Research suggests that misophonia affects more than sensory perception; it also impacts cognitive and emotional regulation:

1. Hypervigilance: Children with misophonia often enter meals on high alert, scanning for potential triggers. This heightened state of awareness can drain cognitive resources and increase stress. [3][6]

2. Fight-or-flight response: Misophonia can activate the body’s fight-or-flight system, leading to physiological symptoms such as a racing heart or sweating, which further disrupt eating behaviours. [2][6]

3. Emotional exhaustion: The cumulative stress from repeated exposure to triggers can lead to emotional burnout, worsening anxiety and depression. [5]

Dietitians play a key role in helping children and their families manage the cognitive and emotional challenges associated with misophonia. Here’s how they can address the issues of hypervigilance, fight-or-flight responses, and emotional exhaustion:

1. HYPERVIGILANCE

Children with misophonia often enter meals on high alert, which can heighten stress and interfere with eating. Dietitians can help by:

Creating Predictable Mealtime Routines by establishing a consistent schedule for meals to reduce uncertainty and provide structure and incorporating calming pre-meal rituals, such as mindfulness or breathing exercises, to help the child relax before eating.

Modifying the environment by suggesting quiet, low-stimulation eating areas to minimise distractions and reduce anxiety and recommending strategies like using noise-cancelling headphones or soft background music to mask triggering sounds.

Providing coping tools by collaborating with therapists to teach children cognitive reframing techniques to reframe their focus away from triggers. and using visual aids or distraction tools (eg, books or calming visuals) to help the child concentrate on positive aspects of the meal.

2. FIGHT OR FLIGHT RESPONSE

When misophonia triggers the fight-or-flight system, children may experience physical symptoms such as a racing heart or sweating, making it difficult to stay at the table or eat comfortably. Dietitians can help by:

Promoting relaxation techniques by recommending deep breathing exercises, progressive muscle relaxation, or other calming activities before meals to reduce physical tension and by Suggesting postural changes or pacing strategies, like taking short breaks, to avoid escalating anxiety.

Gradual exposure therapy support by working alongside therapists to design a plan that gently introduces triggering sounds in controlled increments and by encouraging positive reinforcement and celebrating small milestones to build tolerance over time.

Recommending easy-to-consume foods by focusing on foods that are nutritionally dense but easy to eat under stress, such as smoothies or soft textures and by offering meal replacements or supplements if the child struggles to consume adequate nutrition during high-stress periods.

3. EMOTIONAL EXHAUSTION

The constant stress from misophonia can lead to burnout, anxiety, and depression. Dietitians can address this by supporting both the physical and emotional needs of the child:

Nutritional support for emotional health by suggesting a balanced diet rich in mood-supporting nutrients like omega-3 fatty acids, magnesium, and B vitamins to promote emotional well-being and recommending foods that help stabilise blood sugar levels to avoid mood swings.

Empowering children and families by educating families about misophonia to reduce stigma and create an empathetic environment and by encouraging children to participate in meal planning or preparation, giving them a sense of control and reducing feelings of helplessness.

Encouraging restorative practices by highlighting the importance of sleep, hydration, and physical activity to counteract the effects of emotional exhaustion and by collaborating with families to create post-meal relaxation routines to help children recover from stress.