What is PANDAS?

Q: Our daughter recently got over strep and a mom at school told us to watch out for ‘PANDAS?’ What’s she talking about?

A: PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. It’s a relatively newly known syndrome, first described in the late 1990s. Revised diagnostic criteria and guidelines were just established for the National Institute of Mental Health (NIMH) in 2012. 

A doctor may consider PANDAS as a possibility when a child abruptly develops obsessive compulsive (OCD) behaviors and/or tic behaviors following a strep infection, such as strep throat. It can also occur when a child with a known pre-existing diagnosis of OCD or tic disorder (such as Tourette’s syndrome) abruptly experience worse symptoms shortly after a strep infection. New concerning behaviors include motor and/or vocal tics, obsessions/anxieties and/or compulsions. 

Children may also exhibit an abrupt shift in behaviors such as becoming incredibly moody, irritable, anxious and/or experience a dramatic worsening in school or homework performance.

First-line treatment for PANDAS is the same as treatment of a routine strep throat infection — antibiotics, which can help reduce mental health symptoms as well, according to the NIMH. Other than the laboratory tests to determine the presence (active or recent infection) of strep bacteria, PANDAS is a clinical diagnosis, meaning there’s no one lab test that can confirm the condition. 

Mental health challenges among children with PANDAS-related symptoms may require treatment with medications and/or behavioral therapies.

Not every child who gets a strep throat infection will get PANDAS. Similarly, a child who has an underlying OCD or tic disorder won’t necessarily go on to develop PANDAS after a strep infection. 

Strep throat infections are extremely common, with an average grade-school child having the infection 2 to 3 times in one year. By no means do all these children develop PANDAS. 

So in regard to your daughter, I would watch for any unexplained or dramatically worsening OCD or tic behaviors very shortly following her strep throat infection, and follow up with her primary physician if you notice anything of concern. 

If she’s already recovered uneventfully from her sore throat, fever and/or stomach pain, then I wouldn’t be concerned about PANDAS at this point. 

Learn more about PANDAS (and a related condition called PANS) at tinyurl.com/pandas-mn and facebook.com/pandasnetwork.

Dr. Kimara Gustafson is a Minneapolis mother who works as a pediatrician at Masonic Children’s Hospital and the Adoption Medicine Clinic, both at the at the University of Minnesota. Send your questions to kgustafson@mnparent.com.