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Does your child cover their ears and yell when they hear someone chewing food? Do they react to the sound of coughing and sneezing? Does your child gag when they watch people eat?  Are they able to chew and swallow food without retching?

There are two sets of symptoms to describe gagging and sound irritation. The latter refers to a child who is overly sensitive to hearing people eat. Eating and swallowing sounds are so intense for the child that they are often driven to what some term as ‘sound rage’.

For the purpose of this article, I refer to gagging as simply retching at the sight of watching people eat, and not oral-sensitivity that causes gag-reflex. Gagging may, but not necessarily, overlap with sound-irritation.

Why Does this Happen?

Sound-irritation – Research suggests there is an emotional link related to certain sounds.  In other words the offending sound motivates the negative emotion; so when hearing a person eat, swallow, cough, sniffle or sneeze (or some other distinctive sound) the child responds with an involuntary reaction – usually anger.

Gagging – For the child who gags, an irrational response presents itself when they see people eat. The reaction is an instinctive reflex – usually retching.

Do Genetics Play a Role in Sound-Irritation?

Not necessarily. The stimulus (sound) is a trigger for the child’s reaction, which is a conditioned response (Tim Dozier).  So while it’s possible a genetic link could play a part, the child usually becomes habituated to the condition regardless.

For example, Carla, aged 14 who suffers from sound-irritation says:  “The sound of chomping and swallowing reminds me of my dad because he used to get very cross when any of the family made these noises. I understand this now, especially after developing pretty much the same symptoms myself, but I can’t tell him about this, or how I feel, because he doesn’t live with us anymore.”

What is the Core Problem for a Child who Gags?

While the child gives the impression that foods and watching people eat is a sensory issue, there is however an underlying difficulty that suggests the child could be faced with challenges that link eating with a phobia.

For instance, Dane, aged 6 says: “Once mummy was sick after eating lunch. Sometimes when she cooks I watch her and then I think about her eating the cooked food and getting sick again. This makes me gag, and because I think the food smells like vomit, I gag more. Then I start thinking the food is vomit and so when I watch mummy eat, I gag again.” When asked about what happens during school meals his comments were: “I watch kids eat in the canteen, I see food drip down their chins which reminds me of vomit and I gag.”

Psychological Connection

In sound-sensitivity, the psychological connection appears to affect children mostly with the people closest to them. For instance, when the primary caregiver is there, or if someone the child feels very close to is absent, the child projects a sense of the person being ‘too present’. This sounds like a paradox for the latter; but for example, Carla has fond but sad memories of her father and so it could be that oral sounds serve as an emotional outlet. That is, while certain sounds trigger a conditioned response (anger), it might be that those sounds also subliminally fill her father’s absence which gives Carla instinctual freedom for venting unresolved grief.

In contrast, when the person they feel particularly close to is there, the child appears often to mimic that person’s swallowing sounds; or they might tap their throat when they hear the person clear their throat. These behaviours probably help the child dilute the emotional provocation.

All said, when a person known or unknown to the child is present, the child is still seen to mimic sounds; put their fingers in their ears while blinking slowly; and some will tap their throats and grimace. Although these involuntary behaviours distress the child, they seem to dampen the negative emotion and thus lessen the chance of the child giving into ‘sound-rage’. Without a full-blown rage however, the child’s dampened emotions can sometimes simmer until the offending sound leaves their memory.

Intervention for Sound-Sensitivity 

Emotionally sensitive issues, such as those described in Carla’s situation would be addressed and resolved by engaging them in child-appropriate counselling. In addition, cognitive behavioural therapy (CBT) with graded exposures that focus on listening to sound triggers in relevant settings can be integrated to help a child reduce involuntary reactions.

What about Gagging?   

As suggested, this problem appears to be more in line with developing a phobia.

For Dane, his aversion is watching people eat. The initial trigger seems to be closely associated with his mother after seeing her being sick. The problem then became more established. At the outset then it could be said that the phobia, while connected primarily to his mother, is now apparent in other situations that involves watching people eat.

Exposure Intervention

Slowly exposing the phobic child to different foods is one solution.  Showing them how the foods look, smell and feel (and sometimes taste) before and after cooking; and also getting them to listen to the sounds of food when preparing (e.g. chopping, grating) and the sounds and smells during cooking teaches them that there is little connection between eating and vomiting (reinforcing the fact that a child’s phobic reaction can be altered).

As an example, Dane could be encouraged to prepare and share meals with his mum to alter his perception. The idea is to re-affirm the belief that prepared and cooked meals are for enjoying and sharing with different people in all kinds of situations (e.g. home, school canteen, restaurant) even with the small likelihood that someone may feel ill afterwards.

What are the Differences between Gagging and Oral Sensitivity?

First, I have described possible reasons why a child gags when watching people eat, which isn’t connected to reactions seen in children with oral-sensitivities where food textures for example can cause gag-reflex. Oral-sensitivity, a condition linked to either hyposensitivity (‘oral numbness’) or hypersensitivity (overly sensitive to oral stimulation) that provokes gag-reflex often refers to ‘Oral Defensiveness & Aversions with Sensory Processing Disorder (SPD)’. If you would like further information on this you can Google: ‘Oral Defensiveness Strategies’ – the list offers some good results.

All said, if chewing and swallowing is difficult for the child who gags (in relation to what’s been discussed in this article), then occupational therapy could be useful in addressing this problem.

6 Tips to Help a Child Manage their Symptoms

– Reduce Gagging

  1. Mints can be useful in suppressing the urge to gag. For example chewing on a soft mint before and after a meal could help stop a gagging episode. If this works for your child, ask your child’s teacher to agree to add a couple to their lunchbox.
  2. Show your child how to close their left thumb in their left hand to make a fist. Ask them to squeeze tight when they get the gagging sensation. This helps to suppress the gag reflex.
  3. Teach your child to hum quietly. Help them to understand that it is difficult to hum and gag at the same time. If they learn to do this quietly enough, other people will probably not be aware in which case your child can learn to curb their gagging unnoticed.

– Reduce Conditioned Reactions for the Sound-Sensitive 

  1. The 3M Peltor Junior Earmuffs work great for making unwanted noises more tolerable for the sound-sensitive child. These are comfortable enough for the child to wear at home, the school dining room, restaurants, and other trigger stimulating environments.
  2. Playing music in the dining room can help distract your child from tuning into trigger related sounds. In a restaurant, sitting under the speakers while music is playing might be useful; or in a pub restaurant you could find a family table next to the big-screen TV for further distraction.
  3. Unless teaching staff is aware of your child’s problem, ask them to Google ‘Misophonia Treatment Institute’. Suggest they generate ideas with you for making accommodations that will help your child reduce or eliminate involuntary reactions. Accommodations might include seating the child by the canteen door or permission to wear noise cancelling headphones during a test to drown out other oral noises such as swallowing and throat-clearing or nasal sounds like sniffing and sneezing.

Summary

A child irritated by certain sounds has an automatic reaction to the offending noises. There appears to be no connection to hearing problems; rather this is a conditioned response known as ‘misophonia’. The child is angry at the noise, not the person; or distressed by a particular situation that includes a person being ‘too present’.

Similarly, the child who gags retches at the sight of seeing someone eat, not the person. It appears the child has developed a phobic response that connects eating with a particular stimulus (e.g. vomit).

Treatment for both conditions can include child appropriate counselling e.g. play therapy and/or CBT with exposure to the upsetting provocations, and if necessary occupational therapy.

My contribution for this article includes studying and researching information on gagging as a phobia and the condition ‘misophonia’ with additional input from parents’ reports, adult clarifications and personal experiences.

I respect that readers’ opinions may differ.

Names in this article have been changed to protect identity.