suddenly develop obsessive fears, rituals, or compulsions that weren't there before, like excessive hand washing, checking behaviors, or intrusive thoughts?

Has your child started severely restricting what they'll eat, refusing foods they previously enjoyed, or expressing fears about choking or contamination?

Is your child experiencing new motor or vocal tics, sudden movements, or sounds they can't control?

Has your child become suddenly anxious, clingy, or unable to separate from you when they were previously independent?

Are you seeing dramatic mood swings, explosive rage, or emotional reactions that seem completely out of proportion?

Has your child's handwriting deteriorated, or are they struggling with motor skills or coordination they previously had?

Is your child suddenly wetting the bed after being dry for years, or experiencing urinary frequency or urgency?

Has your child seemed to "regress," acting younger than their age, using baby talk, or losing academic abilities they had mastered?

If you answered yes to several of these, especially if the changes happened suddenly after an illness, your child may be experiencing PANS or PANDAS.

Parents of children with PANS/PANDAS often describe a frustrating journey through the medical system. You know something is wrong with your child. Something changed dramatically and quickly. But when you seek help, you may encounter providers who aren't familiar with these conditions, who dismiss your concerns, or who treat each symptom separately rather than recognizing the underlying pattern.

Children with PANS/PANDAS are sometimes misdiagnosed with anxiety disorders, OCD, Tourette syndrome, ADHD, bipolar disorder, or even psychosis, and treated only with psychiatric medications that may not address the underlying immune dysfunction. While psychiatric support can be an important part of treatment, addressing only the behavioral symptoms without treating the underlying cause often leads to incomplete recovery.

The American Academy of Pediatrics published clinical guidance in 2025, acknowledging PANS as a legitimate clinical entity while also noting the need for careful differential diagnosis and comprehensive evaluation. Getting the right diagnosis requires a provider who understands these conditions and can conduct a thorough evaluation.

Functional medicine is particularly well-suited for PANS/PANDAS because these conditions exist at the intersection of the immune system, the brain, and the gut—and require looking at the whole child rather than treating symptoms in isolation.

The Infection-Immune-Brain Connection: At its core, PANS/PANDAS involves the immune system becoming dysregulated, producing antibodies that cross-react with brain tissue. Understanding why a particular child's immune system misfires requires looking at their entire health picture: their infection history, gut health, nutrient status, genetic predispositions, and environmental exposures.

The Gut-Brain Axis: Research has found that children with PANS/PANDAS often have altered gut microbiome composition compared to healthy children. A 2018 study published in Frontiers in Microbiology found that streptococcal infections can change gut bacterial communities, leading to increased gut inflammation and decreased production of important brain-supporting compounds like short-chain fatty acids and dopamine precursors. This gut-brain connection may help explain why some children develop PANS/PANDAS while others exposed to the same infections do not.

Immune System Vulnerabilities: Some children may have underlying immune system differences that make them more susceptible to autoimmune reactions. Research has found that approximately 20% of PANDAS patients have some form of immunodeficiency. Understanding and supporting immune function is a key part of comprehensive care.

Identifying Ongoing Triggers: Children with PANS/PANDAS often experience flares when exposed to new infections. Identifying chronic infections, addressing environmental triggers like mold exposure, and supporting the body's natural defenses can help reduce the frequency and severity of flares.

Reducing Inflammation: Neuroinflammation, or inflammation in the brain, is thought to play a central role in PANS/PANDAS symptoms. Supporting the body's ability to resolve inflammation through nutrition, targeted supplementation, and lifestyle factors can complement medical treatment.

The true prevalence of PANS/PANDAS is difficult to determine because the conditions are often underdiagnosed or misdiagnosed. Estimates vary widely:

Conservative estimates suggest approximately 1 in 200 children may be affected. A 2023 study examining incidence across three primary care populations found a rate of approximately 1 in 11,765 children ages 3-12, though researchers note this likely underestimates true prevalence due to diagnostic challenges. Dr. Susan Swedo, who first identified PANDAS, estimates that children with PANS/PANDAS may make up as much as 25% of children diagnosed with OCD and tic disorders.

PANS/PANDAS appears to affect boys slightly more often than girls, particularly in younger children. The average age of onset is around 6-7 years, though symptoms can appear anytime before puberty. Cases in adolescents and adults are increasingly recognized as well.

The hallmark of PANS/PANDAS is the sudden, dramatic onset of symptoms, often described by parents as "overnight." The diagnostic criteria require:

Core symptoms (at least one): Sudden onset of OCD or severely restricted food intake

Plus at least two of the following: Anxiety (often severe separation anxiety), emotional lability or depression, irritability/aggression/oppositional behaviors, behavioral or developmental regression, deterioration in school performance, sensory or motor abnormalities, somatic symptoms (including sleep disturbances, enuresis, urinary frequency)

For PANDAS specifically: Evidence of a prior streptococcal infection (positive throat culture, elevated strep antibody titers, or exposure history)

Additional symptoms commonly seen include: Motor or vocal tics, handwriting deterioration, joint pain, personality changes, dilated pupils, fear of contamination, hoarding behaviors, sensory sensitivities (to light, sound, texture), and cognitive changes, including difficulty concentrating and memory problems

The PANS/PANDAS Consortium has established that comprehensive treatment should address three areas simultaneously: treating the source of infection, calming the immune response, and managing symptoms. At Cedars Functional Medicine in Florida, our functional medicine approach complements this framework by:

Comprehensive Assessment: We take a detailed history to understand your child's symptom onset, infection history, and overall health picture. We coordinate with your existing care team and may recommend specialized testing to identify triggers and underlying factors.

Infection Investigation: Beyond standard strep testing, we evaluate for other potential infectious triggers, including Mycoplasma, viral infections, and tick-borne illnesses. We also assess for chronic or hidden infections that may be perpetuating symptoms.

Gut Health Optimization: Given the research linking gut microbiome changes to PANS/PANDAS, we assess digestive function and microbiome health. Supporting gut health may help modulate immune function and reduce inflammation.

Immune Support: We evaluate immune function and work to support healthy immune regulation through targeted nutrition, supplements, and lifestyle modifications. This complements rather than replaces medical immunomodulatory treatments when indicated.

Anti-Inflammatory Strategies: Dietary modifications, omega-3 fatty acids, and other anti-inflammatory approaches may help reduce neuroinflammation and support brain health.

Nutritional Optimization: We assess for nutrient deficiencies that may impact immune function, brain health, and recovery. Many children with PANS/PANDAS develop restrictive eating, making nutritional support especially important.

Collaborative Care: We work alongside your child's pediatrician, neurologist, psychiatrist, and therapists. PANS/PANDAS often requires a multidisciplinary team, and we see our role as complementing, not replacing, conventional medical care.