Panic attack at the dentist today

[MMWG]

Hi all-

My 4 yo son was diagnosed with PANDAS in December. He has had strep once more since then, and we have been working with our pediatrician to figure out the right antibiotic and dosage amount for him with each episode. He responded very well to antibiotics and many of his issues (tic, fight and flight response, extreme emotionality) have decreased significantly. I feel pretty good that we are on top of the situation, and understand the warning signs that we are fighting strep.

Without a strep episode, I have a very energetic, happy, brilliant, into everything little boy. He still struggles with his fine motor skills, and has some sensory sensitivities, and is pretty hyper and into everything, but compared to what we were going through before, all in all we have a delightful little boy. Today we had a dentist appointment. The first time he went to the dentist was about 9 months ago, when we were unaware of PANDAS but knew there were sensory issues, anxiety, etc--we feared it would be a disaster but it went fantastic. His daddy took him first thing in the morning, and he had fun. So today we had a checkup, he was excited about going, and I didn't give it a second thought. I took him after we went to the park, at 2pm. He was fine in the waiting room, and as soon as we went back to the examining room, he had a full scale panic attack. Didn't even want to brush his teeth with the new toothbrush (which he loves to do). He wouldn't get in the chair, was terrified of everything--refused to open his mouth and basically screamed bloody murder the whole time. The nurses were very nice, and the dentist, who my husband said was great last time, was really thrown by his reaction this time, especially since he was fine last time. He actually was pretty harsh with my son, when he wouldn't calm down he held his hands down and told him he better stop screaming because he was scaring the other patients. He told him "mommy will have to leave if you don't calm down, and you'll have to stay here by yourself" which I didn't like--I think he figured if he could get him to stop screaming, he would realize it wasn't a big deal to get his teeth examined. However, it just scared him more (of course) and I put a stop to the whole thing. My kid doesn't ever back down, no matter what. The dentist asked me if I wanted to keep trying, and I said no. It was just a checkup, his teeth are fine. The dentist asked me "What was wrong with him" and "what had happened to him" to make him react so differently this time. I just told him he was worn out from the park, and had had a tough medical year and was probably a bit traumatized about doctors right now. The dentist backed off and was very nice to him then, gave him stickers and told him they would try again next time. He said "maybe he would do better if daddy brought him" and we did it first thing in the morning. Maybe.

 

I am trying to figure out if this reaction is a warning sign we are up against strep again, or if this is a fairly predictable response from a kid who has had a lot of strep swabs in the last 6 months, as well as EKG, blood tests, the works. Last time he was there it was all new, and although he had sensory issues, he thought it was neat and liked it. We have seen this reaction from him before in the hospital (when he had his adenoids removed, and ended up hospitalized for a bacterial infection complication--which we now know was from strep), when he had his blood drawn to check his titers, and anytime he has a strep test. As soon as we left the dentist office, he was totally fine, though exhausted (he fell asleep in the car on the way home.

 

Thoughts? Would going through the PANDAS wringer and being worn out elicit that kind of reaction in our kids? He is a pretty intense, emotional kid anyway, but I didn't see this one coming.

[peglem]

That it came out of the blue...I'd be suspicious of exacerbation. But, before next time, it would probably help if you did some play therapy with him so he knows exactly what to expect.