The Lowdown On Hiccups

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. Parents of infants understandably ask if the hiccoughs of their newborns need to be addressed somehow (more on that below). Why do we hiccup anyway? (great question) And, do any remedies work…and should I use them? (hold your breath, have a sip from the far rim of a cup and we’ll see).

The hiccup is known in medical parlance as the singultus, an apt Latin word for the hitching way one catches their breath while sobbing.  The iconic hic! sound of hiccups results from some funky physiology. 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. 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.

Hiccups usually occur at a rate of 4-60 times a second. The vast majority of cases subside within a minute or three.  In some blessed individuals, we note, hiccups can be heralded by simultaneous other phenomena, such as burping, sneezing or breaking wind. We celebrate their musicality, but the root cause of such prodigious synchrony is beyond the scope of this article.

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. Babies’ tendency to hiccup would seem (and is) rather inevitable. 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 (Not a myth after all: all those old bugs bunny cartoons were right!).  Parents take note: if your adolescent arrives home from a party suddenly hiccupping a bunch, it may be wise to inquire about what they’ve been up to.

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.

Seriously, Chronic Hiccups?

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 is at work goes way, way up.

Generally, a health care provider sees chronic hiccups in a more grown up population.  As one article nicely summarizes (link below) chronic hiccups fall into three main groups: nerve injury or inflammation (such as a nicked nerve after surgery, a neck mass or swollen gland, laryngitis, or even a hair tickling an eardrum); brain issues (infections, strokes, concussion, or a brain injury); or metabolic problems or medication side effects (e.g. diabetes, kidney disease, alcohol, steroids, or other drugs).

Any case would require a careful review of the story of the hiccups, when they started, and what triggered them, followed by a full physical exam. Here’s a gem: hiccups that occur during sleep or that last for days to weeks almost always suggest a more complex problem is afoot. Blood tests or imaging would be done depending on an individual’s story or area of concern.  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. The variety of treatments is staggering, and ranges from benign and inventive, to bizarre, or  unwise.  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.

Photo above by Ashgo . Cartoon below by me.

Nice summary article: http://www.emedicinehealth.com/hiccups/page5_em.htm#Hiccups%20Treatment

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