Frequently Asked Questions about PANS, PANDAS and education

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How do PANS and PANDAS impact children and young people in education?

Our understanding of PANS and PANDAS is still developing, and we do not yet fully know how repeated flares may affect children and young people over time in their education. What we do see is that each flare can bring challenges that may influence learning, wellbeing, and confidence in ways that build up and change the support a child or young person needs.

Because no single resource can capture every possibility, it remains essential for families, schools, and health professionals to work together, share information, and adapt support as both the child’s and young person’s presentation, and the wider evidence base, continue to evolve. This flexible, collaborative approach helps ensure every child and young person feels understood and supported.

Below you will find information and resources for parents and carers, and for schools and educational professionals.

Please note: This information applies to education settings across England, Scotland, Wales, and Northern Ireland. Where processes or terminology differ, this is clearly explained. The information provided on this page is for general educational purposes and is not a substitute for medical or legal advice. Always seek guidance from qualified health professionals for concerns about a child or young person’s health and refer to local statutory guidance for policy requirements.

Select a topic, or scroll through the questions below:

Information for caregivers

Information for educators

General condition FAQs

Information for parents and carers

How do PANS and PANDAS impact children and young people in education?

Children and young people living with PANS or PANDAS can suddenly shift from doing well in education to facing a range of difficulties.

These challenges may include:

Obsessive thoughts and behaviours

Tics (sudden, repetitive movements or sounds)

Anxiety, including separation anxiety

Acting in ways typical of a much younger child

Eating difficulties

Problems sleeping

In some cases, children and young people may develop additional or special educational needs, with or without disabilities.

Other possible symptoms include:

Sensory issues (for example, sensitivity to sounds, lights, or textures)

Decline in attention, memory, or educational performance

Deterioration in handwriting or increased difficulty with maths

Symptoms can come and go and often change over time. Not every child or young person will experience all symptoms. Some may also have pre-existing needs, other conditions, and/or be neurodivergent. Families often report that neurodivergent children and young people are particularly vulnerable to misdiagnosis and delays in treatment for PANS and PANDAS. More information can be found here.

The most important thing to notice is whether symptoms are different from the child’s or young person’s usual presentation, and the pattern and degree of change.

What parents and carers need to know

Educational support is based on need, not diagnosis. Schools can and should provide help as soon as difficulties are identified, even while families are waiting for assessments or while clinical investigations are ongoing.

PANS and PANDAS are medical conditions and can only be diagnosed by a medical professional

Education staff often play a key role in noticing changes, providing evidence, signposting families, and putting support in place

Early identification and treatment usually lead to better outcomes

Every child’s or young person’s education experience is different; there is no one-size-fits-all approach

How can schools and health professionals work together to support my child?

Schools and health professionals should work as a team to make sure children or young people with PANS or PANDAS get the right support. This teamwork is called a Multi-Disciplinary Team (MDT) approach. It means teachers, doctors, and other specialists share their knowledge and make joint decisions with you and your child or young person, so their needs are met in a co-ordinated joined up way.

How can I work with a school to support my child?

We have designed this checklist to help you work effectively with your child’s or young person’s education setting when PANS or PANDAS are diagnosed or suspected.

How can school support my child through symptom flares and recovery?

Children and young people can experience significant changes in health, behaviour, learning and emotional wellbeing during flares and recovery. School support is most effective when it is flexible, compassionate, and guided by the child’s or young person’s current functional capacity; what their body and brain are medically able to manage at that time, which may be very different from their usual abilities when well.

Their views and preferences should always be listened to, helping them feel understood and respected, while recognising that symptoms can significantly limit what is possible. The priority is always safety, connection and wellbeing, with expectations adjusted as health and capacity fluctuate. Progress may be uneven, but with the right support, children and young people can rebuild confidence, and move forward at a pace that is realistic and right for them.

More information for schools supporting children or young people with PANS or PANDAS.

What do I do if there is an infection in my child’s school?

Schools must follow their national public health infection control guidance, which sets out universal hygiene measures and exclusion periods. Because decisions about infection related risk are clinical rather than educational, families who are concerned about potential infection triggers are encouraged to speak with their treating clinician. Their recommendations can then be included in the child’s or young person’s Individual Healthcare Plan (IHCP), enabling the school to respond compassionately, supportively, and in line with the public health rules that apply across all settings.

Read our guide to Individual Healthcare Plans for more information.

What are the options if my child is too unwell to attend school?

Children and young people with PANS or PANDAS are entitled to additional support and reasonable adjustments wherever their symptoms create barriers to learning or participation. Across all four nations, education settings must identify needs early and put appropriate support in place based on those needs, even while medical assessments or investigations are ongoing.*

Attendance difficulties are very common for children and young people affected by PANS or PANDAS, and their health needs must always take priority. Children and young people should not be penalised for absences arising from a medical condition, and schools must recognise that physical and mental health are equally important. Across all four nations, specific statutory guidance makes clear that when a child or young person is unable to attend due to health needs, absences should be recorded as medical where appropriate, and no penalties should be applied.

Local authorities have a duty to arrange suitable education when a child or young person cannot attend school because of ill health. Attendance planning should be included in the Individual Health Care Plan (IHCP) or equivalent. Forced attendance during severe flares can be harmful, so flexible options are essential. These may include:

Medical Needs provision arranged by the local authority

Home tuition for short or longer periods

Education Other Than at School (EOTAS) where appropriate

Special schools, hospital schools, alternative provision, or Pupil Referral Units

Elective Home Education (EHE) Parents and carers should understand that this means taking on full responsibility for their child’s or young person’s education

Sometimes children and young people with PANS and PANDAS are too unwell to access any forms of education for periods of time.

These forms of support are legal entitlements, and the duty to provide suitable education sits with the local authority. Families should be aware that availability and capacity can vary between areas. This does not change the child’s and young person’s rights.

*England: SEND Code of Practice; Wales: Additional Learning Needs (ALN) system; Scotland: Additional Support for Learning (ASL) legislation; Northern Ireland: SEN Framework

How can we plan for big transitions, like starting secondary school?

Transitions should be planned early, collaboratively, and at a pace that feels safe. Key transitions may include moving to a new class or teacher, changing key stage, starting secondary school, moving between schools, shifting to exam years, or returning after a long period of absence.

It is important that the child or young person’s voice is central to this process, with adults taking time to understand what feels manageable, what worries them, and what support they feel they need. You could ask schools to help by arranging visits, phased starts, reduced sensory tours, clear communication about expectations, and meetings with new staff, while ensuring that all relevant plans such as the Individual Healthcare Plan are updated, transferred, and clearly communicated to everyone involved.

Clinicians can contribute to transition planning where helpful, and support should remain flexible because children’s or young people’s needs may fluctuate during these periods of change.

Can PANS or PANDAS affect exams and assessments?

Yes. PANS and PANDAS can affect many areas of functioning, beyond attention, memory, handwriting, and processing speed. Symptoms such as anxiety, obsessive-compulsive behaviours, sensory needs, fatigue, and emotional dysregulation can all make exams and assessments extremely challenging. These difficulties may influence a child’s or young person’s ability to concentrate, manage time, understand instructions, or even attend the exam. Because symptoms often fluctuate and can worsen suddenly during a flare or recovery phase, support needs to be flexible, responsive, and tailored to the child’s or young person’s current presentation.

What can parents and carers do?

Talk to the school early about any difficulties your child or young person is experiencing.

Ask the school to record evidence of needs and adjustments tried.

Request a meeting with the SENCO (England/Norther Ireland), ASN Coordinator (Scotland), or ALNCo (Wales) to discuss exam arrangements.*

For older children and young people, it can be helpful to know who the Exams Officer is. They usually work behind the scenes and may not have direct contact with parents or carers. Their role is to handle the practical side of exam arrangements and to work closely with the SENCO/ALNCo/ASN Coordinator, who leads on identifying needs and communicating with families. Schools differ in how Exams Officers are involved, so discussions about exam arrangements should normally take place with the SENCO, ALNCo/ASN Coordinator who can liaise with the Exams Officer as needed.

What support is available?

Schools can put in place access arrangements.

If illness affects attendance or performance, parents and carers can ask if special consideration for missed or affected exams can be applied.

These arrangements usually require evidence from the school and medical information, but a confirmed diagnosis is not always essential.

Exam Access Arrangements are complicated, and eligibility depends on regulations, evidence of need, and the child or young person’s normal way of working. Schools must follow strict guidance set by their awarding bodies, and processes can vary. Families who need more detail or who would like to understand the criteria in their area can ask the school’s SENCO/ALNCo/ASN Coordinator for clarification and signposting to the relevant guidance.

*England- JCQ – Access Arrangements & Reasonable Adjustments: Detailed regulations on eligibility and application processes → Regulations and Guidance [jcq.org.uk]-JCQ – Special Consideration Guide: How to apply when illness or symptoms affect performance on exam day accessible via the JCQ page above

Northern Ireland additional guidance- CCEA – Access Arrangements & Reasonable Adjustments: Tailored for NI exam centres and follows JCQ rules → CCEA arrangements page [ccea.org.uk]

Wales – WJEC – Special Requirements (Access Arrangements & Special Consideration): Refers directly to JCQ rules applied in Wales → WJEC Special Requirements [wjec.co.uk], [chasehigh.org]

Scotland- SQA – About Assessment Arrangements: Guidance on applying for exam support for additional support needs or disabilities → SQA Arrangements Guidance [sqa.org.uk]– SQA – Learner-Focused Guide: Explains arrangement types and how decisions are made; for discussion with your child’s or young person’s school → SQA Learner Guide [sqa.org.uk]

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Information for educational professionals

There are many adjustments schools and education providers can make to support children and young people affected by PANS and PANDAS.

How can a school support reintegration after a period of absence?

Returning to school after a flare or extended absence can feel overwhelming for a child or young person. Reintegration should be gradual, flexible, and focused on emotional safety and connection before academic expectations. It’s important to respect the child’s agency and voice, plans should be made with them, not just for them, and consider their feelings about readiness, not only physical recovery. Strategies should be agreed collaboratively.

Examples include:

Involve the child or young person in planning, asking what feels manageable and what support they need

Consider short sessions or part-time attendance, building up slowly

Prioritise wellbeing and confidence before academic targets

Offer regular check-ins with a trusted adult to monitor stress and coping

Keep adjustments in place for fluctuating symptoms (e.g., extra time, safe spaces)

Use buddy systems or peer support to maintain friendships and belonging

Provide catch-up opportunities for missed learning without overwhelming the child or young person.

How can schools support sleep difficulties?

Sleep problems are common in PANS and PANDAS, can fluctuate over time, and are not due to poor sleep hygiene. They may be severe and affect concentration, mood, and attendance. Support should be flexible and tailored to the child’s or young person’s needs, and sleep considerations can be included in the Individual Health Care Plan (IHCP) or equivalent. Adjustments can help reduce demands and keep learning achievable while the child’s or young person’s sleep improves.

Examples include:

Rest breaks during the day to manage fatigue
Reduced expectations for homework or non-essential tasks during sleep difficulties
Flexible attendance to allow recovery from poor sleep
Later start times so the child or young person can get more rest

How can schools support obsessive or compulsive behaviours?

As with the other symptoms, obsessive or compulsive behaviours in PANS and PANDAS are medical, not behavioural, and can include visible compulsions as well as mental rituals that are harder to detect, but equally debilitating. Support should recognise triggers, be tailored to the current phase of the condition, consider links to other symptoms, involve health professionals, and be reviewed regularly. Strategies need to reduce demands and help your child or young person feel safe and supported.

Examples include:

Providing a safe, calm space for when anxiety or compulsions escalate
Reducing triggers where possible, such as avoiding sudden changes or stressful tasks
Offering flexible expectations for work completion during severe symptom phases
Using alternative methods for tasks if compulsions affect handwriting or speed (e.g., typing or dictation)
Ensuring staff understand mental rituals and monitor for signs that are not immediately visible
Including clear plans in the IHCP and review regularly with the child and young person and input from health professionals
Behaviour approaches, such as zero tolerance systems or very strict sanctions will not be appropriate for children or young people with PANS or PANDAS related obsessive compulsive type behaviours. A relational, understanding response will help staff support the child or young person more effectively.

How can schools support sensory needs?

Children and young people with PANS or PANDAS may experience increased sensory sensitivities, such as heightened sensitivity to sound, light, touch, smell, or movement. These sensory challenges can fluctuate during flares and may affect concentration, behaviour, emotional regulation, and participation in school life. Support should help the child or young person feel safe, regulated, and able to learn without becoming overwhelmed.

Examples of helpful strategies include:

Provide access to low stimulus or quiet spaces for calming or regulation when sensory input becomes overwhelming.
Reduce sensory demands, such as lowering noise levels, offering dimmed lighting, or seating the child or young person away from busy areas of the classroom.
Offer sensory tools such as ear defenders, weighted items, fidgets, or textured alternatives, depending on the child or young person’s preferences and needs.
Prepare the child or young person for sensory changes, including transitions, loud events, assemblies, or sudden shifts in routine.
Include sensory strategies in the IHCP, sharing them with all relevant staff so responses are consistent and supportive.
Check in regularly, as sensory needs may change rapidly, especially during flares.
A calm, attuned, and flexible approach helps reduce distress, supports regulation, and enables the child or young person to stay connected, engaged, and safe at school. You can find more information about this here.

How can schools support episodes of dysregulation?

Children or young people with PANS or PANDAS may experience extreme distress, panic, shutdown, or aggression during flares. These episodes can be unpredictable and often overlap with other symptoms such as anxiety, obsessive compulsive behaviours or sensory overload. A proactive approach is essential, planning reduces risk and helps staff respond calmly and consistently, rather than reacting in crisis. Strategies should be agreed collaboratively and included in the individual health care plan (IHCP) or equivalent. It’s also important to maintain emotional safety and connection for the child or young person during and after these episodes, while ensuring the safety of other pupils and staff.

Examples include:

Include recognising early warning signs, agreed actions, and communication steps in the IHCP or equivalent
Identify triggers and calming strategies tailored to the child or young person
Provide staff training so everyone understands triggers and safe responses
Offer safe spaces and flexible timetables to reduce pressure during difficult moments
Agree limits for attendance when unwell, so health and safety always come first
Plan for reconnection after an episode, such as a check-in with a trusted adult or a calm activity to restore a sense of safety.

How can schools support schoolwork difficulties?

Fluctuating fine motor skills, working memory changes, or low levels of concentration can make handwriting and academic tasks very challenging for children and young people with PANS or PANDAS. These difficulties often vary from day to day, so support needs to be flexible and responsive. Adjustments should reduce demands and keep learning achievable while symptoms persist. Examples include:

Flexible expectations for handwriting and written work
Alternative methods such as typing or dictation when writing is difficult
Reduced workload during severe symptom phases to prevent overwhelm
Extra time for tasks including breaking work into smaller manageable steps, to accommodate slower processing or fatigue
Access to supportive tools like pencil grips, sloped boards, or speech-to-text software
Emotional reassurance and encouragement, helping your child or young person feel supported and valued, even when work looks different from before.

How can schools support eating difficulties?

Eating difficulties are complex and may include sensory sensitivities, contamination fears, or emetophobia (intense fear of vomiting). These challenges can affect nutrition, energy, and social experiences at school. Support should be included in the Individual Health Care Plan (IHCP) or equivalent, and strategies shared with all relevant staff, including lunchtime supervisors. Adjustments should be discreet and flexible to reduce stress and avoid drawing unnecessary attention. They should also be developed with the child’s or young person’s agency in mind ensuring their preferences, feelings, and readiness guide how support is offered.

Examples include:

Provide a quiet or low-stimulation space for eating if sensory issues are present
Offer alternative food options where possible to accommodate sensory or contamination fears
Allow extra time for meals if eating is slow or stressful
Ensure staff understand the child’s or young person’s needs and respond calmly if difficulties arise
Include clear plans in the IHCP and review regularly with input from health professionals.

How can schools help raise awareness and improve belonging?

Friendships are important for children and young people, but absences and fluctuating symptoms can make having a sense of belonging difficult. Decisions about sharing information on PANS or PANDAS with peers is personal and should be guided by the child, young person and their family. Education settings can help by supporting inclusion and reducing isolation through pastoral care and practical strategies. Examples include:

Use peer buddies or a buddy system to maintain connection during absences
Facilitate virtual check-ins or messages so the child or young person feels included when away from school
Plan friendship-building activities with their peer group when the child or young person returns to school
Offer pastoral support to help the child or young person manage worries about friendships
Respect the child, young person and family decisions on what information to share with peers and ensure confidentiality
Considering whether an assembly or smaller group discussions might be appropriate to raise awareness and promote understanding. We have developed a video to help primary school pupils understand PANS and PANDAS and how to support any affected classmates.

How can schools support siblings?

Siblings may experience stress, worry, or changes in family routines when their brother or sister is affected by PANS or PANDAS. They might feel anxious about what is happening, miss time with parents and carers, or struggle with schoolwork due to disrupted home life. Education settings can help by offering pastoral support and practical strategies to maintain wellbeing and inclusion for siblings while ensuring their agency is respected.

Examples include:

Provide a safe space for conversations where siblings can share feelings and ask questions in a supportive environment.
Offer pastoral check-ins. These may need to continue for several weeks or months.
Maintain normal routines and expectations where possible, while being flexible if home circumstances affect homework or attendance.
Encourage peer support and friendship-building activities to reduce isolation and maintain a sense of belonging.
Signpost to counselling or wellbeing services if siblings show signs of distress or anxiety.
Respect confidentiality and family decisions about what information is shared, ensuring siblings feel supported without breaching trust.

What if a school or educator has safeguarding concerns?

Because PANS and PANDAS can cause sudden and severe changes in behaviour, emotions, or functioning, these symptoms may sometimes be mistaken for safeguarding “red flags.” For example, a child or young person might show a sudden unexpected change such as extreme distress, aggression, withdrawal, or eating difficulties during a flare, which could raise concerns about potential neglect or abuse.

Schools have a legal duty to follow safeguarding procedures, alongside the relevant guidance, and vigilance is essential for every child’s or young person’s safety. Safeguarding concerns should always be considered alongside possible medical causes, and schools should explore both with openness and sensitivity.

What schools can do:

Keep an open dialogue with parents and carers before making assumptions.
Seek medical input where symptoms could have a health-related cause.
Document patterns and timelines of changes in behaviour and functioning, sudden onset and fluctuation are key indicators of PANS or PANDAS.
Avoid punitive responses and focus on understanding the child’s or young person’s needs.
Include safeguarding and medical considerations together in planning, ensuring the child’s or young person’s safety and wellbeing remain central.
Watch this presentation by Kelly Jarvis from Sunshine Support, which discusses FII, safeguarding and PANS and PANDAS.

Why this matters:
Misinterpretation can lead to unnecessary and severe distress for families and delay appropriate medical support. A balanced approach of prioritising safety while recognising complex health needs helps protect children and young people and maintain trust.

Education glossary

Access Arrangements: Adjustments made for exams and assessments to reduce disadvantage caused by disability or health needs (e.g., extra time, rest breaks, use of a computer).

Additional Learning Needs (ALN) – Wales: Children needing extra support with learning. Replaces SEN.

Additional Support Needs (ASN) – Scotland: Children needing extra support for any reason, including health or emotional needs.

ALNCo (Additional Learning Needs Coordinator) – Wales: Staff member coordinating ALN support.

ASN Coordinator – Scotland: Staff member overseeing support for pupils with ASN.

Baseline – Record of a child’s or young person’s usual functioning before difficulties began.

Buddy System A peer support approach where a child is paired with a classmate to maintain social connection and inclusion, especially during absences or reintegration.

Catch-up Learning: Targeted support to help a child recover missed learning after absence or illness, often using flexible methods like tutoring or alternative formats.

Education, Health and Care Plan (EHCP) – England: Legal plan for children up to 25 who need extra support.

Flare: A period when symptoms of PANS or PANDAS worsen significantly, often suddenly, affecting physical, emotional, and cognitive functioning.

Individual Development Plan (IDP) – Wales: Statutory plan for children with ALN, replacing EHCP/SEN support.

Individual Health Care Plan (IHCP) – Plan describing how a child’s or young person’s medical needs will be supported at school.

Masking – When a child or young person hides symptoms at school to cope, making difficulties less visible for staff.

Reasonable Adjustments – Changes education settings must make to ensure disabled children are not disadvantaged.

Relapsing and Remitting – Symptoms improve, then worsen again.

SEN (Special Educational Needs) – England and Northern Ireland: Learning difficulties or disabilities affecting learning.

SEN Support – Support provided by schools for children with SEN without a statutory plan.

SENCO (Special Educational Needs Coordinator) – The qualified staff member who coordinates SEN support in school.

Special Consideration: A post-exam adjustment applied when illness or other circumstances affect a pupil’s performance during an assessment. Schools submit the request and exam boards make the final decision.

Statutory Plan – Legal plan setting out a child’s needs and required support (EHCP, CSP, IDP, Statement).

Suitable Education – Education meeting a child’s age, ability, aptitude, and needs. Local authorities must provide this if a child or young person cannot attend school due to medical needs.

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