If your child changed almost overnight after a strep infection or other illness, PANDAS or PANS may be the reason, and it is treatable.
Many parents describe it the same way. One week their child was happy and easygoing. The next, they were washing their hands until they bled, refusing food, melting down at bedtime, or blinking and grunting with tics they never had before. Some parents can name the exact day they "lost" their child.
If that sounds familiar, you are not imagining it, and you are not alone. Here is what Virginia parents should know, and how we approach PANS and PANDAS at Exodus Wellness.
What are PANS and PANDAS?
PANS and PANDAS are conditions where an infection or other trigger sets off an immune and inflammatory reaction that affects the brain, causing sudden psychiatric symptoms.
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is the broader diagnosis. It means a sudden, dramatic onset of OCD or severely restricted eating, plus at least two other new neuropsychiatric symptoms that appear just as suddenly. (PANDAS Physicians Network)
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is a subset of PANS tied specifically to strep. It involves sudden OCD and/or tics, often complex or unusual ones, that follow a strep infection. (PANDAS Physicians Network)
Strep is the classic trigger, and not only strep throat. Perianal strep, a sibling with strep, or a recent illness with fever, headache or stomach pain should all be considered as potential streptococcal infections. But many other infections can set off PANS, and in our practice we look for all of them:
Bacteria: strep (group A), Mycoplasma pneumonia, sinus infections
Viruses: influenza, HSV, HHV-6, EBV, CMV, chickenpox, measles, mumps or rubella, parvovirus and COVID
Tick-borne infections: Lyme (Borrelia), Bartonella and Babesia
Fungal and environmental: Candida (yeast), mold and mycotoxins, and other toxins
Stress doesn't cause PANS, but it can make symptoms worse. (PANDAS Physicians Network)
There is no single blood test that confirms either condition. Diagnosis is clinical: it rests on the history, the timing of symptoms, and ruling out other causes. (PANS Consensus Statement) Timing matters most. When symptoms build gradually over months rather than days, we look harder at other explanations.
Conditions that can look similar and need to be considered include:
Rheumatic fever and Sydenham chorea
Lyme disease and mold illness
Lupus and other autoimmune or vasculitis conditions
Primary OCD, other mental health conditions, or eating disorders
Rarer causes such as tumors, stroke, medication or drug effects, abuse or trauma
Signs to watch for
The hallmark is speed: a clear "before and after" that you can usually pin to a specific day or week. Sudden OCD, food restriction or severe anxiety in a child should always raise the question of PANS or PANDAS.
The main symptoms:
Sudden OCD. In kids this often looks like handwashing, contamination fears, checking, counting, touching or tapping rituals, rituals at doorways or light switches, hoarding, needing things "just right," looping thoughts, or constant apologizing, confessing and asking for reassurance.
Sudden food restriction. Refusing to eat, or eating only a few foods out of fear of choking, vomiting or contamination.
New tics. Motor or vocal tics, especially complex or unusual ones.
They usually arrive with at least two of these:
Separation anxiety, social anxiety or irrational fears
Mood swings, crying spells or depression
Irritability, rage, aggression or severe defiance
Regression: baby talk, tantrums, acting much younger
A drop in school performance, especially math and visual-spatial skills, often looking like new ADHD
Sensory and motor changes: worse handwriting, sudden trouble tolerating clothing or tags
Urinary urgency, frequency or new bedwetting
Trouble falling asleep, restless sleep or unusual nighttime movements
These symptom categories come from the published PANS consensus criteria. (J Child Adolesc Psychopharmacol, via PMC) Symptoms also tend to come and go in flares, often after a new infection.
Why PANDAS is often missed in Virginia
Virginia has recognized the problem officially, but care is still hard to find. The state created a PANDAS/PANS Advisory Council to advise the Health Commissioner, and the Council has reported that Virginia lacks a full system of care for these families. It also found that many providers need more training, and that parents, educators and the public know little about these conditions. (Virginia PANDAS/PANS Advisory Council report)
The General Assembly has extended the Council through 2028, and Virginia marks October 9 as PANS/PANDAS Awareness Day. (Office of the Governor)
In practice, that means many children are given a label like OCD, anxiety, ADHD or an eating disorder, and treated for the symptoms alone. The sudden onset, the link to a recent illness, and the cluster of new symptoms together are what point to the underlying cause.
How a functional medicine approach helps
The goal is to treat the cause of the brain inflammation, not just quiet the symptoms. At Exodus Wellness, we use a root-cause approach with four parts working together:
Find and clear the trigger, whether strep, a virus, Mycoplasma, a tick-borne infection or mold.
Calm the immune system and inflammation in the brain and body.
Heal the gut and rebuild the foundations. About 70% of the immune system lives in the gut, so we use stool and microbiome testing to see what your child's gut needs, then restore balance alongside key nutrients, sleep and movement.
Support your child day to day with tools for OCD, anxiety, sleep and school while they heal.
These parts build on each other. Clearing a trigger works better when inflammation is calm and the gut is healthy, and a child who is sleeping and eating well can heal faster.
How we evaluate your child
A detailed history: when symptoms started, what came before, and how your child has changed.
Targeted lab testing: to look for infections, inflammation, immune function and nutrient needs.
Advanced testing when needed: including gut and microbiome, mold, tick-borne illness and genomic testing for complex cases.
Ongoing reassessment: we track how your child responds and adjust the plan as they heal.
Planning for flares
PANS and PANDAS often relapse and remit, so care is long-term. We help you spot early flare signs, respond quickly when your child gets sick, and build immune resilience over time. Every plan is individualized and coordinated with your child's other providers.
What you can do right now
Start by writing down what changed and when, because the timeline is the most important clue.
Write the timeline. Note the date symptoms started, what they were, and any illness in the weeks before: sore throat, fever, a cold, a tick bite, a move to a new home or school.
Ask about a strep test. If symptoms appeared after a sore throat, or if a sibling had strep, ask your pediatrician to test. Strep can also hide with few throat symptoms.
Save school and video evidence. Handwriting samples, report cards and short videos of tics or rituals help a clinician see the change.
Don't wait it out. Earlier treatment is generally recommended, because untreated cases can become long-term. (Contact UK)
Find a clinician who knows PANS/PANDAS. Ask whether they evaluate for infection and inflammation, not only psychiatric symptoms.
If your child is not eating or drinking, talks about harming themselves, or is in danger, seek emergency care right away.
Frequently asked questions
Can strep cause sudden OCD in a child? Yes, in some children. In PANDAS, a strep infection triggers an immune reaction that is thought to cause brain inflammation, leading to sudden OCD or tics.
What is the difference between PANS and PANDAS? PANDAS is linked specifically to strep. PANS is the broader term and can follow other triggers, such as viruses, Mycoplasma, Lyme and other tick-borne infections, or mold exposure.
Is there a test for PANDAS? No single test confirms it. Diagnosis is based on the history and symptom pattern. Labs help find triggers and rule out other causes.
Can PANDAS look like ADHD? Yes. New trouble focusing, hyperactivity, memory problems and worse handwriting are common, so a sudden "ADHD" picture deserves a closer look.
Can kids recover from PANS/PANDAS? Many children improve significantly with treatment that addresses infection, inflammation and symptoms together. Flares can happen, so ongoing care matters.
Do I need to live near a specialist? Not necessarily. Exodus Wellness sees Virginia families by telehealth, and labs can be drawn locally.
Get help for your child in Virginia
If your child changed suddenly and nobody has explained why, book a free discovery call with Exodus Wellness. We provide telehealth pediatric functional medicine for children from birth through age 22, including evaluation and care for PANS and PANDAS. Our training includes mentorship with Dr. Nancy O'Hara and fellowship with the Medical Academy of Pediatric Special Needs (MAPS).
This article is for education only and is not medical advice. Talk with your child's healthcare provider before starting or changing any treatment.