Field Guide · First Questions
PANS treatment isn’t one pill — it’s a small number of layers, worked in roughly the right order: treat the trigger, calm the system, find the driver, and — if needed — the deeper menu. Here is the whole map at a glance, so you can see where you are and what comes next. The order, it turns out, often matters as much as the options.
I walked this part of the labyrinth myself — knocked on the doors, read the research, and came back with the map. You don’t have to find the way out alone.
Think of PANS treatment as four layers, not a long list. (1) Treat the infection / trigger. (2) Calm the immune and brain inflammation. (3) Find and fix the deeper driver. (4) The deeper menu for kids who are still stuck. Most families start at the top and only go as deep as their child actually needs. You do not have to do everything — you have to do the right things, in the right order.
1Treat the infection / trigger. The first-line move: if a swab or titers show strep, treat it (usually an antibiotic). If another infection is the trigger — Mycoplasma, a virus — treat that. Removing the thing that lit the fuse is step one, and for early, freshly-triggered kids it’s sometimes most of the battle.
2Calm the immune and brain inflammation. The inflammation is the symptoms, so bringing it down brings relief. This ranges from anti-inflammatories (NSAIDs) and short steroid courses for flares, up to immune treatments like IVIG for more significant immune dysregulation. This layer is where a lot of the day-to-day suffering eases.
3Find and fix the deeper driver. When a child doesn’t fully respond, there’s usually a root that wasn’t addressed: the gut, mold, Lyme and co-infections, the methylation / detox engine, or mast-cell activation (MCAS). This is the layer most ordinary care never reaches — and where stuck kids often turn the corner.
4The deeper menu. For refractory cases, there’s a real menu of options worth knowing exists: IVIG, plasma exchange for the most extreme cases, and a wider set including peptides, hyperthermia, HBOT, phage therapy, and more. Not first-line — but no child should be told “there’s nothing left to try” when there is.
Running underneath all four: nervous-system support. Sleep, the vagus nerve, brain retraining, a calm environment — these don’t replace the medical layers, but they make every other layer work better and help a dysregulated child feel safer. See the nervous-system guide.
Sequencing is often the whole game. The same treatments that fail in one order can work in another. A few examples that recur again and again:
This is why “we tried that and it didn’t work” is so often really “we tried that in the wrong order.” The map below lets you see the sequence.
Wondering which layer your child is in — and what to try next? Plan B reads your child’s history, symptoms, and labs together and turns the whole map into a plan: the likely driver, the right next step, and the order that fits your child. Your first Synthesis is free.
Start your free Synthesis → Parent education, not medical advice. You stay in charge.PANS treatment is a layered map, not a single drug: treat the trigger, calm the inflammation, find the driver, then the deeper menu — with nervous-system support running underneath. Most kids only go as deep as they need to. And because the order so often matters more than the options, “nothing worked” frequently means “not yet tried in the right sequence.” Many children improve substantially, and the earlier the trigger is caught, the better. This is parent education, not medical advice — bring it to your team as questions.
Plan B does not partner with drug companies or doctors, and we never endorse anyone whose healing isn’t verified by families. We show you the options and how to vet them yourself — and we’re building parent verification: look up a practitioner and see real family reviews before you trust them. Universal bad reviews? Skip.