When Your Child Changes Overnight

One of the most unsettling experiences a parent can face is watching a child change almost overnight. Imagine putting your child to bed one evening, cheerful and playful, only to wake the next morning to a completely different child. Suddenly, they are consumed by compulsive handwashing, terrified of germs, refusing food, or showing strange new tics. Their moods are unpredictable, swinging from irritability to tears. Teachers call in concern because their handwriting has suddenly deteriorated, or they can no longer concentrate in class.

For many families, this dramatic shift has a name: PANS and PANDAS. These syndromes sit at the crossroads of psychiatry, immunology, and pediatrics, and though they’ve been debated for decades, they’re finally beginning to receive the recognition they deserve.

What Exactly Are PANS and PANDAS?

Both conditions describe a sudden onset of psychiatric and neurological symptoms in children, often linked to an immune system response.

PANDAS — short for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections - refers specifically to cases triggered by strep throat or other Group A strep infections. The theory is that in certain children, the immune system produces antibodies against strep that also mistakenly attack parts of the brain involved in movement, emotion, and behavior.

PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, is broader. It describes the same dramatic onset of obsessive-compulsive behaviors or restrictive eating, but the trigger can be a variety of things: other bacterial or viral infections, metabolic stress, or sometimes environmental exposures.

The hallmark is how abrupt the symptoms appear. Parents often describe it as a “switch flipped overnight.” A previously happy child may suddenly develop compulsive rituals, intense separation anxiety, mood swings, bedwetting, or difficulty sleeping - and the connection to an infection may not always be obvious.

The Changing Landscape: Recognition at Last

For years, PANS and PANDAS were dismissed or misunderstood. Families often felt unheard, shuffled from pediatricians to psychiatrists with little consensus on what was happening. But in late 2024, something shifted.

The American Academy of Pediatrics (AAP) released a long-awaited clinical report formally recognizing PANS as a legitimate diagnosis. Published in 2025, this report offered guidance to clinicians: treat documented infections when present, prioritize evidence-based psychiatric care like cognitive behavioral therapy, and be cautious about ordering extensive unproven lab panels or rushing into immunotherapy without clear justification.

While this was a significant milestone, it also stirred debate. Advocacy groups argued that the AAP was too conservative and failed to acknowledge the full spectrum of research showing benefits of immune-modulating therapies in certain cases. The tension reflects a broader truth: the science is still evolving, and approaches vary depending on whether a clinician leans more cautious or more proactive in tackling the immune component.

Beyond Strep: The Role of Viruses and COVID-19

Traditionally, the focus has been on strep infections. But more recent research makes it clear that strep is not the only culprit. Viruses - from influenza to Epstein–Barr virus - have been implicated in triggering PANS. In one study, about one in seven children with PANS had a viral illness as the identified trigger.

And then came COVID-19.

Since the pandemic began, case reports have described children who developed sudden-onset OCD, food refusal, or tics following infection with SARS-CoV-2. In some of these children, short courses of steroids led to noticeable improvement, suggesting that inflammation was playing a key role. Researchers have proposed several possible mechanisms: COVID’s ability to ignite a powerful immune response, to open pathways that allow antibodies to affect the brain, or even to reactivate dormant viruses like Epstein–Barr, which then act as secondary triggers.

Families already managing PANS often reported flare-ups whenever their child caught COVID. While not every child with COVID will develop these problems, it seems clear that for vulnerable kids, viral illnesses can be just as much a trigger as bacterial ones.

Why PANS and PANDAS Are Often Missed

Despite growing recognition, many families still endure long and frustrating diagnostic journeys. The biggest problem is that the symptoms mimic other, more common conditions.

A child with sudden compulsive rituals may be labeled with primary OCD. A youngster with new tics might be told they have Tourette syndrome. Food refusal is often mistaken for anorexia, even when the motivation is not body image but fear of choking or contamination. Emotional lability may be attributed to bipolar disorder, and difficulty concentrating may be chalked up to ADHD. In children with pre-existing autism or developmental challenges, new behaviors are sometimes written off as part of their baseline condition rather than a dramatic new development.

What distinguishes PANS is the abruptness of onset and the clustering of diverse symptoms after an infection. But unless a clinician is aware of the syndrome, they may not ask about recent illnesses or consider immune involvement at all. With no single blood test or biomarker to confirm the diagnosis, it often requires careful history-taking and a willingness to think across medical silos.

Adults and the Overlooked Question: Can This Happen Beyond Childhood?

By definition, PANS and PANDAS are pediatric syndromes. Most diagnostic criteria specify prepubertal or early adolescent onset. But the immune and neurological principles underlying these syndromes don’t vanish at age 18.

Some case reports and anecdotal evidence suggest that adults can experience post-infectious neuropsychiatric syndromes that look strikingly similar: abrupt-onset OCD, tics, or mood instability following a viral or bacterial illness. COVID-19 has especially shone a light on this, with many adults reporting new psychiatric symptoms, brain fog, anxiety, or intrusive thoughts after infection. Researchers increasingly frame these not as “adult PANS” but as part of the broader category of autoimmune encephalitis or post-viral neuroinflammation.

For women, this can intersect with hormonal fluctuations. Postpartum, perimenopause, or even cyclical immune shifts may amplify vulnerability to post-infectious changes. A woman recovering from a viral illness might notice an intensification of anxiety, obsessive thoughts, mood swings, or sensory sensitivities - and while these may not fit the strict PANS criteria, they share the same immune-inflammatory thread.

Why Shouldn’t We Have to Fear Every Infection?

At this point you may be wondering: if strep or COVID or the flu can trigger these syndromes, should we be worried every time our kids (or we) catch something?

The answer is reassuring: most people get sick, mount an immune response, and return to baseline without developing PANS-like symptoms. The key difference lies not in the infection itself, but in how the immune system responds.

The deeper issue is immune dysregulation. In healthy immune function, the innate immune system detects an invader, mounts an inflammatory response, and then switches off once the threat is cleared. But in children (and adults) vulnerable to PANS/PANDAS, that off-switch doesn’t work properly. The inflammation lingers, the antibodies misfire, and the brain becomes collateral damage.

This is what scientists mean when they point to innate immune dysfunction. It’s not that strep or COVID are uniquely dangerous - it’s that in certain immune systems, the “resolution phase” of inflammation is faulty. Instead of healing smoothly, the response spirals into autoimmunity and neuroinflammation.

Evidence supports this: studies have found abnormal cytokine patterns, microglial activation in the brain, and autoantibodies in children with PANS. In adults with post-COVID syndromes, similar markers of persistent innate immune activation are being documented.

So ideally, we should be able to get sick, recover, and move on. The fact that some cannot points us to the real target of intervention: not eradicating all infections, but restoring immune resilience and regulation.

A Functional and Naturopathic Lens: Supporting the Whole Child

While antibiotics, psychiatric therapy, and sometimes immunotherapy form the foundation of conventional care, functional and naturopathic medicine offer supportive strategies that can make a tangible difference. The aim is not to replace mainstream care, but to calm the immune system, reduce inflammation, and strengthen the child’s overall resilience.

Nutrition is often the first step. Families are encouraged to build meals around colourful fruits and vegetables, legumes, nuts, seeds, and fatty fish - a Mediterranean-style approach that naturally reduces inflammation. Ultra-processed foods, high in additives and sugars, can be inflammatory and are best minimized. Nutrients like omega-3 fatty acids and vitamin D have particular importance; both are tied to immune balance and brain health, and deficiencies are common in children. Incorporating probiotic foods like yogurt, kefir, or sauerkraut can also support the gut–brain connection, which plays a role in immunity and mood.

Gentle supplements may help in some cases. Magnesium glycinate can ease anxiety and support sleep. N-acetylcysteine (NAC) has been studied in pediatric OCD with promising results. Curcumin, derived from turmeric, is a potent anti-inflammatory, though more data in children is still needed. The guiding principle is to introduce changes slowly, one at a time, and always with professional oversight to ensure safety.

Lifestyle factors matter too. Protecting sleep routines, encouraging daily movement, and equipping families with stress management tools like mindfulness or breathwork can buffer the nervous system during flares. For parents, learning that small, steady daily habits can help calm inflammation often provides a sense of empowerment in an otherwise overwhelming journey.

What Parents Can Do

If you suspect PANS or PANDAS, start with a clear timeline. Write down when symptoms began and whether they followed an infection like strep, flu, or COVID. This simple record can be invaluable when speaking with a doctor.

It’s also important to advocate for appropriate testing. If strep is suspected, ask for a throat swab or culture. Bring your observations to your pediatrician, but also push for mental health support early. Cognitive behavioral therapy, particularly exposure and response prevention, can reduce obsessive-compulsive symptoms even while the underlying immune piece is being addressed.

At home, focus on the basics: balanced meals, adequate sleep, hydration, and manageable routines. Keep a diary of potential triggers, such as illnesses, stressful events, or disrupted sleep, and note how your child’s symptoms fluctuate. Over time, this helps build a clearer picture of patterns and flare cycles. Most importantly, try to build a care team that communicates - ideally including your pediatrician, a mental health provider, and if possible, an integrative or functional practitioner who can bridge the gaps.

The Road Ahead: Hope and Healing

The course of PANS and PANDAS is often relapsing and remitting. Children may flare during infections and then gradually recover, sometimes returning fully to their baseline selves. The earlier the condition is recognized and supported, the better the outcomes tend to be.

For families, the journey can be isolating. Yet awareness is growing, and resources are expanding. More pediatricians now recognize the syndrome, more researchers are investigating treatments, and more families are sharing their stories. Above all, it’s important for parents to know they are not alone - and that their advocacy can make a life-changing difference.

Conclusion: Bridging the Divide

PANS and PANDAS challenge the old idea that psychiatric symptoms live entirely apart from the immune system. They remind us that a simple infection can ripple into behavior, mood, and cognition in dramatic ways. The COVID pandemic has underscored this truth, with new evidence showing how viral illnesses can ignite neuroinflammation in vulnerable children and, at times, adults.

For parents and adults alike, the takeaway is clear: infections are a normal part of life, but if your body cannot regulate the immune response properly, the fallout can be significant. The focus, then, is not on fearing every sore throat or virus, but on building resilient, well-regulated immune systems - through medical care, lifestyle support, and whole-body approaches.

Because when we treat both the body and the mind, healing is possible - and we return to the way it should be: getting sick, recovering fully, and moving forward without fear.

Why I Always Ask About Childhood Illnesses

One of the reasons I always deep dive into a client’s history - including childhood infections, early viral illnesses, and even environmental exposures like mould - is because these often hold the very first clues to immune dysregulation. Many of the autoimmune conditions, chronic inflammatory syndromes, and unexplained symptoms we see later in life don’t come out of nowhere. They often trace back to patterns set early in childhood, when the immune system was still learning how to respond and when resilience may have been shaped or disrupted.

Repeated strep infections, frequent tonsillitis, glandular fever, or even “mystery viruses” can leave a fingerprint on the immune system. Today, we’re also starting to appreciate how mould exposure and other environmental toxins can add another layer of stress, priming the body for exaggerated or poorly regulated immune responses. When we connect the dots between those early-life events and current health struggles, it often feels like the missing piece of the puzzle.

That’s why the best way forward isn’t just chasing symptoms, but supporting and retraining the immune system itself. When we strengthen immune regulation, calm unnecessary inflammation, and give the body the building blocks to heal, we see profound changes in everything from energy and mood to digestion, hormones, and long-term resilience.

If you feel like your health journey has been a trail of unanswered questions - or that there’s still detective work to be done - then know that you don’t have to figure it out alone. In my Integrative Health Programmes, I combine functional medicine with clinical nutrition and coaching to create tailored, root-cause treatment plans. Together, we dig into the “why” behind your symptoms, uncover the early clues, and build a strategy that helps you heal from the inside out.

Client Story: Cracking the Code of a Complex Autoimmune Case

A client came to me in her late 30s with a complicated picture: diagnosed with Hashimoto’s thyroiditis, experiencing relentless fatigue, brain fog, painful digestive bloating, and cyclical joint pain that flared after every viral infection. She had already trialed thyroid medication, iron supplements, and elimination diets - yet her symptoms kept returning.

When we mapped her history together, the early signs jumped out. As a child she had recurrent strep infections and multiple rounds of antibiotics, followed by glandular fever (EBV) in her late teens. In her 20s, she spent several years in a mould-exposed rental home. Each of these factors was a piece of the puzzle, showing us that her immune system had been primed for dysregulation for decades.

Instead of chasing each symptom separately, we went upstream. I ran functional testing to assess her gut microbiome, nutrient status, and inflammatory markers. Results confirmed intestinal permeability, low vitamin D, sluggish detox pathways, and antibodies consistent with thyroid autoimmunity.

Her treatment plan focused on calming the immune system and restoring resilience:

• A personalised anti-inflammatory nutrition plan with gut-healing foods, fibre diversity, and targeted removal of reactive foods.

• Therapeutic supplementation with vitamin D, selenium, NAC, and omega-3s to modulate autoimmunity.

• A mould detox protocol combined with gentle liver support to reduce her toxic load.

• Stress and sleep strategies to retrain her nervous system, which was locked in “fight-or-flight.”

Within six months, her thyroid antibodies dropped by over 40%, her digestion stabilised, and she described her energy as “better than I’ve felt in years.” Importantly, she no longer experienced severe immune crashes after minor viral infections.

✨ This is why I never stop at surface-level symptoms. When we look back at childhood illness, infections, and environmental exposures, the patterns become clear - and with the right plan, the body can be guided back into balance.

This is exactly what we do in my Integrative Health Programmes, where coaching meets functional medicine, and clinical nutrition is used as a tool to heal.

Final say

Overall, childhood illnesses aren’t always just “a phase” to grow out of. For some, repeated infections, early viral hits, or environmental exposures like mould leave lasting fingerprints on the immune system. These can set the stage not only for conditions like PANS and PANDAS, but also for a wide spectrum of neurodivergent presentations, autoimmune conditions, and chronic inflammatory issues that emerge later in life.

At the heart of it all lies a common thread: innate immune dysregulation. When the immune system can’t switch off inflammation properly, the nervous system, hormones, and even mental health are affected. That’s why symptom-chasing rarely leads to lasting relief. The real work - and the real healing - happens when we step back, see the whole story, and design health protocols that calm the immune system, repair the gut, restore nutrient balance, and build resilience from the inside out.

The exciting part? These protocols don’t just manage illness - they create the conditions for children and adults alike to thrive. By addressing immune health at its root, we give the body the tools it needs to recover, adapt, and protect itself for years to come.

References

1. Swedo SE, Frankovich J, Murphy TK. Overview of treatment of pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). UpToDate. 2025.

2. American Academy of Pediatrics. Clinical Report: Recognition and Management of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). Pediatrics. 2025; e2024064451.

3. Frankovich J, Murphy T, Dale RC, 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.

4. Chang K, Frankovich J, Cooperstock M, 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.

5. Pavone P, Parano E, Rizzo R, Trifiletti RR. Autoimmune neuropsychiatric disorders associated with streptococcal infection: Sydenham chorea, PANDAS, and beyond. Int J Immunopathol Pharmacol. 2006;19(4):613–622.

6. Murphy TK, Gerardi DM, Leckman JF. Pediatric acute-onset neuropsychiatric syndrome (PANS): Clinical description of a case series. J Child Adolesc Psychopharmacol. 2014;24(3):140–148.

7. Williams KA, Swedo SE, Farmer C, et al. Randomized, controlled trial of intravenous immunoglobulin for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. J Am Acad Child Adolesc Psychiatry. 2016;55(10):860–867.

8. Prato A, Gulisano M, Vitaliti G, et al. PANDAS and COVID-19: A clinical case and literature review. Front Neurol. 2023;14:1085948.

9. Pallanti S, Di Ponzio F. PANDAS/PANS in the COVID-19 age: Autoimmunity and Epstein-Barr virus reactivation as trigger mechanisms. Front Psychiatry. 2023;14:1128431.

10. Gagliano A, Tascio R, Piras C, et al. Pediatric acute-onset neuropsychiatric syndrome (PANS) and the COVID-19 pandemic: Clinical survey in a sample of Italian children. Brain Sci. 2022;12(7):912.

11. PANDAS Physicians Network. Response to AAP Clinical Report on PANS/PANDAS. 2025. Available at: https://www.pandasppn.org 

12. National Institute of Mental Health (NIMH). Questions and Answers about PANS and PANDAS. 2024. Available at: https://www.nimh.nih.gov 

13. PANDAS Network. FAQs and family resources. 2024. Available at: https://pandasnetwork.org