Columnists :: Kids Health With Dr Jack
The Lowdown On Hiccups by Jack Maypole, MD
MySouthEnd.com ContributorThursday Apr 12, 2012 Hiccups are like divine comedy, aren’t they? In seconds, a paroxysmal hurk can render a child most serene, or an adult most stern into something hilarious. While they rarely pose anything more than a sociodietary awkward moment, hiccups do cause their concerns.
The hiccup is known in medical parlance as the singultus, an apt Latin word for the hitching way one catches their breath while sobbing. Each hiccup is a sudden, involuntary spasm of the diaphragm muscles at the floor of the chest cavity, and the intercostal muscles that sling around the rib cage. Hiccups usually occur at a rate of 4-60 times a second. The vast majority of cases subside within a minute or three. The rapid inhalation of air pulls the glottis home at the top of the airway with a snap, producing that musical noise we love so well.
Meanwhile, what is going on here? Why do hiccups occur? In short, we’re not entirely sure. Hiccups begin in the third trimester of pregnancy and become an undignified fact of life in the first few months after birth. Hiccups are thought to arise due to irritation of the vagus or phrenic nerves connected to the stomach and diaphragm, among other things. In most cases, distension of the tummy from a large meal, swallowing of air with eating (so called, aerophagia), sudden changes in temperature (externally), or ingestion of cold or warm fluids (internally), or emotional excitement or stress trigger hiccuppy signals from the nerves to the respiratory centers in the brain and back again. Presto! Hiccuptime.
Hiccups manifest differently across childhood and beyond. Newborns and infants with their rather unique physiology, are very sensitive to stimuli and stresses in general. Simply feeding or retaining unreleased burps can trigger a bout of infant singulti. Mild spittiness or acid reflux, common in babies, can also be the culprit. In the words of an attending who taught me early in my training: hiccups tend to bother the parents a whole lot more than the baby. Mercifully, hiccups just about never pose a problem in the youngest of the pediatric age set, and resolve on their own.
In older kids, scarfing food too quickly, drinking carbonated beverages, or dining on fatty foods can precipitate a hiccup attack. In teens and adults, transient cases of hiccups may be triggered by other lifestyle habits, including smoking or consuming alcoholic beverages. Parents take note!
And, you might ask, why do we hiccup at all? There is no clear or current evolutionary advantage to our species having hiccups. They aren’t fetching, cool or distracting to predators, that’s for sure. One theory suggests that hiccups may be a primitive (and, to be sure, rather lame) response to choking on food. Rhythmic lurching with rapid inhalation, the theory goes, would dislodge an offending item allowing one to sort of auto-Heimlich oneself. Nifty, perhaps, but not terribly effective.
About 1 in 100,000 hiccups will become a longer term plight. Cases lasting more than 48 hours are called persistent hiccups. (Yikes) Intractable hiccups last more than a month. (Ok, that’d just suck). When an individual hiccups for a longer haul, the index suspicion that some underlying cause (nerve injury? Infection? Meds? Diabetes? It is a long list) is at work goes way, way up. In the end, addressing the underlying condition may be key to ending the hics.
Treatment...if at all.
And so, for the rest of us and our children, what to do for the everyday, acute case of here-we-go-again variety of hiccups? Every family and culture I’ve met seems to have a slightly different, sworn by cure-all for the problem. What research there is suggests that hiccup remedies are at best mildly effective. The mechanisms to end hiccup bouts work possibly by either mildly raising the carbon dioxide levels in the blood, or by stimulating the vagal nerve. Let’s them these treatments up quickly.
Better approaches: #1 Benign neglect (letting them run their course)! Otherwise, try burping an infant or positioning her to relieve gas or abdominal distension. In older children, drinking a cool glass of water, or holding their breath.
Interesting approaches (not for infants and young toddlers!): Placing sugar or honey on the tongue, sipping fluid from the far side of a cup, having someone apply ’traction’ to the tongue.
Not so wise approaches (i.e Don’t!): pressing on the eyeballs, pushing on an infant’s fontanel, startling infants or the elderly, sticking a finger in the ear, or pressing on the palate.
In short, if hiccups are bothering you (or your child) that much, I recommend you run it by a health care provider to be sure that all is well. Just as we say don’t scare kids with the hiccups, don’t let hiccups scare you. And, will a better treatment for them come along anytime soon? Don’t hold your breath.
Jack Maypole, MD is director of Pediatrics at the South End Community Health Center, and Director of the Comprehensive Care Program at Boston Medical Center, a clinic for children with complex and chronic illness. Portions of his articles are drawn from his blog found at thefastertimes.com/pediatrics.