You treat your child. Six weeks later it is back. Before you assume the treatment failed, look at everyone else in the house — and at the toothbrushes.
A meaningful share of strep recurrences trace to a household member who carries strep without symptoms — a sibling, a parent, sometimes a grandparent who visits weekly. They feel fine. They keep re-seeding the child who does not.
Many pediatricians will not swab an asymptomatic person, because standard practice does not treat carriers. The framing that works: "My child has PANS. Recurrent strep exposure triggers a neuropsychiatric relapse. I need to know whether someone in this house is carrying it."
That is a different clinical question than "does this person have a sore throat," and it usually gets a different answer.
Note the date of every strep episode and every flare. If the two line up over a year, you have built the argument for a more aggressive approach — and if they do not, you have learned something equally valuable.
Want this answered for your own child? A Plan B synthesis reads every lab and note you have — together — and tells you what is driving the picture, what has never been checked, and what to ask for next.
The first one is free, and you keep the list either way. Phone photos of labs are fine.
Plan B for PANS is written by a parent, not a physician. Nothing here is medical advice or a substitute for your child's clinicians — it is meant to make you the best-informed person in the room when you talk to them.