Red Flags of PANS/PANDAS Syndrome: When to Suspect an Autoimmune Cause of Neuropsychiatric Symptoms in a Child
Material prepared based on the presentation by Volodymyr Stefanyshyn
“Modern Approaches to the Diagnosis of PANS/PANDAS Syndrome”.
What Are PANS and PANDAS?
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a pediatric neuropsychiatric syndrome with an acute onset characterized by the sudden appearance of obsessive-compulsive symptoms (OCD) and/or significant eating disturbances combined with other neuropsychiatric manifestations.
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is a subgroup of PANS associated with streptococcal infection.
PANS/PANDAS syndromes remain insufficiently recognized among physicians and parents, which is why many children receive treatment for individual symptoms for years without identifying their true underlying cause.
Main Red Flag #1: Sudden Onset of Symptoms
The most important sign of PANS/PANDAS is not a gradual progression, but rather the abrupt emergence of symptoms within a few days or even hours.
Parents often describe it as follows:
“Yesterday my child was completely normal, and today it feels like someone else has taken their place.”
Particular concern should be raised by:
- sudden development of obsessive-compulsive symptoms;
- abrupt food restriction;
- acute deterioration in behavior or emotional state;
- rapid decline in academic abilities.
Red Flag #2: New or Dramatically Increased Obsessions and Compulsions
OCD is one of the key diagnostic criteria for PANS/PANDAS.
A child may suddenly develop:
- compulsive hand washing;
- repeated checking of doors, locks, or belongings;
- a need to count objects;
- an excessive need for order and symmetry;
- constant repetition of the same questions;
- ritualistic behaviors during everyday activities.
It is important to remember that a significant proportion of rituals may go unnoticed by others because they occur mentally.
Red Flag #3: Sudden Changes in Eating Behavior
Eating disturbances are the second leading symptom of PANS/PANDAS after OCD.
Warning signs include:
- sudden narrowing of the diet;
- fear of swallowing;
- fear of vomiting;
- fear of poisoning or contamination through food;
- avoidance of certain textures or smells;
- significant loss of appetite;
- rituals associated with eating.
In some children, dietary restrictions may become so severe that they pose a threat to health and require immediate intervention.
Red Flag #4: Severe Anxiety and Separation Anxiety
PANS/PANDAS is often associated with the onset or sudden worsening of:
- generalized anxiety;
- separation anxiety from parents;
- an excessive need for constant reassurance and safety;
- panic reactions in routine situations.
Such anxiety often appears disproportionate to the child’s age and arises without an obvious cause.
Red Flag #5: Sensory Hypersensitivity
Children may suddenly become highly sensitive to:
- sounds;
- smells;
- tastes;
- clothing textures;
- touch;
- bright light.
As a result, they may experience difficulties with:
- brushing their teeth;
- wearing clothing;
- riding in a car;
- eating meals.
Red Flag #6: Tics and Motor Disturbances
Children with PANS/PANDAS may develop:
- excessive blinking;
- facial muscle twitching;
- vocal tics;
- clumsiness;
- changes in handwriting;
- other motor abnormalities.
An especially important warning sign is a sudden deterioration in handwriting, which is often noticed by parents and teachers even before a diagnosis is established.
Red Flag #7: Developmental Regression
A child may temporarily lose skills that had already been well established.
Possible manifestations include:
- uncharacteristic dependence on parents;
- reverting to more childish behavior;
- tantrums;
- difficulties with self-care;
- increased fear of being alone.
Red Flag #8: Sudden Decline in Academic Performance
Common signs include:
- reduced attention and concentration;
- memory problems;
- slower information processing;
- difficulties with mathematics;
- declining school performance;
- changes in handwriting and graphomotor skills.
If a previously successful student suddenly begins to fall significantly behind in school without an obvious reason, PANS/PANDAS should be considered.
Red Flag #9: Dramatic Mood Swings and Rage Episodes
PANS/PANDAS flare-ups may be characterized by:
- irritability;
- emotional lability;
- depressive symptoms;
- anger;
- sudden rage episodes;
- rapid mood changes over a short period of time.
Parents often describe this behavior as “not like my child at all.”
Red Flag #10: Urinary and Sleep Disturbances
Sometimes these symptoms are the primary reason for seeking medical attention.
Warning signs include:
Urinary Disturbances
- frequent urination urges;
- polyuria;
- daytime enuresis;
- nighttime enuresis after a period of complete bladder control.
Sleep Disturbances
- difficulty falling asleep;
- frequent awakenings;
- parasomnias;
- restless sleep.
When Is It Essential to Consult a Specialist?
A specialist consultation is recommended if:
- symptoms appeared suddenly;
- several of the described manifestations developed at the same time;
- an infection preceded the deterioration (streptococcal throat infection, viral respiratory infection, influenza, COVID-19, mycoplasma infection, etc.);
- tics, handwriting changes, or developmental regression are observed;
- standard psychiatric or psychological treatment does not produce the expected effect.
How Is PANS/PANDAS Diagnosed at Vivere Clinic?
VIVERE CLINIC has developed an exclusive PANDAS Check-Up — a standardized diagnostic program created on the basis of clinical experience to identify streptococcal triggers, assess neuroimmune mechanisms, and determine further patient management strategies.
In general, the diagnostic process includes:
- A detailed analysis of symptoms and medical history.
- Physical examination.
- Assessment of possible infectious triggers.
- Laboratory evaluation of the immune system.
- Additional instrumental examinations to rule out other causes of symptoms.
Important: PANS/PANDAS is a clinical diagnosis that requires a comprehensive evaluation of the child by a multidisciplinary team. Early recognition of red flags allows healthcare providers to identify the cause of symptoms more quickly and begin appropriate treatment.
Useful Resources:
Recording of the presentation “Red Flags of PANS/PANDAS Syndrome – Diagnostic Criteria for Parents”
https://www.youtube.com/watch?v=KLz3SRW7dfA.
Recording of the interview “PANS/PANDAS in Children: Symptoms, Diagnosis, Treatment. What Is Really Happening in a Child’s Brain?”
https://youtu.be/La9DrNouvZw.
