How PANS and PANDAS Are Treated: A Functional Medicine Framework
- Jun 27
- 10 min read
Updated: 4 days ago
You've done everything right. You got someone to finally take it seriously. You pushed until the words PANS or PANDAS were said out loud. And right behind the relief came a new kind of overwhelm, because now you have to figure out what to actually do. You've read the forums. You've seen the supplement lists that run a mile long. And you are trying to work out where to start without asking your exhausted child to swallow forty things a day.
So let me walk you through how care is usually built. What the published guidelines support, what each step is for, and why the plan that helps your child will not look like the plan that helped someone else's.
The short version: care works best when two things run together. Conventional care that finds and treats the trigger and calms an acute flare, and root-cause work that steadies the immune system underneath so flares get less frequent and less severe. The published framework moves through five connected jobs. Find and treat the trigger. Calm the inflammation. Steady the immune system. Address what is driving it underneath. Support the whole child and the whole family. No two children get the same plan, because no two children have the same triggers, labs or history.
If you are still earlier in this and wondering whether what you are seeing even is PANS or PANDAS, start with the PANS and PANDAS overview first, then come back here.
Frequently asked questions
Short answers first. The full reasoning is below.
How long does PANS or PANDAS treatment take?
It varies widely — from weeks to many months — depending on how early it's caught, how severe it is, and what's driving it underneath. The goal is steady, durable progress, not a quick fix that doesn't hold.
Can PANS or PANDAS be treated naturally?
Root-cause and natural supports — anti-inflammatory nutrition, gut repair, nervous-system regulation — are a major part of the framework and can do a lot of good. But "naturally" doesn't mean "instead of" conventional care. The strongest results come from using both together, especially in the early or severe stages.
Do you treat the strep, or does my pediatrician?
Treating active infection is typically coordinated with your child's pediatrician. I focus on the root-cause and whole-child layers and work alongside your existing medical team rather than replacing them.
Will treating my child's gut help their PANS symptoms?
For many children, yes — because so much of the immune system lives in the gut, calming gut inflammation can help calm the immune overreaction driving symptoms. Whether it's a priority for your child depends on what their testing shows.
Where are you located, and do you offer telehealth?
I'm physically located in Omaha, Nebraska, where I see families in person. I also offer telehealth and am licensed to see patients virtually in six states: Arizona, Colorado, Iowa, Nebraska, Tennessee, and Virginia. If you're in any of those states, we can do this entirely online.
What parents notice first
The thing that sets this apart from ordinary childhood worry is how fast it arrives. In the group of children first described in the medical literature, symptoms came on abruptly and severely rather than creeping in over months.
Here is what I would want you to look for at home:
Handwriting that falls apart. This is the one parents almost never think to mention, and it is one of the most telling. Pull out schoolwork from two months ago and put it beside this week's.
Sudden obsessions or rituals. Intrusive thoughts your child is frightened by. New tics. Rage that does not match the trigger and does not look like your child. Going back to wetting the bed or needing the bathroom constantly. Suddenly refusing to eat, sometimes because of a fear of choking or of contamination rather than because of taste.
Write down the date things changed and what was going on that week, including any illness in the house. That timeline is one of the most useful things you can bring to any appointment.
What is actually being treated
The leading explanation, and the one the major research consensus works from, is that an infection or another trigger sets off an immune response that does not shut off the way it should. That misdirected response inflames the brain, especially a region called the basal ganglia that helps run movement, emotion and impulse control. Researchers have found antibodies aimed at basal ganglia targets in children with these presentations.
That framing matters, because it names what is really being addressed. Not just the OCD or the tics on the surface, but the inflammation underneath them and whatever is keeping it lit.
What sets it off, and why it is not always strep
PANDAS is the version triggered by strep. PANS is the wider umbrella, and the trigger can be many things: mycoplasma, which most people know as walking pneumonia, the flu, a sinus infection that never fully cleared, or other viruses. In one described clinic group of children with PANS, an infection was commonly identified around the time symptoms started.
Environmental drivers matter too. Mold exposure in a home and tick-borne infections can both act as triggers or as the thing that keeps a flare going in some children.
Your child's genes may set the stage, but they don't write the script. That is why two children can catch the same strep and have completely different outcomes, and it is why finding your child's specific trigger is the whole first step.
Why one approach is rarely enough
The national treatment guidelines for PANS and PANDAS, published by the PANS Research Consortium, organize care around three things happening at once: treating the infection or trigger, calming the immune and inflammatory response, and supporting the child psychiatrically and behaviorally through it.
The families I work best with want all of that, and they want somebody looking underneath it and asking why this child's immune system is so reactive in the first place. Here is the arc I use.
Step 1: Find and treat the trigger
You cannot settle an immune response while the trigger is still active. The first job is working out what set this off. Strep, another infection, or in some children an environmental driver like mold or a tick-borne infection.
This step uses testing that looks at immune and inflammatory markers and at infection, past and present. The Cunningham Panel goes further and asks what in the body is keeping that immune response going. Active infection is treated, usually alongside your child's pediatrician. Some children also need a plan for repeat infections, because each new one can light things up again.
Step 2: Calm the inflammation
Once the trigger is handled, the goal is to bring the inflammation down fast enough that your child gets real relief and can take part in the rest of the plan. A child mid-flare cannot do the slower, deeper work yet.
This is where anti-inflammatory nutrition does more than people expect, alongside targeted nutrients chosen from what your child's testing showed. For bigger flares, the guidelines also describe provider-directed anti-inflammatory medication, and the stronger ones are co-managed with the right specialist. The point of this step is simple. Turn the temperature down so your child can come back to themselves.
Step 3: Steady the immune system
This is usually the longest stretch, and it is where root-cause work earns its keep. After the acute flare settles, the work shifts from calming the acute response to helping the immune system stop overreacting, so flares become less frequent, less severe and easier to recover from.
For most children this is a patient, layered process rather than one big intervention. A smaller number of children with severe or treatment-resistant disease need specialist-level immune therapies such as IVIG. I do not provide those. They are evaluated and managed by a neuroimmunology or specialist team, and I work alongside that care rather than in place of it.
Step 4: Address what is driving it underneath
This is the part a short visit rarely has time for, and it is where I spend most of mine. Two children can both have PANDAS and have completely different reasons their immune systems are stuck in overdrive. So I look at what is quietly driving the inflammation and build support around what your child's testing actually shows, not around a generic checklist.
Gut health. So much of the immune system lives in the gut, so a reactive, inflamed gut keeps a reactive immune system company. Repairing the gut lining and rebalancing the microbiome is often foundational. (This is why gut testing for kids shows up so often in PANS work.)
Nutrient gaps. Children with PANS are frequently low in specific nutrients the brain and immune system depend on. I replenish those only when testing shows they're low — not on guesswork.
Food sensitivities. Foods that quietly add to the inflammatory load can be identified and removed.
Mast cell and histamine patterns. When an overreactive histamine response is part of the picture, calming it can make a real difference.
Environmental burden. When mold or tick-borne infections are part of the story, addressing that exposure and load is part of the plan.
Other root contributors. Methylation, mitochondrial support, and similar pieces — addressed only when the labs point there.
And before any of that, the Foundational Five have to be in place: sleep, airway, nutrition, hydration, movement. If those are not steady, the rest of it does not hold. I do not lead with a big test panel, and you should be wary of anyone who does.
Step 5: Support the whole child and the whole family
This one runs alongside everything else, not after it, because a nervous system that does not feel safe cannot settle no matter how good the medical plan is.
That can include therapy with a clinician who understands PANS-related OCD and anxiety, protected and consistent sleep, gentle movement your child actually enjoys, and simple daily practices like slow breathing and humming that help a body come down out of alarm. Psychiatric and behavioral support during an acute flare is part of the published guidelines, not a failure.
It also means supporting you. A flare does not just happen to a child. It happens to a whole household.
That's a lot. Here's how it actually works in real life
If you read that list and felt your stomach drop, I understand. On paper a full framework looks like dozens of moving parts. In practice it almost never is, for two reasons.
First, things consolidate. A lot of the supports do more than one job, so a thoughtful plan usually comes down to a handful of changes, not a kitchen counter full of bottles. A lot of functional medicine practices get a bad rap because they layer in twenty or thirty supplements at once for a kid. I do not do that.
Second, it is sequenced. I do not do everything on day one. I start with the foundation that matters most for your child, watch how their body responds, and add the next piece only when it is needed. The detective work is mine to carry.
And this is a map, not a prescription. I cannot tell you through a blog post what your child needs, in what order, or at what dose, and you should be skeptical of anyone who tries. Healthy skepticism is welcome here. Every plan is built one child at a time from their own history, exam and testing, and co-managed with your child's medical team.
When functional medicine isn't the whole answer
I will always tell you the truth about what I can and cannot do. Functional medicine is powerful for finding what has been missed, but some moments call for conventional or emergency care first. A child in an acute psychiatric crisis, expressing thoughts of harming themselves, or refusing to eat or drink, needs urgent medical and psychiatric care right away.
My role is to work alongside that care. To be the person who stays in the room, connects the dots, and keeps advocating for your child through all of it.
If your child is in crisis, call 911 or your local emergency number, or reach the 988 Suicide & Crisis Lifeline.
How this works at Happy Kid Functional Medicine
Most of the families who find me have already done a lot. Labs, referrals, therapies, specialists. They arrive carrying a folder of normal results and a stubborn feeling that something is being missed. My job is to find out what that is.
Through the Missing Piece Method, I map your child's full timeline, order the testing that explains what is happening inside their body, and build a plan that fits the life your family is actually living. Testing, not guessing, but never testing first.
I see families in person in Omaha, and I offer telehealth in Arizona, Colorado, Iowa, Nebraska, Tennessee and Virginia.
PANS and PANDAS rarely travel alone. The same immune and gut patterns often sit underneath attention and focus struggles and other long-running symptoms, which is why whole-child care matters so much here.
The most common thing I hear from parents a few months in is some version of I feel like I have my kid back. And I will never accept or tell a parent this is just how it is, because more often than not, that is not true.
Want more like this? Browse the Happy Kid Functional Medicine blog.
Written by Dr. Amy Patton, Founder Happy Kid Functional Medicine
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About the author
This article was written by Dr. Amy Patton, DNP, APRN, CPNP-PC, FMACP, a board-certified pediatric nurse practitioner and functional medicine provider serving Omaha-area families through Happy Kid Functional Medicine. Dr. Patton specializes in root-cause pediatric care for children's gut health, sleep, behavior, nutrition, immune patterns, and whole-child wellness. She sees patients in person in Omaha and by telehealth across Arizona, Colorado, Iowa, Nebraska, Tennessee, and Virginia.
References
1. Swedo SE, Leonard HL, Garvey M, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry. 1998;155(2):264-271.
2. Chang K, Frankovich J, Cooperstock M, et al. Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): recommendations from the 2013 PANS Consensus Conference. J Child Adolesc Psychopharmacol. 2015;25(1):3-13.
3. Frankovich J, Thienemann M, Pearlstein J, et al. Multidisciplinary clinic dedicated to treating youth with pediatric acute-onset neuropsychiatric syndrome: presenting characteristics of the first 47 consecutive patients. J Child Adolesc Psychopharmacol. 2015;25(1):38-47.
4. Thienemann M, Murphy T, Leckman J, et al. Clinical management of pediatric acute-onset neuropsychiatric syndrome: part I, psychiatric and behavioral interventions. J Child Adolesc Psychopharmacol. 2017;27(7):566-573.
5. Frankovich J, Swedo S, Murphy T, et al. Clinical management of pediatric acute-onset neuropsychiatric syndrome: part II, use of immunomodulatory therapies. J Child Adolesc Psychopharmacol. 2017;27(7):574-593.
6. Chain JL, Alvarez K, Mascaro-Blanco A, et al. Autoantibody biomarkers for basal ganglia encephalitis in Sydenham chorea and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections. Front Psychiatry. 2020;11:564.
7. Cryan JF, O'Riordan KJ, Cowan CSM, et al. The microbiota-gut-brain axis. Physiol Rev. 2019;99(4):1877-2013.
Medical disclaimer: This article is educational and is not medical advice. It does not diagnose, treat, or replace individualized care from your child's pediatrician or licensed medical provider. Supplement types, doses, and combinations should be selected with a qualified clinician who knows your child's full history — never start a new supplement based on a blog post alone. Always consult your pediatrician before making changes to your child's routine, and seek prompt medical care for snoring with gasping or pauses in breathing during sleep, or for any severe, sudden, or concerning symptom.
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