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In this episode of PANS PANDAS Stories, child psychotherapist Lucy McDonald speaks with Michelle Newby, a paediatric occupational therapist who has worked extensively with children affected by PANS and PANDAS. Michelle explains why occupational therapy can be a crucial but often overlooked part of recovery. While treatment for PANS/PANDAS often focuses on infection and inflammation, Michelle argues that occupational therapy should be considered a “fourth pillar” of treatment, helping children rebuild the everyday skills that illness can suddenly disrupt. We discuss how PANS affects a child’s ability to function in daily life – from sensory overload and emotional regulation to difficulties with school, routines and independence. Michelle shares practical insights into how occupational therapy can support children whose nervous systems are overwhelmed, and how families and schools can better understand what these children are going through. The conversation explores: Why children with PANS/PANDAS can suddenly struggle with everyday tasks The impact of sensory processing difficulties and nervous system dysregulation How occupational therapy can help children regain confidence and function Practical strategies for home, school and daily routines Why recognising these challenges can change how adults support affected children This episode offers valuable insight for parents, therapists and educators trying to understand the real-life impact of PANS and PANDAS, and the role that compassionate, practical support can play in helping children recover