Author: Jeffrey Wacks, MD
What Is a Highly Sensitive Child (HSC)?
Highly Sensitive Child (HSC) is a popular term used to describe children with high sensory processing sensitivity (SPS), a temperament trait characterized by heightened sensitivity and responsiveness to environmental and emotional stimuli. SPS is not itself a psychiatric disorder and appears to exist along a continuum in the general population. However, it can certainly manifest in a way that is dysfunctional.
Potentially dysfunctional characteristics of HSCs:
- Easily overstimulated
- More frequent and more intense temper tantrums
- Often associated with heightened anxiety
- Often appear defiant and stubborn
- May be associated with attention/focus issues
HSCs can be challenging to parent due to their more frequent and more intense emotional dysregulation. However, in the right environment, HSCs can also have extraordinary potential. Being a HSC is a gift and a curse. Because their cognitive processing of the world is deeper and more elaborate, they are subject to being easily overstimulated; however, the same tendency toward deeper processing may also have advantages. HSCs may notice subtleties that others miss, process experiences more deeply, and become intensely engaged with subjects that capture their interest.
What Are the Parenting Challenges with HSCs?
I am going to say something here that is a little politically incorrect, but from my experience as a pediatrician it is the truth. Highly sensitive children are more challenging kids to parent. That doesn’t mean parents don’t love their HSC, but if we’re being honest, they don’t always like them. Some of the specific challenges they face include the following:
- The emotional dysregulation interferes with life. Imagine it is time to go to swim class. We need to leave now or we’re going to be late. But the HSC is feeling intense frustration about this because he wants to play. This turns into a temper tantrum and now we are late for swim class… again. The parent may become easily frustrated with this as to them it is illogical. To them, they think, “he can play anytime, swim lessons are at a specific time, we need to go now.” The irrational nature of it to an adult who lives in a world of discipline, responsibilities, and obligations, may make it difficult to understand the child’s perspective.
- Emotional dysregulation of the child can easily trigger emotional dysregulation in the parent. When a child is screaming, yelling, crying, and telling you what a horrible parent you are, it can be hard to keep it together. Parenting a HSC requires immense emotional intelligence and stoicism. If the parent themself has any mental health issue, trauma, or emotional reactivity themselves, this can create a very volatile situation that makes everything worse.
- Increased attention to the HSC may interfere with parenting of the other child(ren). Because so much time is spent trying to regulate the HSC, it may take time and attention away from the other child(ren) in the house. This is not ideal for the sibling(s) and it also creates more guilt in the parent.
- HSCs often do not respond to classical operant conditioning. Some highly sensitive children respond poorly to conventional reward-and-punishment strategies, particularly when those strategies themselves become emotionally activating. Generally, punishment should create a mild negative emotion that disincentivizes the behavior in the future. But an HSC may be so overwhelmed by the shame of the punishment, they simply are not able to learn the behavioral change.
- During periods of severe dysregulation, some HSCs say the opposite of what they mean. During a temper tantrum, an HSC may tell you to leave them alone, but what they really want is for you to stay. If the parent does actually leave, this actually exacerbates and prolongs the tantrum.
- HSCs often do not want to communicate. These kids overthink everything. As a parent, you want to talk about it and explain why their thought process is illogical. But they won’t do it. They are stuck in a complicated maze in their brain and they won’t come out and they won’t let you in.
What Does the Scientific Literature Say About Parenting Strategies for HSCs?
The scientific literature discusses the importance of positive parenting and creating a nurturing environment for HSCs. Under what is referred to as the differential susceptibility model, highly sensitive children are more strongly affected by their environment in both directions — worse outcomes in adverse or harshly parented environments (diathesis-stress), but better-than-average outcomes in supportive, enriched environments (vantage sensitivity). The metaphor describes sensitive children as “orchids” (thrive under ideal conditions, struggle under poor ones) versus resilient “dandelions,” which do OK regardless of the environmental conditions.
From this literature, a reasonable parenting framework is that the job of the parent is to understand that the child is truly overwhelmed with emotions and does not have the cognitive ability to manage it. In other words, they are not purposefully being defiant or difficult, it is literally beyond their control. So parents are advised to be patient, not try to rationalize it, and when the HSC is having a big emotion, just sit with them silently until the storm passes. The mantra is they are not a bad kid and there is nothing “wrong” with them, they are just struggling to deal with a big emotion.
A Functional Medicine Perspective
While we are not psychologists, we do interact with and address HSC-related dysfunction from a biochemical perspective.
Within our Functional Medicine framework, we conceptualize one component of the HSC phenotype as Autonomic Reactivity: a state in which the autonomic stress response activates too easily, too intensely, or remains activated too long relative to the magnitude of the stressor. This is a clinical framework rather than an established mechanistic definition of SPS, but we find it useful for understanding why relatively minor stressors can sometimes produce disproportionately large physiologic and emotional responses. Autonomic reactivity is not that the system is chronically stressed, it is that it enters stress mode too easily or too intensely.
In the case of the HSC, it is the autonomic reactivity which is the primary imbalance, meaning there is no deeper root cause. It is part of their personality. They were just born that way. That being said, there are two other functional issues that interact with it. The first is their blood sugar regulation. Because HSCs are more easily triggering the stress response, it is crucial that they maintain blood sugar stability. Nutritional issues such as undereating, not eating enough anti-inflammatory carbohydrates (i.e., fruits and root vegetables), or eating too much processed/inflammatory foods can create significant blood sugar swings that will make the stress system even more triggerable. Secondly, inflammatory reactivity will also exacerbate autonomic reactivity. Inflammatory reactivity means that the immune system is overresponding and creating too much inflammation to a given trigger. Thus, if a HSC also has allergies, eczema, asthma, etc. this inflammatory reactivity will trigger more emotional reactivity as well. These 2 issues can also expose deeper issues regarding gastrointestinal health, methylation capacity, micronutrient deficiencies, etc. However, we would think of the image below as the immediate framework for how to think about the interrelatedness of these functional imbalances.
There are currently no supplements established as treatments for sensory processing sensitivity itself. In clinical practice, however, clinicians may sometimes consider interventions directed at associated problems such as sleep disturbance, anxiety, nutritional insufficiency, or heightened physiologic arousal. Supplements like magnesium, glycine, L-theanine, lavender oil, and taurine may be appropriate interventions to discuss with your Functional Medicine provider. These supplements may help enhance parasympathetic nervous system activity and help to inhibit the stress signal input. In some situations, we may use medications in a functional way. For example, in HSCs we might use a medication called cyproheptadine, which we have found to be very helpful in many situations. We tend to like cyproheptadine because: (1) it directly calms down the nervous system, (2) it helps with sleep, which is crucial for regulating this process in the long-term, (3) it increases appetite allowing for better blood sugar control, especially in children who are also picky eaters, and (4) it is mildly anti-histaminergic helping with the inflammatory reactivity as well. Cyproheptadine is not an established treatment for SPS, and its use for this purpose is off-label. In some situations, particularly if there is significant anxiety, traditional psychiatric medications, such as SSRIs, may be indicated.
HSCs are not “bad” kids, and being an HSC does not mean that there is something “wrong” with them. However, they can be more challenging to parent because they experience and respond to the world differently. Parents should be thoughtful about their parenting strategies and recognize that approaches that work well for other children may not always work as well for an HSC. When appropriate, parents may also benefit from working collaboratively with teachers, coaches, healthcare professionals, and psychologists or psychiatrists to create an environment in which their child can thrive. With the right understanding, support, and environment, highly sensitive children can grow into happy, healthy, successful, and well-adjusted adults.
References
- Costa-López B, Ruiz-Robledillo N, Moreno O, et al. Sensory processing sensitivity as a predictor of health-related quality of life outcomes via stress and sleep quality. Sci Rep. 2024. doi:10.1038/s41598-024-72657-9
- Shata ZN, Badr ET, Omran HA, et al. The relationship between sensory processing sensitivity trait and emotional and behavioral problems among Egyptian children. BMC Pediatr. 2026. doi:10.1186/s12887-026-07415-z
- Greven CU, Lionetti F, Booth C, et al. Sensory processing sensitivity in the context of environmental sensitivity: a critical review and development of research agenda. Neurosci Biobehav Rev. 2019.
- Weyn S, Greven CU, Schmidt SJ, Gillebert CR. Sensory processing sensitivity and overstimulation in daily life: an experience sampling method study. Sci Rep. 2025. doi:10.1038/s41598-025-31629-3
- Koechlin H, Donado C, Locher C, et al. Sensory processing sensitivity in adolescents reporting chronic pain: an exploratory study. Pain Rep. 2023.