Parents rarely walk into my office saying, “Something has been gradually off for years.” More often they say something like: “This isn’t my kid.” The shift can feel sudden—sometimes seemingly overnight.
And this is where families get stuck. From the outside, many PANS symptoms can look purely psychiatric: anxiety, OCD behaviors, rage, school refusal. It’s easy to be told, “It’s just anxiety,” or “It’s a phase,” especially if basic labs look normal. But in many children, the pattern suggests something else: immune and inflammatory activation affecting the brain.
PANS symptoms can be intense, confusing, and episodic—meaning your child may flare dramatically, partially recover, then flare again. That waxing and waning nature is a big reason it’s misunderstood.
At Restorative Medicine Center, we dig deeper. We look for the root causes driving the pattern—no bandaids, no gimmicks—so families can stop spinning and start making sense of what’s happening. We see families from Rochester Hills, Metro Detroit, and across Michigan who are trying to connect the dots and get their child back.
What Is PANS?
PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome. It’s a syndrome where a child develops sudden-onset neuropsychiatric symptoms (often dramatic and out of character) along with other brain/body symptoms—sleep, urinary changes, GI issues, sensory changes, and school/function decline.
A helpful distinction:
- PANS is broader—there can be multiple possible triggers (not just one).
- PANDAS is a subset of this pattern that is associated with strep-trigger illness patterns.
The label is less important than recognizing the pattern early so you can evaluate triggers and support recovery in a structured, tolerable way.
The Core Hallmark Symptoms of PANS
Sudden-onset OCD symptoms
This is not “a kid who likes things tidy.” This is a sudden, intrusive, fear-driven pattern that can take over quickly, such as:
- Intrusive thoughts and compulsions that feel urgent or terrifying to the child
- Reassurance seeking that becomes constant (“Are you sure I’m okay?” “Did I do it right?”)
- New rituals: washing, checking, counting, repeating, “just right” behaviors
- Avoidance behaviors driven by fear (avoiding bathrooms, school, doorknobs, eating, clothing, leaving the house)
Sudden, significant food restriction
This can look like picky eating at first glance—but it’s usually fear-driven, rigid, or sensory-overwhelming:
- Fear of choking, vomiting, or contamination
- Texture/temperature rigidity (only certain textures, only “safe” temperatures, narrow acceptable list)
- Refusal to eat due to anxiety, sensory overload, or obsessive fear
- Meals becoming battlegrounds or dissolving into tears/panic
If your child has sudden OCD symptoms and/or sudden food restriction, that combination is a major signal to evaluate for a PANS pattern.
Common PANS Symptoms by Category
Anxiety and fear-based behaviors
- Separation anxiety that is new or extreme
- Panic episodes, sudden new phobias (contamination, vomiting, choking, dying, getting sick)
- Excessive reassurance seeking, clinginess
- School refusal that feels irrational but intense
Mood and emotional regulation changes
- Irritability, rage episodes, aggression (often out of proportion to the situation)
- Emotional lability: rapid mood swings, tearfulness, “walking on eggshells”
- Depression-like symptoms or a “flat” affect (less joy, less engagement)
Behavioral and personality shifts
- Sudden oppositional behavior, defiance, impulsivity
- Social withdrawal, loss of interest in friends and activities
- The parent statement you can’t ignore: “They’re not acting like themselves.”
Tics and abnormal movements
- Motor tics: blinking, facial movements, shoulder shrugs, head jerks
- Vocal tics: throat clearing, sniffing, sounds
- Choreiform or “restless” movements (when present): fidgeting that looks neurologic, not just nervous energy
Sensory and cognitive changes
- Light/noise sensitivity; clothing/texture intolerance (tags, socks, seams become unbearable)
- Brain fog, reduced processing speed, “I can’t think”
- Attention issues, memory problems, word-finding trouble
Sleep disruption
- Insomnia, frequent waking, nightmares, night terrors
- Day/night reversal (awake at night, exhausted during day)
- “Wired but tired” pattern—exhausted but unable to settle
Urinary symptoms
These are common and often overlooked:
- Frequency and urgency
- Accidents after being previously dry
- Bedwetting regression
- “Feels like a UTI” symptoms without clear infection findings
GI symptoms
- Nausea, abdominal pain, appetite swings
- Constipation or diarrhea
- Increased food sensitivities (and sometimes sudden “reactivity” to foods/supplements)
Developmental regression and executive function collapse
This can be shocking for parents:
- Baby talk, increased clinginess, loss of independence skills
- Handwriting deterioration, trouble with fine motor tasks
- Difficulty with transitions, planning, frustration tolerance—meltdowns over small changes
School and function decline
Often one of the most visible real-world clues:
- Sudden drop in grades or inability to complete homework
- Increased nurse visits, meltdowns, behavioral issues, attendance problems
- Reduced stamina and the classic post-school crash (child holds it together at school, unravels at home)
The Pattern Parents Notice: Flares, Triggers, and “Waxing/Waning”
One of the most confusing parts of PANS is that it can surge and then partially improve. Parents will tell me, “We thought we were past it… and then it came roaring back.” That waxing/waning pattern is a big reason kids get mislabeled as “just anxious,” “manipulative,” or “acting out.” The reality is: patterns matter.
Common flare triggers to watch for include:
- Infections and exposures
- Viral illnesses (even a “mild cold”)
- Strep illness or strep exposure (including family/classroom exposure)
- Other infections that stress the immune system
- Stress and physiologic strain
- Emotional stress, school stress, testing weeks
- Sleep loss (often the silent trigger)
- Travel, holidays, big schedule changes
- Environmental changes
- Shifts in environment that increase inflammatory load
- Water-damaged buildings or musty environments (when relevant to your child’s history)
PANS is often recognizable by timing + intensity + multi-system symptoms. It’s not just one behavior—it’s a whole-body shift that follows a pattern.
When to Seek Urgent Help
Some PANS presentations cross into medical or psychiatric urgency, and safety comes first. If any of the following are happening, seek urgent evaluation immediately (ER, urgent psychiatric evaluation, or call local emergency services as appropriate):
- Severe food restriction, dehydration, inability to keep fluids down, or rapid weight loss
- Threats of self-harm, suicidal thoughts, statements like “I don’t want to be here,” or extreme hopelessness
- Dangerous aggression or inability to keep the child/siblings/caregivers safe
- Catatonia-like symptoms (frozen, minimally responsive), extreme confusion, or sudden neurologic decline
Guidance: urgent stabilization first. Root-cause workup and longer-term planning come after your child is safe and medically supported.
If you’re in the U.S. and need immediate support, you can call/text 988 (Suicide & Crisis Lifeline). If there’s imminent danger, call 911.
Common Look-Alikes and Why Misdiagnosis Happens
PANS is a pattern diagnosis, and there are several conditions that can overlap symptom-wise—especially early on. This is one reason families are sometimes bounced from office to office with conflicting labels.
Conditions that can overlap include:
- Anxiety disorders, OCD, ADHD, and autism-related presentations
- Especially when subtle traits were present before, and then the child suddenly decompensates
- Depression or bipolar-like presentations (mood swings, agitation, shutdown)
- Seizure disorders (including atypical seizures) and autoimmune encephalopathy considerations
- Thyroid dysfunction, iron deficiency/anemia, and sleep disorders (which can amplify symptoms dramatically)
- Tick-borne infections and other stealth infections (case-dependent)
- Mold/biotoxin-related illness when the history fits (water damage, musty environments, symptom shifts when away)
A child can have anxiety and immune activation. A child can have attention issues and inflammation driving the intensity. Our goal isn’t to argue about labels—it’s to figure out what’s fueling the fire.
What an Evaluation Typically Includes in Our Clinic
When families come to us, they’re usually exhausted—emotionally, financially, and logistically. So we keep the process structured. The goal is clarity, not chaos.
Detailed history + timeline (the backbone of decision-making)
We map out:
- Exactly when the child changed
- What preceded it (illnesses, exposures, stressors)
- How symptoms flare and what helps
- What function looks like at home and school
Root Cause Triad lens (the “why” behind persistence)
We look at three big drivers that commonly stack:
- Microbes (infectious triggers and immune stressors)
- Toxins (including biotoxins when relevant)
- Stress physiology (fight-or-flight patterns that amplify symptoms and reduce resilience)
Targeted testing with decision value (not random panels)
We use testing strategically to:
- Rule in/out key drivers
- Identify inflammatory and immune patterns that affect treatment tolerance
- Guide sequencing (what to address first so your child can actually handle the plan)
We build a phased plan that matches your child’s tolerance. The goal is to stay calm and cover root causes at a rate your child can handle long enough for the downstream symptoms to unwind.
Get Clarity and a Plan You Can Follow
If you’re living through a sudden change in your child—OCD behaviors that came out of nowhere, food restriction, rage, anxiety, sleep disruption, school collapse—please hear this clearly: you’re not crazy. These symptoms are often pattern-based and driven by real physiology: immune activation, inflammation, and nervous system dysregulation that can make a child look like a completely different person.
The sooner you stop trying to “out-parent” the symptoms and start looking for the drivers, the sooner you can get traction. If you suspect PANS in your child, the next step is to schedule a comprehensive evaluation so we can build the timeline, identify likely triggers, and create a phased plan your child can tolerate—calm, steady, and focused on root cause.
Contact Restorative Medicine Center
Restorative Medicine Center (Dr. Teresa Birkmeier-Fredal, MD)
705 Barclay Cir #115, Rochester Hills, MI 48307
Phone: 248.289.6349
Fax: 248-289-6923
Office Hours: Mon–Thurs: 9am–5pm | Fri: Closed
Website: restorativemedcenter.com