by Jessica Pupillo • Correspondent
One morning, 8-year-old Holland woke up
with extreme anxieties, headache and abdominal pain. The previously healthy girl from Scottsdale, Ariz., also had food aversions and light
sensitivities, said her mother, Karen Blandini.
For the next two years, the family hunted for a diagnosis and e;ective treatment, Blandini said. After
Holland could no longer talk or get out of bed, she
arrived at the Children’s Postinfectious Autoimmune
Encephalopathy Center of Excellence at the University of Arizona
Steele Children’s Research Center
where she was diagnosed with Pediatric Autoimmune Neuropsychiatric
Disorder Associated with Streptococcus (PANDAS).
;e term PANDAS was coined in
the 1980s by Susan E. Swedo, M.D.,
FAAP, chief of the Pediatrics and Developmental Neu-
roscience Branch at the National Institute of Mental
Health (NIMH), after she discovered a link between
abrupt-onset obsessive-compulsive disorder (OCD) and
group A Streptococcus (GAS).
;e diagnostic criteria for PANDAS include sud-den-onset OCD or severely restricted food intake, Dr.
Swedo said, and at least two of the following symptoms:
• emotional lability or depression;
• irritability or aggression;
• behavioral regression;
• attention-deficit/hyperactivity disorder-like symptoms that cause a deterioration in school performance;
• sensory or motor abnormalities; and
• somatic symptoms like sleep disturbances and fre-
PANDAS is a subset of Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), which has the same
symptoms but can be caused by infections like varicella
or influenza, she said.
While there are no incidence data on PANS yet,
Dr. Swedo estimates the disorder impacts about 1%
of elementary school-aged children and likely is un-derdiagnosed.
PANDAS primarily a;ects children younger than
12 because they are less likely to have streptococcal
While more centers like the one in Arizona are being
established around the country to treat PANDAS, not
all clinicians are convinced that strep infections trigger
“;e main reason PANDAS/PANS is not diagnosed
more is because of almost 20 years of controversy,” Dr.
by Julie M. Linton, M.D., FAAP, Marsha Griffin,
M.D., FAAP, and Alan J. Shapiro, M.D., FAAP
Immigrant and refugee children
should be treated with dignity and
respect, and not placed in settings
that fail to meet basic standards for
children’s physical and mental health or expose them
to additional risk, fear and trauma, according to a
new AAP policy statement. ;e statement also o;ers
recommendations for the care of children released
into communities while their cases proceed.
;e policy Detention of Immigrant Children, from
the AAP Council on Community Pediatrics, was
developed in response to increasing concerns by pediatricians and child advocates regarding the conditions to which newly arrived immigrant children are
exposed when seeking protection at the U.S. southern
border. In particular, Department of Homeland Security (DHS) facilities do not meet the basic standard
of care for children in residential facilities.
www.aapnews.org Volume 38 • Number 4 • April 2017
Chapter leaders storm
Capitol Hill with ‘united
voice for children’
by Devin Miller • Washington Correspondent
AAP chapter leaders from all 50 states, the District of Columbia and Puerto Rico traveled to
the nation’s capital in late February to urge their
members of Congress to protect children’s health
;e AAP Chapter Leaders Fly-In, made possible by the Friends of Children Fund, was an
opportunity for AAP leaders to introduce themselves and the Academy’s priorities for children’s
health to a new Congress and presidential administration.
“Each leader brings a unique perspective to the
critical advocacy work before us, from those who
live and treat patients in rural America to those
who work in our country’s largest cities,” said AAP
President Fernando Stein, M.D., FAAP, in a communication to all AAP members. “Our patient
stories, our advocacy journeys and the issues that
drive them may vary, but together, we represent
See PANDAS/PANS, page 13
Photo courtesy of Verónica G. Cárdenas-Vento
Julie M. Linton, M.D., FAAP, co-chair of the AAP Immigrant Health Special Interest
Group and policy co-author, checks the vitals of an immigrant girl at a church in
McAllen, Texas, which provides respite for immigrants when released from detention.
See Washington Report, page 3
PANDAS/PANS treatments, awareness evolve, but some experts skeptical
AAP policy says no child should be in
detention centers or separated from parents
See Immigrant children, page 4
In this issue
Pediatricians should look for signs of child abuse in patients
who live in homes where pets have been abused or killed.
Behavioral problems in maltreated children
An updated clinical report helps pediatricians recognize
and manage behavioral problems in maltreated children.