PANS & PANDAS: Understanding Behavior Changes — And How New Therapies Can Help
As parents, we know our children better than anyone. That’s why it’s so unsettling when something shifts — when a once-happy, curious, regulated child suddenly struggles with anxiety, intense emotions, tics, or obsessive behaviors seemingly overnight.
These sudden changes may point to a group of conditions known as PANS or PANDAS — and sometimes even Lyme disease (very common in the Greater Philadelphia area) or other infections may be involved. But here’s something many parents don’t realize: while these conditions are often described as “sudden onset,” the reality is that signs can appear gradually, even in infancy or early childhood, and be overlooked or dismissed as “just a phase.”
What Are PANS and PANDAS?
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are conditions where the body’s immune response — often triggered by infection — mistakenly targets parts of the brain involved in behavior, mood, and movement.
PANDAS occurs specifically after a strep infection.
PANS is a broader category that includes a range of triggers such as viruses, metabolic issues, environmental factors, or tick-borne illnesses like Lyme disease.
This immune misfire can cause neuroinflammation, leading to dramatic shifts in behavior, emotional regulation, and neurological function.
Why “Sudden Onset” Isn’t Always the Whole Story
The hallmark of PANS and PANDAS is often described as a sudden onset — with OCD behaviors, anxiety, or tics appearing almost overnight. And for many families, this is exactly what happens.
But for others, the story is more complicated. Symptoms may:
Begin subtly in infancy or early childhood — such as sensory sensitivities, sleep disturbances, or intense separation anxiety.
Fluctuate with minor illnesses or growth spurts, so changes are written off as developmental “phases.”
Escalate over time — only becoming clearly concerning after months or years of low-level challenges.
It’s important for parents to know that a lack of obvious “sudden onset” doesn’t rule out PANS, PANDAS, or immune-related neuroinflammation. Trust your instincts if you sense something deeper is going on.
Common Symptoms Parents May Notice
Symptoms can vary widely from child to child, but common signs include:
OCD-like behaviors or new compulsions
Tics or repetitive movements/sounds
Sudden or worsening anxiety or separation fears
Emotional instability, rage episodes, or depression
Regression in skills or behavior (e.g., bedwetting, baby talk)
Decline in focus, memory, or school performance
Sleep issues, appetite changes, or sensory sensitivities
The Lyme Disease Connection
One often-overlooked trigger for PANS-like symptoms is Lyme disease and other tick-borne infections (such as Bartonella or Babesia). These infections can cause a powerful immune response that crosses into the brain, creating inflammation and neurological changes similar to PANS or PANDAS.
Key things to know:
Lyme disease isn’t always obvious — many children never develop the classic rash or obvious joint pain.
Behavioral, emotional, or cognitive changes may be the only signs.
Standard Lyme tests can sometimes miss the infection; working with a Lyme-literate clinician can help ensure thorough evaluation.
If your child’s symptoms began after outdoor exposure or a known tick bite — or if they’ve had unexplained health changes — Lyme and co-infections should be part of the conversation.
Healing Is Possible: A Whole-Child Approach
Because PANS, PANDAS, and Lyme-related neuroinflammation involve both the immune system and the nervous system, successful treatment often requires a multi-layered approach. Medical interventions — such as antibiotics, anti-inflammatories, or immune-modulating treatments — are important foundations.
But families often see the most meaningful improvements when they pair medical care with therapies that help the brain and body heal and re-regulate. Two evidence-informed approaches are Low-Level Laser Therapy (LLLT) and Reflex Integration Therapy.
Low-Level Laser Therapy (LLLT): Calming the Brain and Reducing Inflammation
Low-Level Laser Therapy, or photobiomodulation, is a gentle, non-invasive treatment that uses light to stimulate healing at the cellular level. It boosts mitochondrial function, reduces inflammation, and promotes tissue repair — all of which are crucial in neuroimmune conditions.
How LLLT may support children with PANS/PANDAS or Lyme-triggered inflammation:
🌟 Reduces neuroinflammation — calming the overactive immune response in the brain.
🧠 Supports neural healing — improving cellular energy and brain function.
😌 Improves regulation — many families report better sleep, mood, and emotional balance over time.
While more research is still needed specifically for PANS/PANDAS, LLLT is well-studied in other neuroinflammatory and neurological conditions and shows promise as part of a comprehensive care plan.
Reflex Integration Therapy: Rewiring the Nervous System
Our nervous systems develop in stages, guided by primitive reflexes — automatic movement patterns that should integrate as the brain matures. Illness, stress, or inflammation can cause these reflexes to remain active or become reactivated, disrupting regulation, attention, and sensory processing.
Reflex Integration Therapy uses targeted movements and activities to “retrain” the brain and support healthy neural connections. It can help:
💛 Improve emotional regulation — reducing meltdowns, anxiety, and behavioral swings.
📚 Boost cognitive skills — enhancing focus, memory, and learning.
🌿 Balance the sensory system — decreasing sensitivities and improving tolerance.
This gentle, play-based approach supports the brain’s natural healing and complements both medical treatment and other therapies.
The Takeaway: Trust Your Instincts — and Seek Comprehensive Care
Whether your child’s challenges appeared suddenly or built slowly over time, it’s worth exploring the possibility of PANS, PANDAS, or an immune-triggered condition — especially if symptoms appeared after illness, infection, or environmental stressors.
Healing is possible. Many children recover fully with a thoughtful, whole-child approach that combines:
Medical care to address infections and inflammation
Therapies like LLLT and Reflex Integration to support the brain and nervous system
Ongoing support for emotional, sensory, and cognitive development
And most importantly — your instincts matter. If something feels off, keep asking questions and seeking answers. What may once have been dismissed as “just a phase” could, in fact, be the key to understanding and supporting your child’s health.
At B.well, we believe that healing happens when science, therapy, and compassion work together. If you’re navigating PANS, PANDAS, or Lyme-related challenges, we’re here to help your child’s body and brain find balance again — and support your family every step of the way. 💛 Our Neuroadaptive Intensives just outside Philadelphia may be something to help get you and your little one back on track. Have questions? Let us know!