Across the country, more children and teens are suddenly developing severe anxiety, OCD-like behaviors, tics, eating changes, and intense behavioral shifts that seem to come out of nowhere. One week they’re functioning well at home and in school; the next, they’re terrified to be alone, washing their hands repeatedly, having meltdowns over minor things, or refusing to eat.
Conditions like PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) remind us that this is not simply “bad behavior” or “poor coping skills.” These are medical, immune-mediated conditions—in which infections and other stressors trigger inflammation in the brain and nervous system—leading to sudden, dramatic neuropsychiatric changes.
I’m Dr. Teresa Birkmeier-Fredal, an integrative and functional medicine physician at the Restorative Medicine Center in Rochester Hills, Michigan. I have extensive experience working with children and teens with PANS, PANDAS, and infection-triggered autoimmune encephalopathy, often in the context of Lyme disease, mold/biotoxin exposure, and complex chronic illness. My approach focuses on understanding and treating the immune dysfunction and inflammation underneath the symptoms—not just trying to suppress behaviors.
What Are PANS and PANDAS?
PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. In PANDAS, a strep infection (like strep throat or scarlet fever) triggers an abnormal immune response. Instead of only fighting the bacteria, parts of the immune system mistakenly react against areas of the brain, especially regions involved in movement, mood, and behavior.
PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome. It includes a broader group of triggers—not only strep, but also other infections and inflammatory/immune events. In PANS, sudden-onset neuropsychiatric symptoms are linked to:
- Other bacteria (such as Mycoplasma)
- Viruses
- Lyme and co-infections
- Mold and environmental triggers
- Metabolic or inflammatory stressors
Sudden Onset vs. Gradual Changes
One of the hallmark features of PANS/PANDAS is abrupt onset. Common patterns include:
- Sudden, intense OCD behaviors—such as excessive handwashing, checking, repeating rituals, or “stuck” thoughts
- New or rapidly worsening tics
- Acute anxiety, especially separation anxiety
- Sudden eating restriction or fear of choking/contamination
Common Symptoms
While OCD and tics are often the most obvious, PANS/PANDAS can affect many aspects of a child’s functioning. Common symptoms include:
- Obsessive-compulsive behaviors and intrusive thoughts
- Severe separation anxiety, generalized anxiety, or panic attacks
- Tics and abnormal movements (eye blinking, facial grimacing, shoulder shrugging, vocalizations)
- Behavioral regression, irritability, rage episodes, and sudden mood swings
- Urinary frequency or urgency without infection
- Sleep disturbances: difficulty falling asleep, staying asleep, or new night terrors
- Handwriting changes, decline in fine motor skills, or clumsiness
- Academic decline, difficulty concentrating, or sudden “brain fog”
- Co-existing physical symptoms such as joint pain, headaches, and fatigue
How a Functional Medicine PANS/PANDAS Specialist Evaluates Your Child
Comprehensive History
The most powerful diagnostic tool is often a careful, unhurried history. During your child’s evaluation, we work together to build a detailed picture that includes:
- A timeline of symptom onset and progression
- When did you first notice changes?
- Were there “before and after” points—such as a particular illness, stressful event, or exposure?
- Infections, illnesses, and immunization history
- Strep throat, sinus infections, pneumonia, mono, flu, COVID, GI bugs
- Any patterns of “never quite the same since…”
- Environmental exposures
- Possible mold/water-damaged buildings (home, school, relative’s home, daycare)
- Tick bites or known exposure to Lyme-endemic areas
- Chemicals, fumes, or other unique environmental factors
- Family history
- Autoimmune conditions
- Allergies and asthma
- Mood disorders, OCD, tics, or neuropsychiatric conditions
Physical and Neurological Assessment
While the story is central, we also carefully examine the child. A physical and neurological assessment may include:
- Checking for subtle neurologic changes (coordination, reflexes, eye movements)
- Observing motor issues, tics, or unusual movements
- Looking for signs of systemic inflammation, such as joint tenderness, skin findings, or lymph node enlargement
Laboratory Evaluation
Labs are used to support the clinical picture, not replace it. Depending on your child’s history and symptoms, testing may include:
- Strep titers and throat cultures (ASO, anti-DNase B, rapid strep or culture when appropriate)
- Testing for Lyme and tick-borne infections
- Borrelia (Lyme)
- Bartonella
- Babesia
- Other tick-borne organisms as indicated
- Mycoplasma and viral serologies, especially when symptoms followed a respiratory or viral illness
- CIRS biomarkers and inflammatory markers if biotoxin exposure (like mold) is suspected
- These can help assess whether a chronic inflammatory response is contributing to brain and immune dysfunction
- Basic immune function
- Immunoglobulin levels (IgG, IgA, IgM, subclasses)
- Complement levels
- Autoimmune markers where appropriate
Differentiating PANS/PANDAS from Primary Psychiatric Disorders
One of the most important roles of a PANS/PANDAS specialist is to distinguish these conditions from primary psychiatric disorders. We look at:
- The pattern of symptoms
- Sudden onset or abrupt worsening
- Clear connection to an infection, illness, or immune trigger
- Waxing and waning course, with flares often linked to new infections or exposures
- The presence of comorbid conditions that suggest immune dysregulation, such as:
- Dysautonomia or POTS-like symptoms (dizziness, rapid heart rate with standing)
- MCAS (mast cell activation symptoms such as flushing, hives, or chemical sensitivities)
- Other autoimmune or inflammatory conditions
PANS/PANDAS Treatment Near Me: An Integrative, Root-Cause Approach
Addressing Infections (Microbial Root Causes)
Because infections are often the spark that ignites PANS/PANDAS, we begin by treating documented or strongly suspected infections, which may include:
- Appropriate antibiotics or antimicrobial therapies for strep and other identified bacterial infections
- Consideration of Lyme and co-infection treatment when indicated by history, symptoms, and testing
- In some cases, antiviral or immune-supportive strategies if viral triggers play a role
Modulating and Calming the Immune System
Because PANS/PANDAS fundamentally involves an overactive and misdirected immune response, we also focus on modulating—not just suppressing—the immune system. This may include:
- Anti-inflammatory strategies
- Nutritional approaches to reduce inflammatory load
- Targeted botanicals with anti-inflammatory or immune-modulating properties
- Medication-based options when appropriate and safe for the child
- Addressing autoimmune physiology and neuroinflammation, supporting the body’s ability to resolve inflammation in the brain
- Supporting immune regulation (tolerance) so the immune system can distinguish more clearly between “self,” “enemy,” and “innocent bystander”
Treating Biotoxin and Environmental Contributors
If mold or other biotoxins are part of your child’s picture, addressing them is essential; otherwise, the immune system remains in a chronic fight. This may involve:
- Identifying and addressing mold exposure in home, school, or other environments
- Detoxification support appropriate for pediatric patients
- Gentle strategies first; no aggressive detox sweeps that overwhelm
- Supporting liver, lymph, and elimination pathways so toxins have a route out
- Guidance on environmental changes—air filtration, remediation, or relocation when necessary—to reduce ongoing immune triggers
Nervous System and Brain Support
A child in PANS/PANDAS is not just inflamed—they are often terrified, exhausted, and overwhelmed. The nervous system needs as much care as the immune system. We may incorporate:
- Tools for calming nervous system hypervigilance
- Age-appropriate breathwork
- Somatic tools (body-based calming techniques)
- Trauma-informed strategies
- Limbic retraining, when appropriate, to help the brain unlearn constant threat signaling
- Sleep support and circadian rhythm stabilization, as restorative sleep is one of the most powerful anti-inflammatory tools the body has
- Nutrients and supports for mitochondrial and brain function, such as targeted vitamins, minerals, and other supports to improve energy, focus, and resilience
Gut and Nutritional Support
Because the gut and immune system are so tightly connected, we also address gastrointestinal health and nutrition:
- Evaluating and treating gut dysbiosis, constipation/diarrhea, and food reactions as downstream manifestations of immune imbalance
- Crafting anti-inflammatory, nutrient-dense nutrition plans tailored to:
- What your child can realistically eat
- Sensory and texture issues
- Family capacity and schedule
Psychiatric and Behavioral Support Integration
An integrative approach does not ignore psychiatric or behavioral interventions—it integrates them appropriately. That may involve:
- Collaborating with therapists, occupational therapists, and school teams to provide comprehensive support
- Helping families and clinicians distinguish which behaviors are immune-driven (and therefore improve as inflammation resolves) versus those that may require direct behavioral or therapeutic work
- Supporting families in advocating for accommodations and understanding in schools and other settings
Finding Real Help for PANS/PANDAS
When your child’s personality seems to change overnight and no one can explain why, it can feel terrifying and isolating. PANS and PANDAS are complex, but they are not hopeless—and you are not alone. With the right evaluation and a thoughtful, root-cause–focused treatment plan, many children can reclaim stability, function, and joy.
At the Restorative Medicine Center, we don’t dismiss your concerns or reduce your child’s experience to “just anxiety” or “behavioral issues.” We look deeper to understand the immune, infectious, and environmental factors that have overwhelmed your child’s system, and we walk alongside your family as you navigate the path back toward health.
If you are searching for “PANS/PANDAS treatment near me” and want a physician who truly understands the medical, immune, and functional aspects of these conditions, we are here to help.
Contact the Restorative Medicine Center
Restorative Medicine Center
705 Barclay Cir #115
Rochester Hills, MI 48307
Phone: 248-289-6349
Fax: 248-289-6923
Website: www.restorativemedcenter.com