PANS/PANDAS in children · Functional medicine specialist

You knew something was wrong the moment it started.

A sudden personality change. New OCD behaviors that locked your child into 4-hour bedtime rituals. Tics that weren’t there last week. Eating that narrowed to three foods. Anxiety, rage, regression in age-appropriate skills, handwriting suddenly looking like a much younger child’s, math facts they had mastered now forgotten, fear of being separated from you when they used to walk into kindergarten without a backward glance. It came on fast, sometimes overnight, and the pediatrician told you it was probably anxiety, that kids go through phases, that you should consider therapy or maybe an SSRI. But you know your child. This isn’t a phase. You’re probably already deep into research. You’ve heard of PANS. You’ve heard of PANDAS. You’ve maybe seen the IFM-trained practitioners. The treatment gap is brutal, most pediatricians and even most other specialists don’t recognize PANS/PANDAS, and the few who do often have year-long waitlists. We treat PANS/PANDAS as the immune-mediated neuropsychiatric condition that it is. We’re not on a year-long waitlist. We can usually start the consult within two weeks.

What PANS/PANDAS are.

PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections, describes a sudden-onset OCD or tic syndrome that appears (or dramatically worsens) following a Group A strep infection. The strep antibodies are believed to cross-react with neural tissue in the basal ganglia, producing the rapid neuropsychiatric symptoms. PANS, Pediatric Acute-onset Neuropsychiatric Syndrome, is the broader umbrella. PANS includes PANDAS plus cases triggered by other infections (Lyme, Mycoplasma pneumoniae, EBV, others), by environmental exposures (mold, in some cases), or by mechanisms not yet fully characterized. The clinical picture is characteristic enough that the PANS Research Consortium has published diagnostic criteria. The hallmark is abrupt onset of OCD or severely restricted food intake, plus at least two of: anxiety, mood swings, irritability or rage, behavioral regression, deterioration in school performance, sensory or motor abnormalities (including tics), or somatic symptoms (sleep disturbances, urinary frequency). If your child changed dramatically and quickly, and the change hasn’t reverted, PANS/PANDAS is on the differential.

Why your pediatrician hasn’t heard of this, and why it matters that someone has.

PANS/PANDAS are well-established in the medical literature. The PANS Research Consortium has published diagnostic and treatment guidelines used at major academic centers including Stanford, NIMH, and Massachusetts General. There is a textbook from Springer. There are dedicated multidisciplinary PANS clinics at major children’s hospitals. But the conditions aren’t covered well in standard pediatric residency training. Most pediatricians have heard of PANDAS in the abstract but haven’t been trained to recognize the presentation, run the right workup, or treat it. Most other specialists treat the OCD or anxiety symptomatically, with SSRIs or therapy, without recognizing that the underlying trigger is an immune response to infection. Usually strep. Sometimes Lyme. Sometimes EBV. Sometimes mycoplasma. Sometimes mold. When you treat the symptoms without addressing the immune trigger, the OCD comes back. When you treat the immune trigger, the OCD often resolves. This is why the PANS Research Consortium guidelines call for a three-part treatment approach: address the underlying infection or trigger, modulate the immune response, treat the neuropsychiatric symptoms supportively while the underlying drivers heal. All three matter. Most kids who fail conventional treatment fail because only the third leg, symptomatic management, is being attempted.

What functional medicine looks for in a PANS/PANDAS workup.

The PANS Research Consortium guidelines call for a workup that includes (at minimum):

• Strep titers (ASO and anti-DNase B), and not just at the time of flare. Titers can stay elevated for months after infection.
• Mycoplasma pneumoniae IgG and IgM, common trigger, especially in school-age kids.
• Epstein-Barr Virus (EBV) panel, VCA IgG, VCA IgM, EA, and EBNA. Reactivation patterns matter.
• Lyme and tick-borne illness panel, IGeneX or another sensitive lab. Standard Lyme testing misses many pediatric cases.
• Inflammatory markers, CRP, ESR. Often elevated during flares.
• Vitamin D, ferritin, basic metabolic panel, deficiencies are common and worsen the picture.
• Stool testing for gut dysbiosis, most kids with PANS have measurable gut microbiome disruption that interacts with immune dysregulation.
• Mold or mycotoxin screening, when there’s any environmental exposure suspicion.
• Comprehensive metabolic panel + thyroid + ANA, to rule out broader autoimmune contribution.

Not every patient needs all of this. We work through it systematically based on history and symptoms, usually starting with strep titers, mycoplasma, Lyme, GI Map, and inflammatory markers as the first round, then adding from there based on what we learn. Some families ask about advanced antibody panels like Cunningham or Neural Zoomer. In our experience these are rarely worth the cost. They are expensive, and even when results come back, they usually don’t change the clinical plan that history, symptoms, and the first round of testing have already pointed us toward. We will use them in select cases, but they are not a default part of how Kim works.

How Calm Wellness approaches PANS/PANDAS.

PANS/PANDAS is one of the conditions where the 4-Month Concierge Package is often the right starting point. The condition is too complex for a 6-week plan, there is a workup phase (testing, history, building the picture), a treatment phase (addressing identified infections, modulating the immune response, supporting the gut and nervous system), and a recovery phase (adjusting recommendations based on response, working through inevitable flares). The treatment plan typically integrates several layers:

• Addressing the underlying infection picture. Antibiotics for confirmed strep or Lyme may belong with the appropriate clinician. Antiviral or antimicrobial support may be considered when the history and testing fit. We work alongside infectious disease specialists when their input is helpful.
• Modulating the immune response. This may include curcumin, omega-3s, low-dose naltrexone (when appropriate, prescribed within scope), and in severe cases, referral for immunomodulatory therapy.
• Supporting the gut and nervous system. Most PANS/PANDAS kids have gut dysbiosis amplifying the immune dysregulation. We address it directly. We also support the nervous system through magnesium, glycine, sleep optimization, sensory support, and select nervous-system-supportive herbs like saffron or bacopa (chosen judiciously and adjusted for kids). Specific herb choices are individualized; we do not recommend trying herbs on your own based on what is mentioned here.
• Working with a psychotherapist trained in OCD. Exposure and response prevention (ERP) is the gold-standard psychotherapy for OCD; we coordinate with the family’s existing therapist or refer to one. Most PANS/PANDAS families work with us via telehealth, geographic flexibility matters when you’re managing a child in flare. We’re licensed for telehealth in Pennsylvania and New York. Out-of-state families can still see us in-person at our Morgantown, PA clinic. Recovery timelines vary widely. Some children respond within weeks once the immune trigger is addressed. Others take 6 to 18 months for meaningful optimization, especially if the condition has been untreated for years. Optimization means progress that fits the child’s genetic profile and lifestyle, not a guarantee of being symptom-free. We are honest about timelines as we go and we will tell you at month 3 whether we’re seeing the progress we’d hoped, and what to do next if we aren’t.

Acute support during a flare.

Flares, sudden re-emergence or worsening of symptoms during illness, after dental work, after stress, are part of the condition for many families. We can help triage flares acutely:

• Identifying whether a current infection (strep, viral) is driving the flare
• Adjusting immune-modulating support
• Coordinating with prescribers for short-course antibiotics if indicated
• Supporting the family, flares are exhausting, and parents often blame themselves; you didn’t cause this. If your child is unsafe, threatening harm, or needs immediate stabilization, please contact emergency services, local crisis care, or the appropriate local clinician. We are not an emergency service, and these situations require immediate care.