Author: angelahenrylcsw@gmail.com

If you’re a parent or caregiver, nothing can be more overwhelming than watching your child suddenly change—seemingly overnight. One day they’re their usual self, and the next, they’re anxious, moody, or engaging in repetitive behaviors that feel out of the blue. If this sounds familiar, you may have heard the term PANS, which stands for Pediatric Acute-Onset Neuropsychiatric Syndrome. In this blog, we’ll walk you through what PANS is, what it can look like in children, and what families can do to navigate this challenging but treatable condition. What Is PANS? PANS is a condition that appears in children and is marked by the sudden onset of serious neuropsychiatric symptoms, most commonly obsessive-compulsive behaviors (OCD), anxiety, and other emotional or behavioral changes. What sets PANS apart from other childhood disorders is just how quickly these symptoms come on—often within a day or two. Researchers believe PANS may be linked to the immune system, particularly how it responds to infections or environmental triggers. In some cases, the body’s defense system mistakenly targets healthy areas of the brain, causing inflammation that affects thinking, mood, and behavior. What Are the Symptoms? The symptoms of PANS can vary from child to child, but common signs include: Obsessive-compulsive behaviors (e.g., repetitive checking, handwashing, or intrusive thoughts) Severe anxiety or mood swings Sudden academic difficulties or trouble concentrating Sensitivity to light, sound, or touch Physical complaints like frequent urination, joint pain, or fatigue Developmental regression (e.g., talking like a younger child, needing help with tasks they used to do independently) Psychotic symptoms like hallucinations or disorganized thinking (in more severe cases) Sleep disturbances or night-time fears These changes can be distressing for both the child and their family. But the good news is that with the right help, symptoms can be managed and children often improve over time. What Causes PANS? PANS is believed to be triggered by a combination of factors: Infections – Especially Group A Streptococcus (the bacteria that causes strep throat), as well as other bacterial or viral illnesses Environmental stressors – Emotional trauma or exposure to toxins may also play a role Immune system dysfunction – An autoimmune reaction that causes inflammation in the brain The complexity of PANS suggests it’s not caused by just one thing, but rather a combination of triggers that affect a child’s nervous system. How Is PANS Diagnosed? Diagnosing PANS can be challenging because it shares symptoms with other conditions like OCD, anxiety disorders, ADHD, or even autoimmune encephalitis. Doctors typically rely on: Thorough medical history and symptom review Neurological and psychological evaluations Lab tests to rule out infections or inflammation Imaging (like MRI) or EEG in some cases, to look for signs of brain inflammation Because there’s no single test for PANS, it’s essential to work with a provider who is experienced in pediatric neuropsychiatric conditions. How Is PANS Treated? Treating PANS involves addressing both the symptoms and the underlying triggers. Here’s what a care plan might include: Medical Treatment Antibiotics or antivirals to treat any active infections Anti-inflammatory medications or, in some cases, immune-modulating therapies like steroids or IVIG (intravenous immunoglobulin)  Psychological Support Cognitive Behavioral Therapy (CBT) to help manage OCD and anxiety Medications (e.g., SSRIs) may be used carefully under guidance, especially if symptoms are severe Family Education and Support Teaching families what to expect and how to respond to flares Behavioral strategies to support the child at home and at school Ongoing Monitoring Because symptoms can come and go, regular follow-ups help adjust treatment and provide reassurance to families during tough times Why It Matters to Get the Right Diagnosis PANS can look a lot like other disorders, but the sudden onset and immune connection set it apart. Understanding the difference is important because treatment for PANS often goes beyond standard psychiatric care. It also helps families feel seen and supported—because when you have an explanation for what’s going on, it’s easier to move forward with confidence and hope. Final Thoughts PANS is real, and it is treatable. With early recognition, comprehensive care, and strong family support, many children recover or see significant improvement. While there is still much to learn, ongoing research continues to improve how we understand, diagnose, and manage this condition. If your child is showing sudden, intense behavioral changes—trust your instincts and seek out knowledgeable care. You are not alone on this journey, and with the right team and information, healing is possible. For more resources or to speak with a provider experienced in PANS/PANDAS, reach out to your pediatrician or a local neuroimmune specialist. Source: Masterson, E. E., Miles, K., Schlenk, N., Manko, C., Ma, M., Farhadian, B., Chang, K., Silverman, M., Thienemann, M., & Frankovich, J. (2025). Defining clinical course of patients evaluated for pediatric acute-onset neuropsychiatric syndrome (PANS): phenotypic classification based on 10 years of clinical data. Developmental Neuroscience, 1–33. https://doi.org/10.1159/000545598

Understanding Symptom Cycles in Pediatric Neuroimmune Disorders As clinicians and caregivers working with children affected by PANS and PANDAS, it’s common to hear the phrase: “My child is in a flare.” But what does a flare actually mean in the context of these conditions? And how can we respond when a child is going through one? Thanks to growing research—particularly from the team at Stanford’s Immune Behavioral Health (IBH) Clinic—we now have better data to help define and understand this phenomenon. When we know better, we do better—so let’s take a closer look at what a PANS or PANDAS flare involves and how this evolving research can inform our clinical and caregiving decisions. For more foundational information about PANS and PANDAS, you can refer to this published article. Why Terminology Matters Clear, standardized terminology is crucial when diagnosing and managing conditions like PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome), which often present without clear biological markers. Inconsistencies in language can lead to confusion among clinicians, caregivers, and researchers, making it harder to design effective treatment plans or study outcomes. Just like in other inflammatory or immune-mediated conditions, having a common language helps guide better research, clinical decisions, and support. How the Definition of a “Flare” Was Studied The Stanford IBH Clinic conducted a longitudinal study involving 264 pediatric patients who had their first clinical encounter between September 2012 and March 2022, with follow-up data collected through July 1, 2023. Children were diagnosed with PANS based on sudden onset of OCD and/or severe eating restrictions, along with additional neuropsychiatric symptoms. In cases of PANDAS, sudden OCD and/or tics were observed alongside similar neurological and behavioral changes. Clinician and caregiver reports, psychometric assessments, and symptom severity scores were analyzed to help track symptom patterns and long-term trajectories. What Did the Study Reveal About Flares? Flare Duration and Frequency Average flare duration: 3.7 to 4.1 months 95% of flares resolved within one year 77% of patients experienced multiple flares within 5 years of their initial onset 43% had flares lasting more than 12 months The study emphasized a highly variable course among patients: some experienced only one flare, while others followed a relapsing-remitting pattern, and a smaller subset had persistent symptoms. What Do Flares Look Like Clinically? Flares are typically marked by a sudden worsening or reappearance of neuropsychiatric symptoms, including: Obsessive-compulsive behaviors Tics Anxiety or emotional lability Behavioral regression Motor or sensory changes Importantly, many children show early flare-like symptoms before officially meeting diagnostic criteria for PANS. This underscores the need for vigilance—clinicians and caregivers must be attuned to even subtle symptom shifts. Clinical Course Classifications Based on their findings, researchers proposed terminology to classify the clinical course of PANS: Single Flare: One flare followed by sustained recovery Relapsing-Remitting (RR): Recovery from the initial flare followed by one or more recurrences These classifications help standardize how we talk about disease progression and improve care planning across the board. Why This Matters for Clinical Care Understanding that many patients experience a relapsing-remitting course—even years after the first flare—reinforces the importance of long-term monitoring, flexible treatment approaches, and family education. The study also encourages clinicians to adopt more precise language when describing symptom trajectories and flare-ups, which can lead to more effective communication and individualized care. Looking Ahead: Research and Refinement The next steps for research include: Clarifying definitions of flares, recovery, and functional impact Investigating the relationship between flare duration and quality of life Developing validated biological markers for diagnosis and treatment tracking Until then, studies like this one serve as essential tools in deepening our understanding of PANS/PANDAS and strengthening how we support affected children and their families. In Summary PANS and PANDAS flares represent more than temporary setbacks—they are critical indicators of disease activity that require close attention and coordinated care. As the field continues to evolve, embracing standardized terminology and research-based classifications can help clinicians and caregivers respond more confidently and compassionately. By understanding what a flare is and how it fits into the broader clinical picture, we can take informed, supportive steps—together.