It's the PANDAS, not your child

When a flare hits, the child you know seems to disappear. Rage you have never seen, fears that make no sense, behaviors that look nothing like them. It is easy in those moments to lose track of who is in front of you. This page is to help you hold on to one truth: the child is still there.

What is actually happening

PANS and PANDAS flares are driven by inflammation in the basal ganglia, an area of the brain involved in movement, mood, and impulse control.¹,⁴ When that area is inflamed, the brain cannot do the things it normally does to regulate fear, manage transitions, override OCD thoughts, or hold back impulses.

This is not behavior the child can choose their way out of, any more than a fever is a choice. The mechanism is physical.⁶

What this means in the moment

• The behaviors are real. They are not manipulation, attention-seeking, or willfulness.
• Your child is suffering. They feel the same shock and confusion you do, often worse.
• Discipline strategies that work for typical kid behavior will not work here. The brain that processes consequences is the brain that is currently inflamed.
• The child you know is underneath. They come back as the flare resolves.

What helps you hold on to this

Many parents find it helpful to name the flare externally, in a quiet moment: "That is the PANDAS, not you." Some say it to themselves; some say it to the child once the flare has passed. The goal is not to excuse harmful behavior, but to keep the child separate in your mind from the inflammation.

When the flare passes, and most do, your relationship with your child does not have to be permanently changed by what happened. Many families come back from very dark weeks.