Treatment Options for Hiccups in Children
The most effective treatment for hiccups in children begins with simple physical maneuvers, progressing to pharmacological options only for persistent cases, with chlorpromazine being the first-line medication for intractable hiccups. 1
Understanding Hiccups in Children
Hiccups (singultus) are involuntary contractions of the diaphragm followed by sudden closure of the glottis, producing the characteristic "hic" sound. They can be classified as:
- Acute: Less than 48 hours
- Persistent: More than 48 hours but less than 2 months
- Intractable: More than 2 months
First-Line Treatment: Physical Maneuvers
For most children with acute hiccups, the following physical interventions should be attempted first:
- Breath-holding for short periods
- Drinking water rapidly (small sips for younger children)
- Swallowing granulated sugar (for older children who can safely consume it)
- Stimulating the uvula/pharynx (in older children only)
- The Larson maneuver (gentle compression of the diaphragm while holding breath) 1
These techniques work by disrupting the hiccup reflex arc and are generally safe and effective for most cases of acute hiccups in children.
Pharmacological Treatment
If physical maneuvers fail and hiccups persist beyond 48 hours, medication may be considered:
First-line medication:
- Chlorpromazine: For children 6 months and older
- Dosage: 0.25 mg/lb body weight every 4-6 hours as needed
- Example: A 40 lb child would receive 10 mg every 4-6 hours 2
Important precautions with chlorpromazine:
- Should generally not be used in children under 6 months of age
- Start with low doses and increase gradually
- Monitor for hypotension, sedation, and extrapyramidal symptoms
- Use lower doses in debilitated children 2
Treatment Algorithm Based on Hiccup Duration
Acute hiccups (<48 hours):
- Physical maneuvers first
- Usually self-limiting and resolve without medical intervention
Persistent hiccups (>48 hours but <2 months):
- Identify and treat underlying causes
- Consider chlorpromazine at age-appropriate dosing
- Start with lowest effective dose and increase gradually if needed
Intractable hiccups (>2 months):
- Comprehensive evaluation for underlying pathology
- Pharmacological treatment with chlorpromazine
- Consider specialist referral if unresponsive to treatment 1
Common Causes to Address
Hiccups in children are often caused by:
- Overdistension of the stomach (most common)
- Gastroesophageal reflux
- Gastritis 3
Addressing these underlying causes may help resolve hiccups:
- Smaller, more frequent meals
- Avoiding carbonated beverages
- Proper positioning after meals (especially for infants)
Special Considerations
For Choking vs. Hiccups
It's critical to distinguish between hiccups and choking. If choking is suspected:
- For infants: Deliver five back blows followed by five chest thrusts
- For children over 1 year: Five back blows followed by abdominal thrusts (Heimlich maneuver)
- Never perform blind finger sweeps of the pharynx 4
For Anesthesia-Related Hiccups
During or after anesthesia, hiccups may occur and require special management:
- Ensure adequate depth of anesthesia
- Consider proper airway management
- Monitor for respiratory complications 4
Pitfalls to Avoid
Overlooking serious underlying conditions: Persistent hiccups can indicate serious pathology requiring investigation
Overmedication: Don't rush to medication for acute hiccups that are likely to resolve spontaneously
Inappropriate interventions: Avoid abdominal thrusts in infants under 1 year as they may cause abdominal organ damage 4
Blind finger sweeps: Never perform blind finger sweeps in the pharynx as this can push foreign bodies further into the airway 4
Excessive chlorpromazine dosing: Start with the lowest effective dose and increase gradually only if necessary 2
By following this stepped approach to treating hiccups in children, most cases can be effectively managed while minimizing risks and complications.