While uncommon, some children may experience an abrupt change – new rituals, motor or vocal tics, big emotions – soon after strep. This rare immune-mediated pattern may point to something called PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections).
In this article, you’ll learn what PANDAS is, how it’s diagnosed, treatment basics, and more.
What Is PANDAS?
PANDAS is a rare pediatric condition in which a child develops a sudden onset (often within days) of OCD behaviors and/or tics after a strep infection. The prevailing model is immune-mediated neuroinflammation affecting deep brain regions involved in movement, motivation, and behavior (notably the basal ganglia). Misdiagnosis as primary OCD, anxiety, ADHD, or even eating disorders is common (1).
The true prevalence of PANS/PANDAS is unknown, and estimates vary greatly. The PANDAS Network suggests that these conditions may be more common than previously recognized, possibly as high as 1 in 200 children (2), while a 2023 retrospective study found a much lower annual incidence of about 1 in 11,765 among children ages 3-12 (3). Because these syndromes are often misdiagnosed as primary OCD, anxiety, ADHD, eating disorders, or even framed as “behavioral problems,” prevalence is difficult to capture, and many cases go unrecognized.
Potential PANDAS Symptoms
Parents may notice any of the following symptoms (1):
- Abrupt onset or dramatic worsening of obsessive–compulsive behaviors (OCD) and/or motor or vocal tics
- Episodic course: symptoms may remit and then flare with new infection
- Recent strep infection (e.g., positive throat culture or elevated anti-strep antibodies)
- Other common signs: heightened anxiety, irritability, sleep problems, urinary frequency/bedwetting, sensory sensitivities, regression, and a drop in school performance
PANDAS vs. PANS
The terms PANDAS and PANS are sometimes used interchangeably, but there are important distinctions to be aware of. PANDAS is a subcategory of PANS. PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome, an umbrella term for the sudden, severe onset of OCD, motor or vocal tics, or markedly restricted eating before puberty, often with additional mood, sensory, or motor changes
PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections, and it is the strep-triggered subset of PANS, where symptoms appear soon after a confirmed group A strep infection (like strep throat or scarlet fever).
How Is PANDAS Diagnosed?
At this time, there isn’t a single test that can confirm PANS or PANDAS. Both are clinical diagnoses, meaning doctors look closely at your child’s history, symptoms, and exam rather than relying on one lab result.
According to the American Academy of Pediatrics (AAP), diagnosis generally includes:
- Sudden, dramatic onset of obsessive–compulsive behaviors (OCD) or severely restricted eating
- At least two other abrupt neuropsychiatric symptoms, such as:
- Heightened anxiety
- Mood swings or depression
- Irritability or aggression
- Developmental regression
- Sudden drop in school performance
- New sensory or motor changes
- Physical or “somatic” symptoms (e.g., sleep problems, urinary frequency, unexplained aches)
The difference between the two conditions comes down to triggers:
- PANDAS is diagnosed when there’s clear evidence of a recent strep infection (positive throat culture or elevated strep antibody titers).
- PANS is used when the same abrupt changes happen but may follow another infection, immune trigger, or sometimes no obvious cause.
Because other conditions (like Tourette syndrome, Sydenham chorea, or autoimmune encephalitis) can look similar, a careful evaluation is important. Most children don’t need an extensive lab or imaging workup unless symptoms suggest something more serious.
For parents, it can feel frustrating to not have a clear diagnostic test to explain what your child is experiencing, and it’s not uncommon for parents to find themselves facing roadblocks when seeking answers, especially when a child’s symptoms align with PANS or PANDAS, but traditional providers are hesitant to consider it. This hesitation often stems from the fact that diagnostic criteria and treatment guidelines are still evolving.
The AAP released a 2024–2025 clinical report on PANS to help standardize care. Awareness is growing, and more clinicians are recognizing the importance of taking these cases seriously. A thoughtful provider will consider current guidance, your child’s full history, and the unique pattern of symptoms when making a diagnosis.
PANDAS: What’s Going On in the Brain?
Emerging research suggests that in susceptible children, immune responses to strep can produce cross-reactive antibodies that affect basal ganglia circuitry (dopamine signaling), leading to tics/OCD-like behaviors, a process similar to the better-known post-strep condition Sydenham chorea (4). This area is active and evolving, but it helps explain why targeted anti-infective and anti-inflammatory strategies may help some kids.
PANDAS Potential Treatment Options Overview (Conventional + Integrative)
Treatment for PANDAS is multifaceted and should be guided by a knowledgeable practitioner. PANDAS treatment may involve several areas:
1) Treating the Infection
Antibiotics are commonly used when there’s evidence of an active strep infection or a close temporal link between infection and symptom onset. Some children show rapid improvement with appropriate antibiotics; others may need a longer, multi-pronged plan (5).
2) Calming Neuroinflammation
In some cases, calming inflammation in the brain can help ease symptoms. Depending on your child’s situation, a doctor may recommend a short course of anti-inflammatory medication (like NSAIDs), especially if symptoms are moderate to severe. In more complex or persistent cases, specialists may explore options like steroids, IVIG (intravenous immunoglobulin), or in rare instances, therapeutic plasma exchange (6).
While some studies show promise with these treatments, the overall evidence is still evolving and there aren’t many high-quality randomized trials yet. Because of this, treatment decisions are often made collaboratively between families and providers, weighing risks, benefits, and a child’s unique history.
For this reason, if you suspect PANS or PANDAS in your child, it is crucial to find a supportive doctor
3) Supporting Brain–Behavior Health
Alongside medical care, supporting your child’s emotional and behavioral health can make a world of difference. Gentle, consistent routines and a calm environment often help kids feel safer and more in control. Many families also find that working with a therapist experienced in OCD and anxiety, especially someone who understands PANS and PANDAS, can provide helpful strategies during flares.
4) Naturopathic Whole-Body Support for PANDAS
A naturopathic doctor is a valuable member of your team when dealing with a PANDAS diagnosis. They’ll be able to guide you on whole-body support, which may include:
a. Nutrients that support brain health, cellular protection, and a healthy inflammatory response, such as:
Curcumin
- Curcumin is a well-known antioxidant which helps promote glutathione production and contributes to overall cellular health (7). In children with PANDAS, supporting antioxidant pathways may play a role in maintaining health function (8).
- May support healthy brain function by promoting levels of BDNF (brain-derived neurotrophic factor), which is associated with learning, memory, and focus (9).
- Helps maintain a healthy inflammatory response (10).
- Supports the health and integrity of the blood brain barrier (11).
N-acetylcysteine (NAC)
- NAC is a precursor to glutathione (12), often referred to as the body’s “master antioxidant.”
- Supports healthy detoxification and cellular defense (13, 14) by promoting sufficient glutathione levels.
- Helps modulate glutamate activity in the brain (15), which may support emotional regulation and cognitive clarity.
- May help maintain a balanced immune response by supporting cytokine regulation (16).
Omega-3s
- Promotes a healthy inflammatory response (17).
- Supportive of neuronal membrane health and neurotransmitter activity (18).
- Supports brain health and a balanced mood (19).
b. Immune-supporting and calming nutrients, such as:
Magnesium (Glycinate, L-Threonate)
- Magnesium plays a central role in nervous system regulation and stress resilience (20).
- Supports GABA activity (a calming neurotransmitter) (21).
- Helps regulate calcium in the brain, which supports healthy nerve signals and may be helpful for kids with tics or sensory challenges (22).
Vitamin D
- Supports immune system function (23).
- Encourages a healthy inflammatory response and supports the production of mood-related chemicals like serotonin and dopamine (24).
- Research shows that many kids with immune-related neuropsychiatric symptoms (like those seen in PANDAS) have low vitamin D levels (25, 26).
Zinc
- Supports immune cell (like T-cells and neutrophils) function (27).
- Provides antioxidant support (28).
- Important for taste reception (29).
c. Gut support, especially if antibiotics have been a part of the treatment plan:
High-quality probiotics
- A healthy microbiome is crucial, as disruptions from antibiotics, infections, and poor diet can impact both digestive and neurological health (30).
Mucosal supports
- Such as bone broth, L-glutamine, or slippery elm where appropriate.
d. Nutrition support, such as an anti-inflammatory diet, which may involve:
- Minimizing ultra-processed foods
- Some families try gluten-free and/or dairy-free or low-histamine plans
Please be sure to explore these options with an experienced practitioner who can personalize recommendations for your family.
When To Seek Urgent Care
While most children with PANS or PANDAS can be supported at home and through outpatient care, there are times when urgent help is needed. Please reach out to your pediatrician right away or head to the nearest emergency department if something feels “off” and your gut tells you your child needs urgent medical attention or your child experiences:
- New neurological symptoms (such as sudden weakness, severe headache, or unusual movements that go beyond typical tics)
- Signs of dehydration, rapid weight loss, or severely restricted eating
- Thoughts of harming themselves or suicidal behaviors.
Summary
PANDAS describes a sudden, infection-linked onset of neuropsychiatric symptoms in children, most often OCD and/or tics. Diagnosis is clinical, meaning there’s no single lab that rules it in or out. Treatment usually combines infectious-disease management, inflammation control, and behavioral support, and a naturopathic doctor can be a key member of your team, providing guidance on the use of adjunctive, whole-child strategies. Because guidance for PANS & PANDAS is still evolving and individual responses vary, the most important step is partnering with a clinician who listens, tracks patterns over time, and tailors care to your child.
References:
- National Institute of Mental Health. (2025). PANS and PANDAS: Questions and Answers. https://www.nimh.nih.gov/health/publications/pandas
- PANDAS Network. (n.d.). Statistics. https://pandasnetwork.org/get-involved/statistics/
- Wald ER, Eickhoff J, Flood GE, Heinz MV, Liu D, Agrawal A, Morse RP, Raney VM, Veerapandiyan A, Madan JC. Estimate of the incidence of PANDAS and PANS in 3 primary care populations. Front Pediatr. 2023 Sep 21;11:1170379. doi: 10.3389/fped.2023.1170379. PMID: 37808558; PMCID: PMC10551157.
- Cunningham, M. W., & Cox, C. J. (2015). Autoimmunity against dopamine receptors in neuropsychiatric and movement disorders: a review of Sydenham chorea and beyond. Acta Physiologica, 216(1), 90–100. https://doi.org/10.1111/apha.12614
- La Bella S, Scorrano G, Rinaldi M, Di Ludovico A, Mainieri F, Attanasi M, Spalice A, Chiarelli F, Breda L. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): Myth or Reality? The State of the Art on a Controversial Disease. Microorganisms. 2023 Oct 13;11(10):2549. doi: 10.3390/microorganisms11102549. PMID: 37894207; PMCID: PMC10609001.
- Jelena Eremija, Patel, S., Rice, S., & Daines, M. (2023). Intravenous immunoglobulin treatment improves multiple neuropsychiatric outcomes in patients with pediatric acute-onset neuropsychiatric syndrome. Frontiers in Pediatrics, 11. https://doi.org/10.3389/fped.2023.1229150
- Piper JT, Singhal SS, Salameh MS, Torman RT, Awasthi YC, Awasthi S. Mechanisms of anticarcinogenic properties of curcumin: the effect of curcumin on glutathione linked detoxification enzymes in rat liver. Int J Biochem Cell Biol. 1998 Apr;30(4):445-56. doi: 10.1016/s1357-2725(98)00015-6. PMID: 9675878.
- Tagi VM, Tosi M, Greco IP, Stucchi E, Verduci E, Zuccotti G. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and gut microbiota composition: what do we know? Front Nutr. 2025 Jan 6;11:1477893. doi: 10.3389/fnut.2024.1477893. PMID: 39834450; PMCID: PMC11743372.
- Sarraf P, Parohan M, Javanbakht MH, Ranji-Burachaloo S, Djalali M. Short-term curcumin supplementation enhances serum brain-derived neurotrophic factor in adult men and women: a systematic review and dose-response meta-analysis of randomized controlled trials. Nutr Res. 2019 Sep;69:1-8. doi: 10.1016/j.nutres.2019.05.001. Epub 2019 May 9. PMID: 31279955.
- Peng Y, Ao M, Dong B, Jiang Y, Yu L, Chen Z, Hu C, Xu R. Anti-Inflammatory Effects of Curcumin in the Inflammatory Diseases: Status, Limitations and Countermeasures. Drug Des Devel Ther. 2021 Nov 2;15:4503-4525. doi: 10.2147/DDDT.S327378. PMID: 34754179; PMCID: PMC8572027.
- Wu S, Guo T, Qi W, Li Y, Gu J, Liu C, Sha Y, Yang B, Hu S, Zong X. Curcumin ameliorates ischemic stroke injury in rats by protecting the integrity of the blood-brain barrier. Exp Ther Med. 2021 Jul;22(1):783. doi: 10.3892/etm.2021.10215. Epub 2021 May 19. PMID: 34055082; PMCID: PMC8145684.
- Raju PA, Herzenberg LA, Herzenberg LA, Roederer M. Glutathione precursor and antioxidant activities of N-acetylcysteine and oxothiazolidine carboxylate compared in in vitro studies of HIV replication. AIDS Res Hum Retroviruses. 1994 Aug;10(8):961-7. doi: 10.1089/aid.1994.10.961. PMID: 7811547.
- Tenório MCDS, Graciliano NG, Moura FA, Oliveira ACM, Goulart MOF. N-Acetylcysteine (NAC): Impacts on Human Health. Antioxidants (Basel). 2021 Jun 16;10(6):967. doi: 10.3390/antiox10060967. PMID: 34208683; PMCID: PMC8234027.
- Yamada M, Kojima N, Paranjpe A, Att W, Aita H, Jewett A, Ogawa T. N-acetyl cysteine (NAC)-assisted detoxification of PMMA resin. J Dent Res. 2008 Apr;87(4):372-7. doi: 10.1177/154405910808700417. PMID: 18362322.
- McQueen G, Lally J, Collier T, Zelaya F, Lythgoe DJ, Barker GJ, Stone JM, McGuire P, MacCabe JH, Egerton A. Effects of N-acetylcysteine on brain glutamate levels and resting perfusion in schizophrenia. Psychopharmacology (Berl). 2018 Oct;235(10):3045-3054. doi: 10.1007/s00213-018-4997-2. Epub 2018 Aug 23. PMID: 30141055; PMCID: PMC6182588.
- Al-Shukaili A, Al-Abri S, Al-Ansari A, Monteil MA. Effect of N-acetyl-L-cysteine on Cytokine Production by Human Peripheral Blood Mononuclear Cells. Sultan Qaboos Univ Med J. 2009 Apr;9(1):70-4. Epub 2009 Mar 16. PMID: 21509278; PMCID: PMC3074764.
- Zivkovic AM, Telis N, German JB, Hammock BD. Dietary omega-3 fatty acids aid in the modulation of inflammation and metabolic health. Calif Agric (Berkeley). 2011 Jul;65(3):106-111. doi: 10.3733/ca.v065n03p106. PMID: 24860193; PMCID: PMC4030645.
- Zinkow A, Grodzicki W, Czerwińska M, Dziendzikowska K. Molecular Mechanisms Linking Omega-3 Fatty Acids and the Gut-Brain Axis. Molecules. 2024 Dec 28;30(1):71. doi: 10.3390/molecules30010071. PMID: 39795128; PMCID: PMC11721018.
- Dighriri IM, Alsubaie AM, Hakami FM, Hamithi DM, Alshekh MM, Khobrani FA, Dalak FE, Hakami AA, Alsueaadi EH, Alsaawi LS, Alshammari SF, Alqahtani AS, Alawi IA, Aljuaid AA, Tawhari MQ. Effects of Omega-3 Polyunsaturated Fatty Acids on Brain Functions: A Systematic Review. Cureus. 2022 Oct 9;14(10):e30091. doi: 10.7759/cureus.30091. PMID: 36381743; PMCID: PMC9641984.
- Cuciureanu MD, Vink R. Magnesium and stress. In: Vink R, Nechifor M, editors. Magnesium in the Central Nervous System [Internet]. Adelaide (AU): University of Adelaide Press; 2011. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507250/
- Papadopol V, Nechifor M. Magnesium in neuroses and neuroticism. In: Vink R, Nechifor M, editors. Magnesium in the Central Nervous System [Internet]. Adelaide (AU): University of Adelaide Press; 2011. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507254/
- Mousain-Bosc M, Siatka C, Bali JP. Magnesium, hyperactivity and autism in children. In: Vink R, Nechifor M, editors. Magnesium in the Central Nervous System [Internet]. Adelaide (AU): University of Adelaide Press; 2011. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507249/
- Martens PJ, Gysemans C, Verstuyf A, Mathieu AC. Vitamin D’s Effect on Immune Function. Nutrients. 2020 Apr 28;12(5):1248. doi: 10.3390/nu12051248. PMID: 32353972; PMCID: PMC7281985.
- Ye X, Zhou Q, Ren P, Xiang W, Xiao L. The Synaptic and Circuit Functions of Vitamin D in Neurodevelopment Disorders. Neuropsychiatr Dis Treat. 2023 Jul 3;19:1515-1530. doi: 10.2147/NDT.S407731. PMID: 37424961; PMCID: PMC10327924.
- Stagi S, Lepri G, Rigante D, Matucci Cerinic M, Falcini F. Cross-Sectional Evaluation of Plasma Vitamin D Levels in a Large Cohort of Italian Patients with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. J Child Adolesc Psychopharmacol. 2018 Mar;28(2):124-129. doi: 10.1089/cap.2016.0159. Epub 2017 Nov 7. PMID: 29112476.
- Çelik G, Taş D, Tahiroğlu A, Avci A, Yüksel B, Çam P. Vitamin D Deficiency in Obsessive-Compulsive Disorder Patients with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections: A Case Control Study. Noro Psikiyatr Ars. 2016 Mar;53(1):33-37. doi: 10.5152/npa.2015.8763. Epub 2016 Mar 1. PMID: 28360763; PMCID: PMC5353234.
- Prasad AS. Zinc in human health: effect of zinc on immune cells. Mol Med. 2008 May-Jun;14(5-6):353-7. doi: 10.2119/2008-00033.Prasad. PMID: 18385818; PMCID: PMC2277319.
- Powell SR. The antioxidant properties of zinc. J Nutr. 2000 May;130(5S Suppl):1447S-54S. doi: 10.1093/jn/130.5.1447S. PMID: 10801958.
- Mozaffar B, Ardavani A, Muzafar H, Idris I. The Effectiveness of Zinc Supplementation in Taste Disorder Treatment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Nutr Metab. 2023 Mar 8;2023:6711071. doi: 10.1155/2023/6711071. PMID: 36937245; PMCID: PMC10017214.
- Dash S, Syed YA, Khan MR. Understanding the Role of the Gut Microbiome in Brain Development and Its Association With Neurodevelopmental Psychiatric Disorders. Front Cell Dev Biol. 2022 Apr 14;10:880544. doi: 10.3389/fcell.2022.880544. PMID: 35493075; PMCID: PMC9048050.
