Pediatric Special Needs - PANDAS/PANS

PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcus) and PANS (pediatric acute-onset neuropsychiatric syndrome) are rare conditions that affect children and young adolescents, which produce a sudden change in a child’s typical behaviour, often following an infection (many parents report their child changed “overnight”). PANDAS/PANS develops when the body has an inappropriate immune response to an infection (frequently a “strep” infection but can involve other types of infections as well such as the flu, mononucleosis, or Lyme disease).

An autoimmune response causes the immune system to target the brain and nervous system, producing inflammation and irritation in specific parts of the brain that can affect behaviour, movement, mood, sensation, and thought processing. Although, PANDAS and PANS are triggered by an infection, the condition itself is not contagious.

Symptoms of PANDAS/PANS

Specific symptoms can vary significantly between individuals but there are two key highlights – a sudden onset of symptoms that often include obsessive or compulsive behaviours (or both).

Obsessive behaviour can include being fixated on specific things and needing things to be a particular way (e.g. tasks need to be performed in a specific order, toys need to be organized in a certain way), concerns about cleanliness and germs or other intense fears that are newly developed.
Compulsive behaviour can include specific rituals (e.g. frequent handwashing, touching/tapping things in a specific order or specific number of times, etc.) and repetition.

Children may be challenging to comfort, have severe difficulty stopping or changing their behaviour, and require a lot of repeated reassurances from others that things are being done “the right way”.

Other symptoms can include:
• Tics (repetitive or jerky movements, restlessness)
• Stuttering
• Increased sensory sensitivity (e.g. noise, touch, food textures, light, etc.)
• Mood swings
• Anxiety or new phobias
• Aggressive behaviour (rages or screaming)
• Hyperactive behaviour
• Changes in fine motor skills and coordination (e.g. difficulty writing, hand-eye coordination, etc.)
• Changes in attention, memory and learning skills
• Sleep disruption (e.g. bedwetting, insomnia, etc.).

The Naturopathic Medicine Approach

It is important to remember that not every child with some or all of the above symptoms have PANDAS/PANS which is why a thorough assessment is essential. This will include a detailed discussion about a child’s medical history and current symptoms as well as other aspects of a child’s health such as diet, sleep habits, energy level, cognition (focus and memory), learning skills, mood and mental well-being, amongst many other things. Although, there is currently no conclusive blood or neurological test to diagnose PANDAS/PANS, lab tests and medical assessments can still provide vital information – some of them may have already been performed by a pediatrician or other medical specialist or some may be recommended to you during your Naturopathic visit. All of the gathered information will assist with a diagnosis (of PANDAS, PANS or a completely different medical disorder) as well as a treatment plan.


Naturopathic medicine addresses each child as a unique individual with their own specific symptom picture and health needs. After a thorough assessment and relevant testing, a treatment plan will be tailored specifically for them and will be modified on an ongoing basis as changes and improvements are seen.

Treatment plans for PANDAS/PANS are usually collaborative and often involve many practitioners working as a team. A medical doctor may prescribe medication to manage the infection or behavioural symptoms, therapists/psychologists may use cognitive behavioural therapy or other techniques to treat OCD (obsessive compulsive disorder) & other behavioural symptoms, speech language therapists may help with stuttering, occupational therapists to help with fine motor skills or coordination, etc.

As a Naturopathic doctor, many different types of treatments can be utilized but the primary approach will involve reducing inflammation and re-balancing the immune system to stop the irritation of the brain and nervous system which are causing symptoms. Food intolerances often worsen inflammation so identifying and eliminating food triggers is often a part of the assessment (food sensitivity testing) and treatment plan. Naturopathic immune support can also assist with supporting the body to properly fight off strep and other types of infections which were the initial triggers. Nutritional deficiencies can often worsen certain symptoms so targeted supplementation may be of benefit. Various Naturopathic treatments may also address a child’s individual behavioural and physical symptoms (e.g. anxiety, sleep disruption, mood swings, etc.). Many PANDAS/PANS children using prescription pharmaceutical treatments can also experience side effects from them such as digestive upset, reduced appetite, mood changes, hyperactivity, and/or fatigue – integrating Naturopathic medicine can often reduce the side effects from those medications.

What is the prognosis for PANDAS/PANS?

Most children who are treated appropriately for PANDAS/PANS make a complete recovery; however, some children may have persistent symptoms or may experience “flares” with new infections.

Although PANDAS/PANS can be challenging and complex, there are numerous Naturopathic treatment options that may be helpful to improve or resolve symptoms and also to prevent future flares by supporting the overall health and well-being of the child.

Speak with our reception team to book a visit with Dr. Jennifer Yee who has expertise and experience in treating PANDAS/PANS.