What is the best way to treat hiccups in a baby?

Treatment of Hiccups in Infants

For acute hiccups in a baby, five sharp back blows to the middle of the back is the most effective treatment as they create an artificial cough mechanism that may terminate the hiccup reflex. 1

First-Line Physical Approach

• Position the infant in a prone position with the head lower than the chest while delivering the back blows, or across your thighs while kneeling 1, 2
• Deliver five sharp blows to the middle of the back to create an artificial cough mechanism that can help terminate the hiccup reflex 1, 2
• Ensure the infant's head is properly supported during this maneuver 2

Important Safety Considerations

• Never perform blind finger sweeps of the pharynx as these can push foreign bodies further into the airway or impact objects in the larynx 1, 2
• Avoid abdominal thrusts in infants as they may cause injury to abdominal organs 2, 1
• Do not use chest thrusts specifically for hiccups, as these are reserved for choking emergencies 2

When to Seek Medical Attention

• Medical evaluation is necessary if the infant:
  • Develops difficulty breathing or signs of respiratory distress 1
  • Has hiccups that persist beyond 48 hours (considered persistent hiccups) 3
  • Shows signs of discomfort, inability to feed, or sleep disturbance 3

Pathophysiology and Mechanism

• Hiccups result from sudden involuntary contractions of the diaphragm and intercostal muscles followed immediately by laryngeal closure 3
• The reflex arc involves peripheral phrenic, vagal and sympathetic pathways with central midbrain modulation 3, 4
• In infants, hiccups are usually benign and self-limited 3

Alternative Approaches

• If back blows are ineffective and hiccups are causing distress, consider:
  • Repositioning the infant to help relieve any potential gastric distention 3
  • Feeding the infant (if age-appropriate) as swallowing may help interrupt the hiccup reflex 5

Remember that most cases of hiccups in infants are benign and self-limiting, but persistent cases may require medical evaluation to rule out underlying conditions 3, 6.