If your child has PANS or PANDAS, you have asked yourself at least once about what will happen if your little one gets COVID19. Like other parents, even a small risk of a deadly disease for your child sends chills up your spine. Unlike other parents, any viral or bacterial disease, however minor in other children, could send your child’s mental health into a downward spiral. Will COVID-19 restart your child’s obsessive-compulsive behavior, panic attacks, depression, or tics off again?
Parents of children with Pediatric Autoimmune Neuropsychiatric Syndrome (PANS) or Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep (PANDAS) have more to worry about than the average parent with dealing with COVID-19. Their children already deal with the effects of autoimmune inflammation in their brains. Some otherwise minor infection like strep in the case of PANDAS or any other infection in the case of PANS caused the child’s immune system to attack the child’s nervous system. This attack leads to inflammation which leads to weird effects in the child.
These parents work hard to prevent their children from getting another infection that might trigger another attack of tics, panic attacks, or depression among other possible symptoms. They already have some level of vigilance, even hypervigilance for their child’s well-being. Adding the possibility of COVID-19 to their concerns is stressful enough. Adding the stress of masking, lockdowns, and disruption of daily activities due to other’s fear of COVID-19 adds another layer of stress.
These researchers asked a scientific question, “Did the non-infectious effects of COVID-19 on society exert any positive or negative effects on children with PANS or PANDAS?” On one hand, the seclusion of these children from the normal amount of childhood illness exposure could potentially benefit them. Being around fewer other children and the possible viral infections might lessen their infections and reduce their PANS/PANDAS flares. On the other hand, given the pre-existing psychiatric symptoms, would these children suffer more flares during the psychosocial stress of societal upheavals.
The study evaluated 108 children with prior diagnosis of PANS or PANDAS in a multicenter PANS/PANDAS research program. The group administered a web-based survey to the parents measuring the parent’s perceptions of changes in symptom severity during the pandemic period. They did not have comparison groups such as pre-lockdown changes nor children who did not have the diagnosis. While the survey methods could exclude the effects of natural progression of disease, the study was short term and a small sample size of 108.
The researchers expected to find an improvement in patient symptoms given their likely reduced exposure to disease triggers (infections). Instead, 71% of the parents reported increased symptoms for their children. The increase in symptoms appeared related to symptoms of “depressed mood and eating problems”. “Irritability and oppositional behavior” also predicted acute exacerbations. On the other hand, no influence of parental coping strategies was apparent in the study.
The researchers quickly review some of the potential explanations for PANS/PANDAS and some of the proposed therapies like anti-inflammatories and anti-microbials. For the basic condition and the symptom exacerbations during the COVID-19 pandemic, they suggest cognitive behavioral therapies and Parent Management Training (PMT) as management options.
The researchers also review some of the other literature describing the mental health effects on other children either with or without psychiatric or neurologic disorders. These studies show increases in both psychiatric and somatic (body related) symptoms during the pandemic’s times of increased stressors. Not surprisingly, studies indicate that parent’s handling of the pandemic stress impacts their children’s ability to handle the stress. Adequate communication with the children explaining the life changes also lowers children’s symptoms.
Reflecting on the research findings, their confirmation of what we would expect is reassuring but does not answer other questions. As a functional medicine pediatrician, I already know that just like their parents, children are whole and integrated persons. Separating out their mental health from their physical from their spiritual from their relational health ignores that we are made a whole persons. As one who recognizes the impact of fear on one’s health, I am not surprised that either adults or their children have been harmed by the ongoing era of fear in our world. Fear is isolating. Isolation is harmful. The harm continues until something changes.
As we have treated several children with PANS and PANDAS during the onset of this pandemic, the emotional and relational impact was already evident prior to reading this study. For patients who were beginning to recover and beginning to return to normal life activities when the pandemic shut down social life, a great deal of discouragement occurred. Their debilitating symptoms were subsiding and they were looking forward to social activities again, but those opportunities disappeared as the lockdowns and cancellations kicked in. Just as some were learning to not have obsessive fears of germ contamination, the rest of the world began sterilizing their groceries and running from coughs.
This is one study that will change Sanctuary’s medical practice very little as we already knew these principles. Of course, having a study so that we can claim evidence is nice, but sometimes common-sense observations are sufficient. We have been treating and will continue to treat the children with PANS as whole persons within a family unit. Helping the child and their parents cope with life stressors goes along with directly addressing the infectious triggers which started their PANS and PANDAS in the first place. Ignoring either does not help children live a healthier more abundant life whereas our approach increases the chances that the child and their family achieve that goal.
Guido, Cristiana Alessia et al. “The Impact of the COVID-19 Epidemic During the Lockdown on Children With the Pediatric Acute-Onset Neuropsychiatric Syndrome (PANDAS/PANS): The Importance of Environmental Factors on Clinical Conditions.” Frontiers in neurology vol. 12 702356. 11 Aug. 2021, doi:10.3389/fneur.2021.702356
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.