Sudden Onset Disordered Eating Behaviors and Appetite Issues in a Local Clinical Cohort of Children With Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)
RESEARCH IMPACT:
“Sudden Onset Disordered Eating Behaviors and Appetite Issues in a Local Clinical Cohort of Children With Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)” underscores that sudden-onset disordered eating is a prominent and under-recognized cardinal symptom of PANS, often mimicking ARFID but with distinct clinical triggers and trajectory. Recognizing the unique eating restriction patterns and baseline eating behaviors in patients with PANS is essential for timely diagnosis and appropriate immunological and psychiatric interventions.
SUMMARY
“Sudden Onset Disordered Eating Behaviors and Appetite Issues in a Local Clinical Cohort of Children With Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)” explores the prevalence and characteristics of disordered eating in children diagnosed with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS), a neuroinflammatory condition associated with abrupt-onset psychiatric symptoms. The authors stress it is important to understand the unique disordered eating patterns related to PANS as it will lead to early intervention to eradicate strep or other infections that may be triggering the symptoms.
Among the 130 patients that fulfilled the study criteria to be included in the review, more than half experienced sudden restrictive eating behaviors during a PANS flare, with patterns closely resembling subtypes of Avoidant Restrictive Food Intake Disorder (ARFID). These included selective eating (48%), low appetite or disinterest in food (41%), and fear of aversive consequences such as choking or contamination (37%). At least two patients presented to the ER and required IV hydration. Interestingly, concerns about body image or weight were rare (only 4%).
Many children demonstrated overlapping neuropsychiatric symptoms including emotional lability, cognitive impairment, and behavioral regression, which often accompanied the eating changes. Notably, 12% of the cohort had baseline eating restriction before their PANS diagnosis with some being described as picky eaters and low appetite. Over half of the individuals showed a distinct, new pattern of food restriction during flares. The sudden onset and fluctuation of symptoms with infection or inflammation strongly differentiate PANS-related eating restriction from typical ARFID, which tends to to be static or slowly evolve in a predictable way.
The findings of this study highlight the importance of screening for PANS in children who present with abrupt-onset disordered eating and understanding the unique patterns of eating restriction that may occur in this population, as targeted anti-inflammatory and infection-related treatments can significantly improve outcomes.
LINK TO PAPER: https://doi.org/10.1002/eat.24388
CITATION
Kapphahn, C., Peet, B., Gao, J., Chan, A., Farhadian, B., Ma, M., Silverman, M., Tran, P., Schlenk, N., Thienemann, M., & Frankovich, J. (2025). Sudden Onset Disordered Eating Behaviors and Appetite Issues in a Local Clinical Cohort of Children With Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). The International journal of eating disorders, 10.1002/eat.24388. Advance online publication. https://doi.org/10.1002/eat.24388