Treating PANS/PANDAS
LISTENING | SUPPORT | HOPE
Sudden change matters.
​
PANS and PANDAS are complex clinical presentations that may involve the immune system, infections, inflammation, the nervous system, and psychiatric symptoms. PANS/PANDAS is not simply “regular anxiety” or “typical childhood behavior.” Parents often describe a sudden and dramatic shift in their child’s personality, functioning, emotions, sleep, eating, or intrusive thoughts. If your child changed rapidly after illness or another immune stressor, it may be worth a more comprehensive evaluation.
At Wild Ember, we take a careful, whole child approach that looks beyond behavior alone while also ruling out other medical, psychiatric, developmental, and environmental contributors
At Wild Ember Psychiatry & Therapy, we provide psychiatric and functional psychiatry support for children and adolescents with sudden or dramatic changes in mood, behavior, anxiety, OCD symptoms, tics, eating patterns, sleep, school functioning, or emotional regulation.
​
For some children, these symptoms may appear suddenly after an infection or immune trigger. Families may describe their child as changing “overnight” or becoming unrecognizable compared to their baseline. In some cases, this pattern may raise concern for PANS or PANDAS.
​
PANS stands for Pediatric Acute-Onset Neuropsychiatric Syndrome. PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. PANDAS is generally considered a subset of infection-associated acute-onset neuropsychiatric symptoms, while PANS may involve other infectious, inflammatory, or physiologic triggers. NIMH describes PANS/PANDAS as conditions involving sudden onset of OCD or restrictive eating with other neuropsychiatric symptoms, and notes that treatment focuses on addressing the underlying cause, managing symptoms, and supporting the immune system. National Institute of Mental Health
​​​​​​​​​When to Consider PANS/PANDAS
PANS/PANDAS may be considered when a child has a sudden, dramatic onset of symptoms, especially OCD symptoms, restrictive eating, or tics, along with other emotional, behavioral, cognitive, or physical changes. The PANDAS Physicians Network notes that PANS/PANDAS should be considered when OCD, eating restriction, or tics begin suddenly and are accompanied by other emotional, behavioral, cognitive, neurologic, urinary, motor, or handwriting changes. Pandas PPN
​
Parents may notice symptoms such as:
-
sudden OCD symptoms or compulsive rituals,
-
new or worsening tics,
-
sudden separation anxiety or panic,
-
emotional outbursts or rage episodes,
-
severe irritability,
-
restrictive eating or fear of choking/vomiting/contamination,
-
new sensory sensitivities,
-
urinary frequency or bedwetting,
-
handwriting decline,
-
sleep disruption,
-
regression in behavior or school functioning,
-
brain fog, attention problems, or memory changes,
-
new fears, intrusive thoughts, or obsessive reassurance-seeking,
-
sudden depression or mood instability.
​​​​​​​​​​​​​
Not every child with anxiety, OCD, ADHD, tics, or emotional dysregulation has PANS/PANDAS. The pattern of sudden onset, episodic flares, medical history, infection history, and associated neurologic or physical symptoms matters.
Our Approach
At Wild Ember, we approach PANS/PANDAS through a functional psychiatry lens. This means we do not only ask, “What medication treats this symptom?” We also ask:
-
What changed before the symptoms started?
-
Was there a recent infection or immune trigger?
-
Are there signs of inflammation or immune activation?
-
Are sleep, nutrition, stress, hormones, gut health, or environmental triggers playing a role?
-
Are there psychiatric, neurologic, developmental, or medical explanations that also need to be considered?
-
What support does the child need right now to function safely at home, school, and in daily life?
Our goal is to help families understand the full picture and build a thoughtful, individualized treatment plans.
Evaluation
A PANS/PANDAS-informed evaluation may include:
-
detailed psychiatric history,
-
timeline of symptom onset and flares,
-
infection history, including strep and other possible triggers,
-
medical and autoimmune history,
-
family history,
-
sleep, nutrition, sensory, and behavioral review,
-
review of school changes and functional decline,
-
medication and supplement review,
-
lab review or lab ordering when clinically appropriate,
-
collaboration with pediatricians, immunology, neurology, infectious disease, therapy, or other specialists when needed.​
There is no single definitive test that proves PANS or PANDAS in every case. PANDAS Network describes PANS/PANDAS as a clinical diagnosis based on symptoms, history, lab findings, and ruling out other medical or neurologic explanations. PANDAS Network
Labs and Medical Workup
When clinically appropriate, lab evaluation may help identify possible contributors such as infection exposure, inflammation, immune abnormalities, thyroid concerns, nutrient deficiencies, or other medical issues. Labs are not interpreted in isolation. Results must be considered alongside the child’s symptoms, timeline, exam findings, and clinical history.
Potential areas of evaluation may include:
-
strep testing or strep antibody patterns,
-
inflammatory markers,
-
immune markers,
-
thyroid function and thyroid antibodies,
-
vitamin and mineral status,
-
iron/ferritin,
-
metabolic markers,
-
infectious history when clinically indicated,
-
autoimmune screening when appropriate.
​
A normal lab panel does not always rule out PANS/PANDAS, and an abnormal result does not automatically confirm it. The clinical pattern matters.
​
Treatment Philosophy
Treatment may involve several layers of care. PPN describes treatment as potentially including antimicrobials, immunomodulatory therapy, and psychotherapeutic/behavioral therapy depending on the individual case and severity. Pandas PPN
At Wild Ember, care may focus on:
​
Psychiatric Stabilization
Children may need support for anxiety, OCD symptoms, mood instability, panic, sleep disruption, irritability, ADHD-like symptoms, intrusive thoughts, or severe emotional dysregulation.
​
Medication may be considered when symptoms are impairing, unsafe, or preventing the child from functioning. Medication decisions are individualized and made carefully, especially because some children with PANS/PANDAS-like presentations can be sensitive to medication changes.
​
Functional and Medical Contributors
We may evaluate for contributors such as inflammation, infection history, nutrient depletion, sleep disruption, hormonal changes, gut health concerns, environmental stressors, and immune system patterns.
​
This does not mean every child needs extensive testing or supplements. It means we look for clinically relevant patterns that may be affecting the nervous system.
​
Therapy and Behavioral Support
Children and families often need support beyond medication. Depending on the child’s needs, therapy may include CBT, exposure and response prevention for OCD symptoms, parent coaching, nervous system regulation skills, trauma-informed support, or family-based strategies.
​
Collaboration
PANS/PANDAS care is often multidisciplinary. We may coordinate with pediatricians, therapists, schools, immunology, neurology, infectious disease, ENT, allergy/immunology, or other specialists when needed.
​
Wild Ember does not replace your child’s pediatrician or specialty medical team. Instead, we help support the psychiatric and functional psychiatry pieces of care.