PANDAS: Understanding a rare but serious childhood condition

Pandas, the black-and-white bears, are often seen as cuddly, harmless creatures. But in reality, they’re strong, territorial and capable of doing serious damage when provoked.

The same goes for PANDAS—not the animal, but a rare condition in children that can be just as surprising and serious. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) can turn a typical strep throat into something much more alarming: a sudden and dramatic change in a child’s behavior, mood and movement.

While it may sound far-fetched, this medical condition can cause children to develop obsessive-compulsive behaviors, anxiety, tics and other neurological symptoms, seemingly overnight.

What is PANDAS?

PANDAS is a condition in which a child’s immune system mistakenly attacks healthy brain tissue, particularly in the basal ganglia, the part of the brain that helps control movement and behavior. This abnormal immune response often occurs after a group A streptococcal infection, such as strep throat or scarlet fever.

The result? A sudden and dramatic onset of symptoms that can resemble obsessive-compulsive disorder (OCD), anxiety disorders or tics.

How common is PANDAS?

PANDAS is considered rare, though exact numbers are difficult to track due to underdiagnosis and misdiagnosis. The PANDAS Network estimates that PANDAS will affect roughly 0.5% of children. However, awareness among pediatricians and mental health providers is still growing, which means many cases may be overlooked or attributed to other causes.

Signs and symptoms

PANDAS symptoms typically appear very suddenly, often overnight, and are a stark change from a child’s normal behavior. Key signs include:

Behavioral and emotional changes

• Obsessive thoughts or compulsive behaviors
• Severe separation anxiety
• Mood swings or emotional outbursts
• Irritability or aggression
• Depression or suicidal thoughts
• Sudden onset of fears or phobias

Neurological symptoms

• Motor or vocal tics (such as blinking, grunting, or shoulder shrugging)
• Deterioration in handwriting or fine motor skills
• Hyperactivity or attention difficulties
• Sleep disturbances
• Changes in eating habits, including food restriction or fear of choking

Physical clues

• Frequent urination or bedwetting
• Joint pain
• Sensory sensitivities
• History of recent strep infection (often within 4–6 weeks of symptom onset)

Diagnosis and testing

No single test confirms PANDAS, which makes diagnosis challenging. Doctors typically rely on the following information to help with diagnosis:

• A detailed clinical history
• Evidence of the sudden onset of symptoms
• Recent or recurring strep infections
• Ruling out other conditions like Tourette’s, anxiety disorders or autoimmune diseases

In some cases, providers may also recommend blood tests to look for strep antibodies or throat cultures to detect ongoing infection.

Treatment options

Treatment usually involves a multi-pronged approach.

Antibiotics - If a strep infection is still active, antibiotics such as penicillin or amoxicillin are the first line of treatment. Even in children without current strep, a course of antibiotics may be prescribed to reduce lingering bacteria and inflammation.

Immune-Modulating Therapy - In severe or persistent cases, treatments that calm the immune system may be considered.

• Steroids to reduce brain inflammation
• IVIG (intravenous immunoglobulin)
• Plasmapheresis,  a procedure that filters harmful antibodies from the blood

Psychiatric and Behavioral Support - Cognitive behavioral therapy, medications for anxiety or OCD and school accommodations may help children manage symptoms while their immune system recovers.

Tonsillectomy - In children with frequent strep infections, removing the tonsils may be considered to reduce the risk of future flare-ups.

Long-term effects and prognosis

The good news is many children recover completely, especially when PANDAS is diagnosed and treated early.

However, without treatment, symptoms can become chronic and disruptive. Some children experience relapses with each new strep exposure, and in rare cases, symptoms can persist into adolescence or adulthood.

Early intervention gives children the best chance at full recovery. With proper medical care, most children return to their baseline functioning within months, though follow-up and monitoring are often needed.

When to seek help

If you notice any of the following, seek medical attention for your child:

• Sudden and unusual behavior changes
• Tics or obsessive behaviors that seem to appear overnight
• A pattern of behavioral symptoms following strep infections

SIU Medicine’s pediatric and behavioral health teams are here to help. Call 217.545.8000 or visit siumed.org to schedule an evaluation. Providers in our Express Care clinic are also able to test for illnesses such as strep, prescribe treatments and offer advice on your next steps for care.