When a child suddenly changes becoming anxious, obsessive, aggressive, withdrawn, or regressing in their skills it can be frightening and overwhelming. For many families, PANS (Paediatric Acute-onset Neuropsychiatric Syndrome) or PANDAS (a subset linked to streptococcal infection) may be part of the explanation.
Nutrition and Inflammation
Emerging evidence suggests that neuroinflammatory conditions like PANS/PANDAS may be influenced by diet. Supporting immune function and reducing inflammation through nutrition is a helpful place to start.
Recommended dietary approaches include:
- Increasing anti-inflammatory foods (oily fish, leafy greens, berries, olive oil, turmeric)
- Avoiding ultra-processed foods and added sugars
- Considering omega-3 supplementation (under professional guidance)
- Exploring the impact of gluten and dairy removal, if tolerated and indicated
- Being alert to signs of histamine intolerance (e.g. worsened symptoms after aged or fermented foods)
Consulting a paediatric dietitian or functional nutritionist familiar with neuroimmune conditions can be especially useful.
Emotional and Sensory Support
Flare-ups may lead to dramatic emotional and behavioural shifts. Children may display obsessive-compulsive behaviours, tics, rage, separation anxiety, or regression. These are neurological symptoms, not character flaws.
Supportive strategies at home might include:
- A calm down space with sensory tools (weighted blankets, fidget items, visual emotion charts)
- Structured daily routines to reduce anxiety
- Gentle validation of fears, without reinforcing them
- Reducing overstimulation (noise, light, screens during flares)
Parents may need emotional support themselves. Connecting with other families or trained counsellors can be protective.
At School: Advocacy and Practical Adjustments
PANS and PANDAS are often misunderstood in educational settings, where children may appear well but struggle with attention, behaviour, or attendance. Educating school staff and securing appropriate accommodations is crucial.
Working with the SENCo or SEND Team
In the UK, children with PANS or PANDAS may qualify for:
- A Special Educational Needs (SEN) support plan
- An Education, Health and Care Plan (EHCP) if needs are complex and ongoing
Recommended accommodations include:
- Reduced workload and homework expectations during flares
- Use of a “time out” or quiet space
- Flexibility with attendance and punctuality
- Access to a teaching assistant during transitions or emotionally charged periods
- Sensory supports: noise-cancelling headphones, fiddle tools, visual schedules
Regular review meetings can help track progress and adjust support over time.
Communicating with Staff
Simple, one-page pupil profiles or briefings can help teachers understand the condition. These might include:
- A summary of the diagnosis and typical symptoms
- Signs of flare ups and what helps
- Triggers to avoid
- Emergency response plans (e.g. for meltdowns or sudden distress)
Approaching staff as allies not adversaries often leads to better outcomes for everyone involved.
Understanding Medical and Post-Infectious Triggers
There is growing scientific recognition that PANS/PANDAS may be part of a broader picture of post-infectious neuroinflammation. This includes post-COVID immune responses in some children.
A 2024 review in Paediatric Autoimmune Review noted shared immunological mechanisms between PANS/PANDAS and post-viral syndromes, including Long COVID. If a child developed symptoms after an infection (including COVID 19), clinicians should consider a post-infectious neuroimmune process.
In such cases, referral to a paediatric neurologist, immunologist, or specialist in post-viral syndromes is recommended.
Medical Approaches and Therapeutic Support
Treatment Pathways
Treatment for PANS or PANDAS is typically multi-modal. According to emerging clinical guidelines and expert consensus, approaches may include:
- Antibiotics, if bacterial triggers (particularly Group A strep) are identified
- Anti-inflammatory agents such as ibuprofen (short-term, under supervision)
- Immunomodulation, including corticosteroids or IVIG, in selected cases
- Treatment of co-infections, where Lyme disease, mycoplasma, or viruses are involved
Specialist oversight is essential. Some interventions carry risks if used inappropriately or at the wrong stage.
Therapeutic Recovery
Once acute symptoms are stabilised, many children benefit from:
- Occupational Therapy for sensory processing issues
- Educational psychology input to rebuild learning confidence
These therapies are more effective once inflammation is under control.
What Tests Might Be Useful?
While no single test confirms PANS or PANDAS, the following investigations may be considered:
- ASO titre and anti-DNase B (to check for streptococcal exposure)
- CRP and ESR (general inflammation markers)
- Vitamin D and zinc levels
- Immunoglobulin profiles and autoimmune panels
- Tick-borne disease screening, if Lyme is a concern
Testing should be guided by a paediatrician or immunologist familiar with neuroimmune disorders.
When to Refer: Signs That Require Specialist Input
Consider referral to a specialist if:
- Symptoms appeared abruptly and dramatically
- There is evidence of regression, OCD, tics, or school refusal
- Symptoms worsen after infections or vaccinations
- There is a family history of autoimmunity or neuropsychiatric illness
- Basic interventions have not improved symptoms within weeks
Clinics with experience in PANS/PANDAS and postviral syndromes are best placed to manage complex cases.
Final Thoughts
Supporting a child with PANS or PANDAS can be emotionally and physically exhausting. For parents, this may mean years of advocacy, misunderstood symptoms, and frustration with fragmented systems. For professionals, it may mean navigating a poorly defined diagnostic category while trying to do what’s best.
What’s clear is this: these children are not “just anxious” or “just naughty”. They are often in the grip of a neurological and immunological firestorm. When parents, teachers, and doctors work together, outcomes improve.
Stay curious. Stay kind. Keep going.
Selected Resources:
- PANS PANDAS UK – Advocacy, information and UK medical directory
- Long COVID Kids – For families dealing with post-viral complications
- Royal College of Paediatrics and Child Health – Policy updates and clinical guidance
Disclaimer :
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified healthcare providers with any questions you may have regarding a medical condition.
Long Covid Journey 