Pandas In Children: Symptoms, Causes, Diagnosis And Treatment

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Pediatric autoimmune neuropsychiatric disorder or PANDAS in children is closely attributed to Streptococcus pyogenes infections. The symptoms develop suddenly after a strep infection, and the condition tends to deteriorate quickly. Children commonly contract Streptococcus infections by inhaling droplets of an infected person’s saliva or nasal secretions or by touching a contaminated surface and then touching their face.

Strep infections are typically mild, resulting in a minor skin infection or sore throat. However, they may cause serious conditions, such as strep throat, scarlet fever, and rheumatic fever. Some children fully recover from a strep infection, while others experience severe physical and physiological complications.

Read this post to learn more about the symptoms, causes, and treatment options for PANDAS in kids.

Symptoms Of PANDAS In Children

The symptoms of PANDAS in children start abruptly, after about four to six weeks after a pyogenes infection. The symptoms can be grouped under two categories, psychological and physical (1) (2).

Psychological or neuropsychiatric symptoms include:

  • Hyperactivity, inattention, or fidgeting.
  • Obsessive-compulsive disorder (OCD) and repeated activities.
  • Separation anxiety, wherein the child becomes clingy and always wants to be close to the parents or the caretaker.
  • Swift mood changes, such as irritability, sadness, and suicidal thoughts.
  • Learning disabilities, such as short-term memory problems.
  • Hallucinations and a terror-stricken look

Physical symptoms include:

  • Tics — involuntary and unusual jerky movements.
  • Changes in motor skills, such as sudden changes in handwriting.
  • Joint pains.
  • Nighttime bed-wetting, frequent daytime urination, or both.
  • Sleep disturbances.
  • Eating problems and weight loss.
  • Sensitivity to light, sound, and touch.

Your child may not show all these symptoms, but they will generally show a mix of psychological and physical symptoms.

Due to the overlapping of the symptoms, PANDAS is often mistaken for autism and classic obsessive-compulsive disorder (OCD). However, these conditions and PANDAS are not related. The key features that set PANDAS apart are the sudden onset of symptoms and the presence of symptoms such as sleep difficulties, loss of bladder control, loss of appetite, and tics (3). 

Causes Of PANDAS In Children

PANDAS often occurs after a strep infection. Thus, what could be the relationship between these two? Let’s find out.

Although the exact cause of PANDAS is still under research, there is a theory that explains the PANDAS to be an immune response to a strep infection.

Strep bacteria try to survive in the human body by hiding themselves from the body’s immune system. The bacteria mimic and synthesize molecules similar to those found on your child’s heart, joints, skin, and brain tissues. They then place these molecules on their cell wall to look identical to the cells of the body.

Eventually, the body’s immune system recognizes the bacterial cells and produces antibodies against them.

As the bacterial cells are similar to certain proteins on the body’s cells, the antibodies can sometimes attack other parts of the body, causing a myriad of symptoms (2).

Risks And Complications Of PANDAS In Children

PANDAS is a disorder generally found in children aged three to 12. However, research has found that it can occur in adolescents in some rare cases. Children who have a weak immune system due to comorbidities or those who have repeated strep infections could be at a higher risk of developing PANDAS (2).

Children with PANDAS have an increased risk of developing obsessive-compulsive disorder (OCD), tic disorders, and Tourette syndrome (4).

Diagnosis Of PANDAS

There is no one specific test for the diagnosis of PANDAS. One of the initial diagnostic criteria is the sudden onset of symptoms associated with OCD or a tic disorder following a strep infection.

The common diagnostic criteria include the following (5).

  • The doctor would ask you when the symptoms started to worsen.
  • A throat swab to test for strep may be done when the symptoms first appear.
  • If the throat swab does not show any signs of strep infection, a blood test for an antibody called anti-streptolysin O (ASO) is recommended.
  • Other tests such as EEGs and echocardiograms may also be ordered based on the condition of your child.

Treatment Of PANDAS In Children

Your doctor would examine the reports and prescribe the best possible treatment option to eliminate the strep infection.

Antibiotics are the first-line treatment for a strep infection. Once the infection is eliminated, the PANDAS symptoms would subside. After the course of antibiotic treatment, the doctor would recommend a throat culture.

In case your child has psychological symptoms of PANDAS, your doctor might refer to standard medications (antidepressants) or behavioral therapies (cognitive behavioral therapy), or both.

Other treatments such as plasma exchange or immunoglobulin (IVIG) may be considered for children who are severely affected by PANDAS. However, these treatments have side effects such as nausea, vomiting, headaches, and dizziness (2).

PANDAS can be cured once the strep infection is treated. However, it might take some time for the symptoms to subside once the infection is cleared. Also, there are chances of your child developing PANDAS if they catch a strep infection again.

Prevention Of PANDAS

The only way to prevent the PANDAS syndrome in children is by protecting them from strep infections. Follow the tips mentioned below to reduce the risk of your children catching a strep infection.

  • Make sure they wash their hands before eating and after returning from a crowded place.
  • Instruct them not to share personal items, such as towels, clothes, and drinking utensils with others.
  • Teach them to cover their nose and mouth while coughing and sneezing.
  • If anyone in your family has strep infections, isolate them and make sure your children are not in their vicinity.

Frequently Asked Questions

1. How long can a child have PANDAS?

The duration of PANDAS depends on several factors, including the symptoms’ severity, type of treatment, and how soon treatment is availed. The symptoms may recur at different points during childhood, but with proper treatment, they can be entirely mitigated by adulthood (6) (1).

2. How common is PANDAS in children?

PANDAS is estimated to affect one in 200 children in the US (1).

3. What happens if PANDAS goes untreated?

If left untreated, PANDAS can result in severe complications, such as permanent debilitation and, in some cases, inflammation of the brain (encephalitis) (7).

4. How does PANDAS affect the brain?

The strep bacteria that cause PANDAS force the immune system to attack healthy brain cells, resulting in neurological and psychological anomalies (1).

5. What is the prognosis for PANDAS?

Some children respond well to treatment and can regain normal functioning entirely. This favorable prognosis depends on whether the cause of the disorder has been identified and how early it has been diagnosed.

PANDAS are common in children aged 3 to 12 years who have had a Strep infection. It has the potential to induce both physical and psychological or neuropsychiatric symptoms, which might manifest suddenly. The importance of early diagnosis in the treatment of PANDAS in children cannot be overstated. Although it may be treated with specific antibiotics and other medications, the symptoms in children can take a significant amount of time to subside. In addition, educating your child on how to avoid catching strep infections might be beneficial.

Key Pointers

  • PANDAS is a neuropsychiatric disorder seen in children after a severe Streptococcus pyogenes infection.
  • Symptoms in children may include hyperactivity, OCD, separation anxiety, and hallucinations.
  • They may also show jerky movements, changes in handwriting, bedwetting, and other physical symptoms.
  • The condition is usually treated with antibiotics for the infection and behavioral therapy for the psychological manifestations.

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
1. What is PANDAS?; Pandas Network
2. PANDAS—Questions and Answers; National Institute of Mental Health
3. PANDAS Syndrome: How it Differs from Autism; Autism speaks
4. Sonja Orlovska et al.; Association of Streptococcal Throat Infection With Mental Disorders Testing Key Aspects of the PANDAS Hypothesis in a Nationwide Study; JAMA Psychiatry (2017).
5. PANDAS Fact Sheet; International OCD Foundation
6. Diagnosis and Treatment for PANS and PANDAS; Stanford Children’s Health
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Dr. Dur Afshar Agha

(MS)
Dr. Dur Afshar Agha is a consultant pediatrician with decades of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association. She has also completed her Post Graduate Program... more

Dr Bisny T. Joseph

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has 3+ years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education made... more

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