PANS/PANDAS Diagnosis in Children: What Parents Need to Know

Aug 4

My perspective as a parent, therapist, and nurse on the AAP’s 2025 updated recommendations on treating PANS/PANDAS in children

By Tyler Slay, LPC

Summary: If your child is struggling with severe, sudden-onset anxiety that your medical provider believes may be related to PANS/PANDAS, the American Academy of Pediatrics (AAP) currently only definitively recommends standard strep throat treatment with antibiotics plus specialized therapy for OCD, tics, anxiety, and restrictive eating from a qualified mental health provider. The AAP cautions against using IVIG infusions, steroids, NSAIDs, or extended antibiotic courses due to associated risks and a lack of strong evidence for effectiveness.

Whether your child’s symptoms stem from PANS/PANDAS or more typical OCD/anxiety, working with a mental health specialist trained in cognitive behavioral therapy (CBT) for OCD and anxiety is likely to benefit them in the long run. If your child is experiencing sudden-onset psychiatric symptoms after a recent illness or infection, the best path forward is to involve both a pediatrician and a therapist who specializes in anxiety and OCD.

What Does PANS/PANDAS Look Like?

If your child suddenly, almost overnight, develops obvious OCD symptoms, tics, or intense food restrictions, there’s a small chance they may meet the criteria for a clinical diagnosis of PANS/PANDAS.

Some of the hallmark symptoms include [1]:

Sudden onset of OCD (obsessive fears and compulsive behaviors)
Eating challenges, including severe restriction or even anorexia
Sensory sensitivities (clothes, sound, light)
Deterioration in handwriting or fine motor skills
Bedwetting or increased urinary frequency
Tics
Difficulty focusing, memory issues, or distractibility
Panic attacks or fears of things that weren’t previously distressing
Sudden separation anxiety or inability to sleep alone
Intense meltdowns or tantrums
Germ-related fears and other OCD-like symptoms

One helpful description phrases it this way:

“...a normally joyful, emotionally balanced, independent, and social child may turn into a child who has extreme temper tantrums, cannot leave a parent’s side without accommodation, and experiences panic attacks or unusual anxieties. In addition to the typical obsessional fears and compulsive behaviors, this may also include the sudden, severe onset of food avoidance, anorexia, or eating restrictions.” [1]

What Causes PANS/PANDAS?

PANS/PANDAS is a diagnosis of exclusion. This means there is no specific test that confirms it. It is often suspected when severe psychiatric symptoms emerge suddenly during or shortly after a strep infection. The leading theory is that, in certain cases, the body’s immune response to infection mistakenly targets areas of the brain, leading to abrupt-onset OCD or related symptoms.

Parents often report being able to name the exact day their child’s symptoms began. That’s quite different from the typical slow onset of anxiety or OCD, which tends to develop gradually over months or years. I describe OCD in more detail here, here, and here.

For context, most OCD in children appears between ages 9 and 10, but PANDAS can show up earlier, sometimes around ages 5 or 6, often coinciding with strep infection [1].

Some people believe other infections (besides strep) may also cause this response, but according to the AAP, evidence supporting those claims is limited. [3]

Anxiety disorders, OCD, tics, and restrictive eating are not rare in childhood. If your child develops these symptoms, it is far more likely that they are experiencing anxiety (possibly for the first time) than a rare autoimmune condition. I fully support medical treatment and believe in evidence-based care, but I also believe that most anxiety is not a medical problem. And even when it is triggered by a medical issue, long-term recovery rarely comes from medical solutions alone.

In some cases of true PANDAS, a standard course of antibiotics for strep may lead to a rapid improvement in symptoms. Your doctor may use this as a test: if the symptoms go away with antibiotics, the cause may be PANDAS. If not, it’s likely standard OCD or anxiety [2].

Regardless of the cause, the AAP emphasizes the importance of evidence-based mental health treatment, especially for OCD and anxiety. Even if a strep infection is treated successfully, the habits and fears can stick around in the form of residual OCD, so knowing how to address them through therapy is crucial.

What the AAP Now Recommends (2025 Update)

According to the American Academy of Pediatrics [3], many providers are going overboard with testing and treatments that may not help and could carry risks.

Unless your child has symptoms that suggest a broader medical issue beyond OCD, tics, or eating difficulties, extensive medical workups are generally not necessary. Your child’s pediatrician can help rule out other concerns, and you should work very closely with them to be sure that there is no other medical cause for their symptoms.

As of the 2025 update, the AAP makes two clear recommendations when PANS/PANDAS is suspected:

Strep testing and standard antibiotic treatment if a strep infection is diagnosed or suspected
Specialized therapy for OCD, anxiety, tics, or restrictive eating

Notably, the AAP does not recommend IVIG infusions, steroid treatments, prolonged antibiotic courses, or long-term NSAID use unless other conditions are present and justified by a physician.

Specifically, the AAP report states, “Most children with OCD, tics, and/or other neuropsychiatric symptoms likely have conditions unrelated to PANS. Even when PANS is strongly considered, psychosocial, behavioral, and psychiatric therapies are effective and should be first-line therapies for children with PANS. In addition, a 10-day course of amoxicillin or other recommended antibiotic should be administered to children who have a positive test result for an acute, symptomatic GAS throat infection. There is no strong evidence to support the use of other treatments.” [3]

What Parents Should Do Next

If your child is experiencing sudden, severe anxiety or OCD-like symptoms, the most helpful steps you can take are:

See your pediatrician for a strep test and evaluation. They will know what additional tests they want to run if a simple throat swab is negative.
Begin therapy with a mental health provider who specializes in OCD and anxiety in children (especially someone trained in Exposure and Response Prevention)

Delaying therapy in hopes of a medical fix can prevent your child from developing the skills they need to manage fears, reduce distress, and return to a more typical developmental path.

The good news is that OCD and anxiety treatment, especially Exposure and Response Prevention, works for a high percentage of kids. With the right support, your child can come out of this stronger, more resilient, and more confident.

Sources:

[1] International OCD Foundation: PANDAS

[2] UpToDate: PANDAS – Pediatric autoimmune neuropsychiatric disorder associated with group A streptococci

[3] AAP 2025 Guidelines – Pediatrics Journal

About Tyler Slay

Tyler Slay, LPC, is a licensed professional counselor based in Madison, Mississippi. He specializes in treating Obsessive-Compulsive Disorder (OCD), anxiety disorders, and trauma. Tyler offers Christian counseling for clients who want therapy to align with their faith or who are seeking a faith-integrated approach to mental health.

He has completed advanced training through the International OCD Foundation and uses evidence-based treatments including Exposure and Response Prevention (ERP), Cognitive Behavioral Therapy (CBT), and Acceptance and Commitment Therapy (ACT).

Tyler provides therapy for children, teens, and adults across Mississippi, both in person and via telehealth. He also works with clients struggling with perfectionism, boundary-setting and assertiveness, family conflict, pornography, anger, failure to launch, relationships, depression, autism (Asperger’s), social skills, tics, PANS/PANDAS, body dysmorphic disorder (BDD), and body-focused repetitive behaviors (BFRBs), including skin picking & hair pulling disorders.

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