Understanding and Addressing Restrictive Eating in PANS/PANDAS: Symptoms, Examples, and Homeopathic Approaches

Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) are complex autoimmune conditions that can profoundly impact a child’s behavior, emotions, and physical health. One of the hallmark symptoms of PANS/PANDAS is restrictive eating, which can manifest suddenly and severely, often leaving parents bewildered and concerned. In this blog, I’ll explore the nature of restrictive eating in PANS/PANDAS, provide case examples, and discuss homeopathic remedies that may support healing, while emphasizing the importance of working with qualified professionals.

What is Restrictive Eating in PANS/PANDAS?

Restrictive eating in PANS/PANDAS is characterized by a sudden onset of food avoidance or severe limitations in food intake, often driven by neuropsychiatric symptoms rather than typical eating disorder motivations like body image concerns. It’s a core diagnostic criterion for PANS, with approximately 50% of patients experiencing some degree of restrictive eating, and about 17% facing life-threatening complications due to malnutrition or dehydration. The underlying cause is a misdirected immune response that triggers brain inflammation, leading to symptoms such as obsessive-compulsive disorder (OCD), sensory hypersensitivities, or irrational fears around food.

Unlike traditional eating disorders like anorexia nervosa, restrictive eating in PANS/PANDAS is often rooted in:

• OCD-driven fears: Contamination fears (e.g., germs, poison, or allergens), fear of choking, vomiting, or swallowing.

• Sensory sensitivities: Aversion to certain textures, tastes, or smells.

• Swallowing difficulties: Physical or psychological barriers to swallowing

This symptom can lead to significant weight loss, nutritional deficiencies, gastrointestinal issues, and developmental delays, making prompt recognition and treatment critical.

Case Examples of Restrictive Eating in PANS/PANDAS

To illustrate the impact of restrictive eating, here are anonymized examples based on documented cases and clinical insights:

1. Case 1: Fear of Contamination 

A 8-year-old boy, previously a “fearless and sweet” child, developed PANDAS after a strep infection. Overnight, he began refusing food, insisting that it was “contaminated with germs.” He would only eat prepackaged foods he deemed “safe,” leading to a diet limited to a few brands of crackers. His parents reported a 10-pound weight loss in two months, and he became lethargic and irritable. His contamination fears extended to refusing to drink water unless it was from a specific bottle, highlighting the OCD-driven nature of his restriction.

2. Case 2: Sensory-Driven Restriction

A 10-year-old girl with PANS exhibited sensory hypersensitivities that made eating a challenge. She refused foods with certain textures, like anything “slimy” (e.g., yogurt or fruit), and gagged at the smell of cooked vegetables. Her diet shrank to dry cereal and plain bread, causing nutritional deficiencies and frequent stomachaches. Her parents noted she would cry during meals, overwhelmed by sensory input, which was later linked to brain inflammation from PANS.

3. Case 3: Fear of Choking

An 7-year-old boy diagnosed with PANS stopped eating solid foods after developing an intense fear of choking. He would only consume smoothies, but even then, he limited intake due to anxiety about swallowing. His parents observed him spitting out saliva, refusing to swallow it, which led to dehydration concerns. A swallowing study ruled out physical issues, confirming the restriction was tied to PANS-related OCD.

These examples highlight the diversity of restrictive eating presentations in PANS/PANDAS, driven by a combination of OCD, sensory issues, and irrational fears, all stemming from brain inflammation.

Homeopathic Remedies for Restrictive Eating in PANS/PANDAS

Homeopathy, a holistic approach that uses nano doses of natural substances to stimulate the body’s self-healing mechanisms, has been reported to help manage PANS/PANDAS symptoms, including restrictive eating. It’s critical to note that homeopathy is highly individualized, and remedies should be selected by a trained homeopath based on the child’s unique symptom profile. Below are some commonly cited homeopathic remedies for symptoms associated with restrictive eating, along with their typical indications:

1. Arsenicum Album  

Indications: Best suited for children with OCD-driven restrictive eating, particularly those with contamination fears (e.g., fear of germs or poison in food). These children may exhibit anxiety, restlessness, and a need for control, such as insisting on specific foods or rituals around eating.

Example Application: In the case of the 8-year-old boy with contamination fears, Arsenicum Album might be considered if he shows repetitive behaviors like excessive hand-washing or anxiety about food safety.

Note: Improvements may be seen in anxiety and eating behaviors within days to weeks, but adjustments in potency or remedy may be needed if no progress occurs after 3-5 weeks.

2. Hyoscyamus Niger  

Indications: Effective for children with ritualistic behaviors, such as repeating actions during meals, or those displaying emotional volatility (e.g., sudden weeping or aggression). It’s also indicated for sensory driven behaviors or restlessness that may contribute to food refusal.

Example Application: The 10-year-old girl with sensory aversions might benefit from Hyoscyamus if she shows repetitive actions or emotional outbursts during meals.

Note: This remedy may help reduce ritualistic behaviors and improve emotional regulation, potentially easing mealtime stress.

3. Cina Maritima  

Indications: Used for children with sensory sensitivities or irritability that lead to food refusal. It’s particularly helpful when restrictive eating is accompanied by physical symptoms like stomachaches or sensory-driven aversions to textures.

Example Application: The 7-year-old boy with choking fears and saliva refusal might respond to Cina if irritability and sensory issues are prominent.

Note: This remedy may also address accompanying symptoms like grunting or screaming, which can occur during PANS/PANDAS flares.

4. Stramonium  

Indications: Indicated for children with intense fears, such as fear of choking or vomiting, often accompanied by separation anxiety or aggression. It’s particularly useful when restrictive eating is linked to emotional lability or night-time fears

Example Application: The 7-year-old boy with contamination fears and separation anxiety might benefit from Stramonium if his eating restrictions are tied to intense fears or rage.

Note: Case reports suggest Stramonium can reduce emotional volatility and improve eating behaviors over time.

Important Considerations for Homeopathic Treatment

Individualization is key. With over 3,000 homeopathic remedies available, the correct remedy must match the child’s specific symptoms. A skilled homeopath will assess unique physical, emotional, and behavioral signs to select the appropriate remedy and potency. Also patience and follow-ups are essential. Healing is not usually instantaneous. Improvements may begin within days but can take months for lasting results. Regular follow-ups (every 4-6 weeks) are essential to adjust remedies or potencies based on the child’s response.

Psychotherapeutic support such as Cognitive-behavioral therapy (CBT) or exposure and response prevention (ERP) can help address OCD-driven eating fears, though severe cases may require medical intervention first.

A Path to Healing

Restrictive eating in PANS/PANDAS is a challenging symptom that can disrupt a child’s health and a family’s well-being. By recognizing the signs—such as sudden food refusal, contamination fears, or sensory aversions—and understanding their autoimmune roots, parents can take proactive steps. Homeopathy, when guided by a skilled practitioner, offers a gentle, individualized approach to support healing, as seen in cases where remedies like Arsenicum Album or Cina Maritima have reduced anxiety and improved eating behaviors.

For parents navigating this journey, patience is key.  As one parent shared on X, homeopathy helped their child recover from PANS, transforming their life (https://x.com/mamaswakeup/status/1930723548886433920). While every child’s path is unique, hope and healing are possible with the right support.

By combining awareness, and professional care, families can help their children reclaim their health and vitality from the challenges of PANS/PANDAS.