What are PANS and PANDAS?
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) describes a sudden, dramatic onset of obsessive-compulsive symptoms or severely restricted eating in a child, together with other abrupt neuropsychiatric changes. PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is a subtype in which the onset or flare is linked to a strep infection. The leading theory is that, in some children, an infection or other immune trigger leads to inflammation that affects the brain, especially the basal ganglia, which are involved in movement, habits and emotional regulation.
What makes PANS and PANDAS different from typical childhood OCD or anxiety is the speed of onset. Parents often describe it as their child changing “overnight” or within a few days.
Signs parents commonly notice
Children meeting criteria for PANS have an abrupt onset of obsessive-compulsive symptoms or severely restricted food intake, plus at least two of the following, appearing just as suddenly:
- Anxiety, often intense separation anxiety, new fears or panic.
- Emotional changes, such as mood swings, tearfulness or depression.
- Irritability, aggression or severely oppositional behavior.
- Behavioral or developmental regression, such as baby talk, tantrums or loss of skills.
- A sudden decline in school performance, including handwriting changes, trouble with math or poor concentration.
- Sensory or motor changes, such as tics, sensitivity to light, sound or textures, or clumsiness.
- Physical symptoms, such as sleep problems, new bedwetting or urinary frequency.
Symptoms often follow a relapsing-remitting pattern, with flares that may coincide with new infections. Other medical and psychiatric conditions need to be considered and ruled out as part of the evaluation.
Why early, careful evaluation matters
PANS and PANDAS remain debated in medicine. Some clinicians are unfamiliar with the diagnosis, and its causes and best treatments are still being studied. That uncertainty can leave families bouncing between appointments while a child struggles. A thorough evaluation helps by documenting the timeline of symptoms, looking for infections and other triggers, ruling out conditions that can look similar, and building a coordinated plan with your child’s pediatrician and other specialists. For a deeper parent-focused overview, read our PANS / PANDAS guide for parents.
How we evaluate a child for PANS / PANDAS
A detailed timeline
We ask exactly when symptoms began, how fast they appeared, what illnesses or exposures came before, and how symptoms have changed since. Photos, school reports, handwriting samples and videos can all help.
Medical history and examination
We review infections (including strep, sinus, respiratory and other illnesses), family history of autoimmune conditions, sleep, eating, growth, and any previous testing or treatment.
Targeted testing
Depending on the history, testing may include throat cultures or strep antibody tests, other infection screening, inflammatory markers, and nutrient and general health markers. We coordinate with your pediatrician on tests and on referrals to specialists such as pediatric neurology, rheumatology or immunology when they are needed.
Screening for other explanations
Typical-onset OCD, anxiety disorders, autism, tic disorders, eating disorders and other medical conditions can overlap with PANS. Getting the picture right guides the right care.
Integrated treatment options
Expert consensus guidance for PANS and PANDAS describes three complementary areas of treatment, usually used together:
- Treating the trigger. When an active infection such as strep is found, it is treated, typically with antibiotics. Preventing and promptly treating new infections in the household is also important.
- Calming inflammation and immune activity. Depending on severity, this may range from anti-inflammatory approaches to more intensive immune treatments that are managed by specialists. We coordinate these referrals and support the overall plan.
- Psychiatric and behavioral support. Cognitive behavioral therapy with exposure and response prevention (ERP) is a core treatment for OCD symptoms, adapted to a child’s current capacity during a flare. Parent coaching, school accommodations and, where appropriate, medication are also part of care.
Alongside these, we pay close attention to the factors that influence a child’s resilience: sleep, nutrition (especially when eating has become very restricted), gut health, stress in the family, and screen habits. See gut-brain and digestive health and nutritional psychiatry.
Supporting the whole family
A child with PANS or PANDAS can need a lot of care, and siblings and parents feel the strain. Families often benefit from practical guidance on how to respond to compulsions and rituals, how to handle mealtimes when food is restricted, how to talk with teachers, and how to look after their own wellbeing during long flares. We include parents in every step and help put school supports in place where needed.
PANS / PANDAS at school
Flares often hit school performance first: handwriting deteriorates, math becomes suddenly difficult, attention drops and anxiety makes getting through the door a struggle. Practical supports can make a big difference, such as reduced workload during flares, extra time, access to a quiet space, permission for bathroom breaks, flexible attendance and a clear point of contact at school. Depending on the impact, a Section 504 plan or an Individualized Education Program (IEP) may be appropriate. We can provide documentation that explains your child’s needs and how symptoms may fluctuate.
Recovery and what to expect over time
The course of PANS and PANDAS varies. Some children have a single episode that resolves with treatment; others have flares over months or years, often triggered by new infections, which tend to become less frequent and milder over time. Tracking symptoms with a simple diary or rating scale helps families and clinicians see patterns, judge whether treatment is working and act early when a flare begins. Recovery is often gradual, with good weeks and setbacks, and it helps to plan for both.
How PANS care fits our whole-child approach
Our work with PANS / PANDAS follows the same principles as the rest of our care: look for what is driving symptoms, treat the body and mind together, and coordinate with everyone involved. Learn more about holistic psychiatry, integrative psychiatry, functional psychiatry and root causes and medication management.
Our experience
Care is led by Dr. Koichi Tanji, ND, LMHC, FMAPS, a Fellow of the Medical Academy of Pediatric Special Needs, who works with children and families facing complex neuropsychiatric and neurodevelopmental presentations, including PANS / PANDAS, ADHD and autism. Our approach combines medical assessment, psychotherapy and family support, and we work alongside pediatricians and specialists rather than replacing them. See also ADHD and autism support and mood dysregulation.
When to seek urgent care
Seek emergency care right away if your child refuses all food or fluids, shows signs of dehydration, talks about harming themselves or others, or develops new neurological symptoms such as weakness, confusion or seizures. In a crisis, call 911 or call or text 988.
Getting started
We see children and families in person at 2135 112th Ave NE, Suite 201, Bellevue, and by secure telehealth anywhere in Washington. We are in-network with Premera, Regence, BlueCross BlueShield, Aetna, Cigna and Kaiser PPO. Before your first visit, gather any records of recent infections, lab results and a written timeline of symptoms. Book online or call (425) 278-6166.
