From Infection to Tics: Understanding the PANS Timeline

Why the sequence of symptoms matters more than you think

There’s a very specific feeling when a parent sits in front of me and I just know.

The infection came first.
The behaviour followed.
The timing makes sense.
The pieces line up.
The parent’s shoulders soften.

You can almost see the relief settle in.

Because what felt sudden, frightening and completely out of character now has a pattern.

A child who was thriving begins washing repeatedly.
Refuses school.
Develops tics.
Becomes anxious, angry or withdrawn.
Sleep unravels.

And everyone says, “It’s just a phase.”

But you know it isn’t.

Why the Timeline Matters in PANS

When I assess a child with sudden onset tics, anxiety or obsessive behaviours, one of the first things I explore is the timeline.

Not just what is happening.

But when it started.
What came before it.
What shifted in the weeks leading up to the change.

In many children with PANS patterns, the sequence often looks like this:

• A viral or bacterial infection
• Ongoing congestion, snoring or inflammation
• Digestive disruption or food sensitivities
• Emotional sensitivity increasing
• Then sudden behavioural or neurological symptoms

The immune system activates first.

Then the nervous system reacts.

Then behaviour changes.

Understanding that sequence changes everything.

The Infection Is Not Always Obvious

In some children, the trigger is clear. Strep throat. Influenza. A viral illness.

In others, it is quieter:

• Chronic sinus congestion
• Recurrent ear infections
• Gut infections or dysbiosis
• Mould exposure
• Lingering low-grade immune activation

Parents often tell me, “They never really recovered properly.”

That detail matters.

Because in PANS, the issue is not simply the infection itself. It is the immune response that follows and the inflammation that affects the brain and nervous system.

When Tics Appear, It Is Often the Middle of the Story

By the time tics appear, the body has usually been under strain for some time.

The nervous system may already be overwhelmed.
The gut may already be inflamed.
The immune system may already be dysregulated.

Tics are rarely the beginning.

They are often a signal that the system is struggling to regulate.

This is why suppressing symptoms alone rarely creates long-term change.

We have to look back before we move forward.

What I Look For in a First Consultation

In your first appointment, we do not focus only on behaviour.

We map the full story.

We look at:

• The sequence of infections and illnesses
• Sleep patterns and nervous system signs
• Gut symptoms and food reactions
• Immune history and inflammatory patterns
• Nutritional foundations
• Environmental stressors

We identify where regulation was lost.

Then we build it back gently.

Not all at once. Not aggressively. Step by step.

Because children with PANS patterns often have sensitive systems. They need calm, paced support.

Gentle Support Is About Regulation

Support may focus on:

• Calming immune overactivation
• Reducing inflammatory load
• Supporting gut health and microbiome balance
• Restoring nutritional sufficiency
• Helping the nervous system feel safe again

The goal is not to “fix” the child.

It is to help the body return to regulation.

When inflammation settles and the nervous system stabilises, behaviours often soften naturally.

A Gentle Word for Parents

If your child has changed suddenly and the timeline feels connected to illness, trust that instinct.

You are not imagining patterns.

You are noticing them.

Sudden tics, anxiety or OCD behaviours after infection deserve careful, thoughtful support. The earlier we understand the sequence, the clearer the path forward becomes.

If this reflects your child’s experience, you can learn more about my PANS approach here.

Or book a consultation so we can explore your child’s timeline together.

You do not need to navigate this alone.

With warmth and care,
Ayelet

About the Author

Ayelet is a Sydney-based clinical naturopath, herbalist, nutritionist and homeopath, and the founder of Botanic Artisan Bespoke Holistic Health. She specialises in root-cause, evidence-informed care for women and children, with a focus on children’s gut, immune and nervous system health, PANS/PANDAS, sleep and behavioural regulation, and hormonal balance during perimenopause.

She holds formal qualifications in naturopathy, herbal medicine, nutrition and homeopathy and supports families across Australia through personalised, gentle and practical treatment plans. Through her clinical work, Ayelet has supported many children with complex chronic health concerns including PANS, neuroinflammation and gut-brain dysregulation.

Her work integrates herbal medicine, nutrition, homeopathy and functional testing, combining modern science with traditional wisdom to restore balance, resilience and long-term wellbeing.

Learn more about her clinical approach:
https://www.botanicartisan.com.au/about

Book a consultation:
https://www.botanicartisan.com/work-with-me