PANS and PANDAS: Exploring the Link Between Bacterial and Viral Infections and Learning and Behavioral Disorders

Boy Crying

Does this sound familiar? One day, your child is happy and easy-going, playing with friends, and excelling at school. The next day, he wakes up acting possessed — crying, yelling, throwing tantrums.

Maybe you also notice he has an aversion to certain fabrics he wears, or foods that he used to enjoy. Then you discover that, seemingly overnight he has developed a learning disability and is struggling in school. And nothing you say or do has any effect; he’s just not as communicative as he once was.

What happened?

Here at Restoration Healthcare, we are hearing from more parents asking that question and telling us very similar stories of their child’s sudden and inexplicable transformation. Most have already taken their child to several doctors, none of whom has given them a satisfactory explanation for their child’s condition, or for that matter, presented any treatment options that help. Some families have suffered for months and even years without an answer.

So, what’s going on? In many cases, the child is suffering from a condition referred to as Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) or, more generally, Pediatric Acute-onset Neuropsychiatric Syndrome (PANS).

What Are PANS and PANDAS?

PANS and PANDAS are autoimmune conditions that impact the body’s central nervous system and disrupt normal neurological function. Autoimmunity occurs when the immune system mistakenly identifies the body’s own cells as pathogens (harmful bacteria and viruses) and then attacks them. In the case of PANS and PANDAS, the immune system attacks brain and nerve cells.

PANS is caused by a bacterial or viral infection that triggers an immune response. The immune system should respond, but in the course of its attack on the virus or bacteria, brain and nerve cells suffer collateral damage.

Theoretically, any infection can trigger an immune response resulting in PANS, but the following infections are thought to be primarily responsible:

  • Borrelia Burgdorferi (a tick-borne bacteria that causes Lyme disease)
  • Epstein Barr (the virus that causes “mono”)
  • Herpes simplex (the virus that causes herpes)
  • Influenza (any virus that causes the flu)
  • Mycoplasma pneumonia (“walking pneumonia”)
  • Streptococcus (the bacteria that causes “strep”)
  • Varicella (the virus that causes chickenpox and shingles)

PANDAS is a subcategory of PANS associated specifically with streptococcal infection. The PANDAS diagnosis was first, followed by PANS, at a time when doctors began seeing patients with the same symptoms with infections other than strep.

Symptoms of PANS and PANDAS

Patients with PANS or PANDAS typically experience a dramatic change in their health or behavior overnight or in a matter of days. Symptoms include the following:

  • Attention-deficit: Fidgeting, restlessness, poor concentration, hyperactivity.
  • Depression: Sadness or crying, social isolation, decreased interest in favorite activities, low energy, increased irritability, poor concentration, self-harming behavior.
  • Food restriction: Aversion to food or certain foods, loss of appetite, weight loss, or nutritional deficiencies from not eating enough or a variety of foods.
  • Impairment of fine motor skills: Including difficulty with drawing, handwriting, pronouncing words, imitating subtle facial gestures, or blowing bubbles.
  • Increased urination: Frequent urination during the day, wetting the bed at night, or both.
  • Obsessive-compulsive thoughts and behaviors: Recurring and distressing thoughts, sensations, or ideas (obsessive) and engagement in certain repetitive behaviors (compulsive) to provide relief from that mental distress.
  • Personality or mood changes: One day, a child who’s typically happy-go-lucky becomes irritable, angry, depressed, or moody. Some children may react uncharacteristically or disproportionately to a situation — for example, throwing a temper tantrum over a minor frustration.
  • Separation anxiety: Excessive fear/anxiety over being separated from parents, caregivers, siblings, or friends.
  • Sleep problems: Difficulty staying asleep or falling asleep.
  • Tics: Uncontrolled, repetitive movements (physical tics) or vocalizations such as grunts or repetition of words (vocal tics) — similar to symptoms of Tourette’s syndrome.
  • Changes in performance or behaviors at school: Grades are slipping or parents are receiving reports about uncharacteristic behavioral issues at school.

Two factors separate PANS and PANDAS from other conditions, such as obsessive-compulsive disorder (OCD), attention deficit disorder (ADD), eating disorders:

  • The sudden and unexplained onset of symptoms
  • The link to a bacterial or viral infection

Note: Infections are not always obvious. The infection may have occurred a long time before symptoms appear, or the child may have had an infection without exhibiting obvious symptoms. Bacteria and viruses can lie dormant in the body for many years after an active infection. PANS and PANDAS patients often test positive for bacterial or viral infection or for antibodies created to fight past infections.

PANS/PANDAS Diagnosis and Treatment

Here at Restoration Healthcare, we follow a functional medicine protocol to diagnose and treat PANS and PANDAS — Diagnose, Repair, and Optimize.

Step 1: Diagnose

Diagnosis of PANS/PANDAS involves conducting a thorough clinical evaluation of the patient and his or her medical history, listening closely to the parents, and testing for any active, dormant, or hidden infections. We may also order a lab test to check for biomarkers associated with brain inflammation.

Step 2: Treatment

Treatment involves fighting the infection, restoring immune system health and function, and reducing inflammation:

  • Fighting the infection: In the case of active infection, we may prescribe an antibiotic or antiviral medication or natural supplements that serve the same purpose. If necessary and helpful, we will coordinate our treatment with the patient’s primary care physician.
  • Restoring immune system health and function: The digestive system, and the beneficial bacteria and other microorganisms that reside there, play a key role in immune system health and function, so one component of treatment focuses on restoring gut health:
    • Repairing the lining of the gut
    • Restoring balance to the beneficial microorganism that inhabit the gut
    • Detoxing the body through a gentle, medically supervised detox protocol
    • Improving sleep to enable the body to repair and restore itself
  • Reducing inflammation: An overactive immune system causes inflammation. In the case of PANS/PANDAS, inflammation occurs in the brain and nerve cells. Restoring immune system health and function addresses the root cause of the inflammation, but additional treatments can be used to target the inflammation more specifically, such as the following:
    • Eliminating or reducing certain inflammatory foods from the diet, including sugar and other sweeteners, refined carbohydrates, trans fats, dairy, and gluten
    • Supplementing the diet with healthy oils
    • Using dietary supplements, such as quercetin and bromelain


As practitioners of functional medicine, we treat patients — not illnesses. Our objective is to optimize health, not merely eliminate ailments. To that end, we test for any nutritional deficiencies that may be getting in the way of our patient’s optimal health, and then we address those deficiencies. We also look for any other underlying issues that may be standing in the way of optimal health and fitness.

Preventing PANS/PANDAS

The key to preventing PANS or PANDAS, or any autoimmune disorder for that matter, is to support the immune system. The following factors negatively impact immune system health and function:

  • Increased exposure to toxins in our diet and environment
  • Any impairment to the body’s ability to detox itself
  • Gut dysbiosis — an imbalance of microorganisms in the intestines
  • Leaky gut, which is caused by damage to the lining of the intestines
  • Nutritional deficiencies
  • Insufficient physical activity (exercise)
  • Emotional and psychological stress
  • Poor sleep

Here are a few practical ways to support immune system health and function:

  • Eat healthy: Mostly plants (fresh veggies, fruits, nuts, and seeds) along with high-quality proteins and healthy fats. Avoid sugary foods and beverages, simple carbs, and artificial sweeteners, all of which contribute to inflammation and gut dysbiosis. Include fermented foods, such as unsweetened yogurt, kefir, and sauerkraut. Take a quality probiotic (we can recommend one). Avoid foods that trigger an immune response — we can help you identify those (they’re different for everyone).
  • Drink plenty of clean water: If your urine is dark yellow, you’re not drinking enough water.
  • Improve sleep: The body heals itself during sleep, so prioritize both sleep quantity and quality. Go old school — set a reasonable bedtime, and lights out when that time arrives, meaning lights out and no TV or other electronic devices.
  • Reduce stress: Emotional and physical stress impact children as well as adults. Seek ways to reduce stress and increase opportunities for relaxation.
  • Reduce exposure to toxins: Buy organic foods and eat lower on the food chain (more plants, less animal products); use natural cleaning products around the home; avoid nonstick pans; don’t use plastic water bottles, food containers, or tableware; avoid chemical pesticides; air out your home regularly; and spend more time in nature.

Getting Help for Your Child

If your child is exhibiting any of the symptoms described in this post and you have no clear and reasonable diagnosis or explanation for what has caused them, we urge you to consult with a functional medicine practice to examine your child from a different perspective. Your child may be suffering from PANS or PANDAS or another condition that conventional medical practitioners do not fully understand.

Even if PANS or PANDAS isn’t what is going on with your child, these symptoms are almost always the result of autoimmunity and its ugly twin, inflammation — each capable of impacting the central nervous system. Treatments are available to restore immune system health and function and reduce the inflammation. The sooner you act, the sooner your child will experience relief, and the better the outcome. Left untreated, these conditions can cause long-term health and developmental problems.

If a functional medicine practice is not an option, print this post and other articles and research papers about PANS and PANDAS and bring them with you to your child’s next doctor’s appointment. One way to start the conversation tactfully is to ask your child’s doctor whether he or she has considered the possibility of a PANS or PANDAS diagnosis. These conditions are recognized among practitioners of conventional medicine, but it’s possible that your child’s doctor may not be aware of them or may not have considered them as a possibility.


Disclaimer: The information in this blog post about Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is provided for general informational purposes only and may not reflect current medical thinking or practices. No information contained in this post should be construed as medical advice from the medical staff at Restoration Healthcare, Inc., nor is this post intended to be a substitute for medical counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this post without seeking the appropriate medical advice on the particular facts and circumstances at issue from a licensed medical professional in the recipient’s state, country or other appropriate licensing jurisdiction.