Caring for a child with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) or Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) comes with many challenges.

Rage attacks are a common behavior for children with PANDAS. They may be triggered by many outside factors, from unfulfilled OCD behaviors to food dye sensitivities.

Dealing with a raging child doesn’t have to feel like the end of the world, and there are ways to help. Let’s talk about it.

PANS/PANDAS: A Brief Overview

Characterized by nearly-overnight changes in demeanor, a child with PANS/PANDAS disorder will exhibit a range of symptoms, including:

  • Anxiety: general anxiety, phobias, or separation anxiety
  • Behavioral/developmental regression: might revert to “baby talk” or bedwetting
  • Emotional lability: depression or sudden changes in emotions
  • Oppositional behavior: aggression or irritability
  • Sensory or motor abnormalities: sensitivity to stimuli, clumsiness, or hyperactivity
  • Somatic symptoms: tics, sleep disturbances, or urinary frequency
  • Deterioration of school performance: lack of focus or preoccupation with their new symptoms

To meet the diagnostic criteria for PANS/PANDAS, the child must present with sudden onset Obsessive Compulsive Disorder (OCD) plus recent development of two of the above symptoms.

Pediatric OCD can present in a variety of ways. It may look like your child obsessing over an event, such as washing their hands. The child may create a ritual around it, completing it in a certain way, every time. It may also present as restrictive eating, also called anorexia.

Other psychiatric disorders such as Tourette’s Syndrome or Bipolar Disorder must also be ruled out.

The rage attack is one behavioral change that’s particularly difficult for parents of children with PANS/PANDAS to manage. These episodes of sudden outbursts of anger or distress can be triggered by many things. Rage attacks may be caused by stress, food dye sensitivities, or overstimulation, among other factors.

Rage attacks can be unsettling for caregivers of children with PANS/PANDAS since it’s atypical behavior compared to the child’s previous demeanor. Understanding what’s happening before and during a rage attack is vital in helping your child through future episodes.

Why does PANDAS syndrome cause rage in my child?

PANDAS is an autoimmune condition that develops from a rare complication of a strep infection. When the immune system sends antibodies to combat the strep bacteria, PANDAS develops when antibodies also attack the brain. This attack on the brain results in neurological symptoms, including episodes of rage.

Rage attack symptoms may include:

  • Chest pain/tightening
  • Fear
  • Heart racing
  • Increased stress
  • Shaking
  • Shortness of breath

Behaviors during a rage attack may include biting, hitting, kicking, making threats, shouting, or throwing objects.

Rage attacks tend to happen in the home more than in other locations because children tend to feel more comfortable letting emotions take over while at home.

Rage attacks can be triggered in a number of predictable ways, including:

  • Unfulfilled OCD ritual. OCD is one of the primary psychiatric symptoms of PANS/PANDAS. Preventing a child from completing an OCD ritual could cause a rage attack.
  • Fight or flight response. Outbursts of anger can be caused by events that cause a child to feel anxious or fearful.
  • Food dye. Those with food sensitivities may be more susceptible to rage attacks when exposed to the offending food or additive. Red dye is particularly well-known for triggering neurological issues in kids.
  • Overstimulation or under-stimulation. Outbursts can occur when a child doesn’t know how to respond to an influx of stimuli, e.g. many sounds or people talking at once. Conversely, a rage attack may result if the child feels bored or in need of stimulation.
  • Tic suppression. The frustration a child might feel when attempting to suppress a tic may lead to rage.

How can I support my child through a rage attack?

The best way to support your child through a rage attack is to stay calm. Becoming agitated or emotional could exacerbate the situation.

Be sure your child cannot harm themselves by ensuring the environment is safe. If your child has anything potentially harmful in their grasp, confiscate the item.

A child experiencing an episode of rage is not in a state to be reasoned with, don’t try! It’s okay to wait until the rage attack is over before speaking to your child. Remember, this isn’t a sign that your child is being disrespectful or disobedient.

When emotions have settled, speak kindly and gently to your child. Your child may feel guilty and confused. Offer reassurance that they are still a good kid despite their diagnosis!

Discipline is not the answer to a rage attack. Discipline works for tantrums because they are voluntary and goal-oriented. Rage attacks are involuntary, neurological storms.

Because the body’s sympathetic and parasympathetic nervous systems aren’t working together correctly during a rage attack, your child is more sensitive to some stimuli and quicker to have a fight-or-flight response.

While witnessing these attacks can be unsettling, the rage episode is most upsetting to the child experiencing it. Try not to take any statements expressed in anger to heart. Anything shouted during a rage attack is not premeditated.

Antibiotics and Supplement Supports

Antibiotics are the first line of treatment essential in combating the strep infection causing PANDAS.

After the initial infection has cleared, additional supplements and treatment options exist which may alleviate the lingering PANDAS symptoms.

Beyond antibiotics, other treatment options include:

  • Plasmapheresis.  For severe PANS/PANDAS symptoms, plasma exchange may be helpful. During plasmapheresis, blood is extracted from the body and cycled through a machine to remove or replace the plasma from the blood cells. Studies show it helps alleviate symptoms by 78% on average.
  • Cognitive behavioral therapy (CBT). CBT can help manage neuropsychiatric symptoms associated with PANDAS.
  • Vitamin D with probiotics. The PANDAS Physicians Network recommends Vitamin D and probiotics as complementary treatment options. Vitamin D works well for boosting the immune system. With most of the immune system located in the gut, probiotics continue the work of optimizing gut and immune system function.
  • Intravenous immunoglobulin (IVIG). IVIG treatment is used for severe cases of PANS/PANDAS. However, we don’t recommend this treatment as it hasn’t proven particularly effective.
  • Peptide therapy. Peptides are amino acids that act as signaling molecules in the body. Very specific peptides are used for therapeutic purposes.
  • Supplements. Cilantro tincture and fermented cod liver oil may be helpful supplements.

If Western Medicine Can’t Help, Try Functional Medicine

Here at the M Center, we work with many families who’ve felt inadequately supported by primary care physicians. If you’re looking for further support in your child’s journey to healing, get in touch with us. We strive to provide practical next steps for your child’s health and wellness.


  1. Latimer, M. E., L’Etoile, N., Seidlitz, J., & Swedo, S. E. (2015). Therapeutic plasma apheresis as a treatment for 35 severely ill children and adolescents with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Journal of Child and Adolescent Psychopharmacology, 25(1), 70-75. Full text:
  2. Williams, K. A., Swedo, S. E., Farmer, C. A., Grantz, H., Grant, P. J., D’Souza, P., … & Leckman, J. F. (2016). Randomized, controlled trial of intravenous immunoglobulin for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Journal of the American Academy of Child & Adolescent Psychiatry, 55(10), 860-867. Abstract: