Managing hiccups

Hiccups in children needing palliative care

Hiccups are caused by the involuntary myoclonic contraction of the diaphragm and the auxiliary respiratory muscles in irregular series, followed by abrupt closure of the glottis. Each contraction is followed by a sudden closure of the vocal cords, which produces the characteristic “hic” sound.

Hiccups are quite common and can be overlooked as a cause of distress for a child with palliative care needs. They can cause considerable interruption to normal activity and may also be responsible for low mood, feeding and sleep disturbances, thus affecting quality of life.

Hiccups can be classified as follows:

Acute hiccups

Acute hiccups last for less than 48 hours.

Persistent hiccups

Persistent hiccups last for more than two days.

Intractable hiccups

Intractable hiccups last for more than a month.

Causes of hiccups

Intractable hiccups are likely to have more sinister causes which could include:

  • Irritation of the phrenic nerve or diaphragm by a tumour or chest infection
  • Irritation of the vagus nerve from gastro-oesohpageal reflux, oesophagitis, hiatus hernia, acsites or hepatic tumour
  • Metabolic disturbances such as uraemia and hyponatremia
  • CNS tumours (especially brain stem)
  • Certain medications such as benzodiazepines, corticosteroids and barbiturates

Hiccup, Causes, Signs and Symptoms, Diagnosis and Treatment

Watch the excellent short video below from Medical Centric that describes the causes, possible diagnoses and treatments for hiccups.

Management of hiccups

Non-pharmacological and pharmacological management of hiccups

The following treatment table is taken from Chapter 6 of the Oxford Textbook of Palliative Care for Children in Africa

Condition Management
All patients
  • Stimulate the pharynx (e.g. swallowing dry bread)
  • Stimulate the vagus
    • Try re-breathing through paper bag
    • Drink cold drinks or water
  • Give small frequent meals to reduce gastric distension
Metabolic disturbances
  • Correct if possible
Oesophagitis and reflux
  • ¬†Refer to management of gastrointestinal symptoms
Reduce vagus nerve irritation by reducing gastric distention
  • Prokinetics such as domperidone or metoclopramide
  • Antacids and antiflatulents
Relaxing smooth muscle
  • Nifedipine
  • Baclofen
Central suppression
  • ¬†Chlorpromazine or promazine or haloperidol