Child Has Strep Throat & Behavior Changes? What You Need To Know About PANDAS

Strep throat is a bacterial infection that every parent is likely familiar with. What many parents aren't familiar with is pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. That's a mouthful, so it's been shortened to PANDAS. Basically, some children who have streptococcal infections act and behave completely different, as if they are a different person altogether. They become moody, aggressive, clingy, and anxious, and they may display tics, which are uncontrollable body movements. They may exhibit signs of obsessive-compulsive disorder as well. Here's what you need to know if your child has these symptoms after a diagnosis of a strep infection. 

Why does it happen? 

The bacteria hides from your child's immune system by blending in and looking almost identical to molecules in your child's body, including in the brain. Eventually, the immune system recognizes this and begins to produce antibodies to attack the strep bacteria molecules and the molecules it mimicked. When this happens in the brain, it causes the mental health symptoms of PANDAS.

How is it diagnosed?

There are no tests for PANDAS. Diagnosis will be determined based on medical history and presenting symptoms in a clinical examination with your child's pediatrician. The key thing that aids in diagnosis of PANDAS as opposed to unrelated mental health conditions is that PANDAS comes on suddenly when there's a strep infection. A throat culture will be necessary. If the test is negative, there may still be a strep infection in the sinuses, anus, or vagina, which the pediatrician can also test for. 

How is it treated? 

Treatment for PANDAS involves treatment for the strep infection with antibiotics. The symptoms of PANDAS should subside with the treatment of antibiotics. If not, your child may have a more pervasive PANDAS, meaning they are more severely affected and will need further treatment that may include options such as selective serotonin reuptake inhibitor medication and immunoglobulin therapy. 

Could it be something else? 

If the strep tests come back negative, perhaps your child may have been bitten by a tick and has developed neuropsychiatric Lyme. Therefore, your pediatrician should consider testing your child for Lyme disease, which is also treated with antibiotics. Another condition that may cause PANDAS is mono, which your pediatrician can test for. Sometimes, a child can have more than one cause of PANDAS, so it's a good idea to have a full range of tests done, particularly if you see no improvement in your child after taking a course of antibiotics after a positive throat culture for strep.