Baby hiccups: why they happen, what helps and when to worry

Hiccups are very common in babies and usually harmless. They happen when the diaphragm, the sheet of muscle under the lungs, suddenly tightens, and they often follow a big feed or a gulp of air. Australia's Pregnancy, Birth and Baby guide to hiccups says hiccups don't need treatment and usually stop on their own within a few minutes, and that most babies aren't bothered by them.

If hiccups start during a feed, pause, sit your baby upright and try a burp. The AAP's guide to burping, hiccups and spit-up suggests going back to feeding for a few minutes if they haven't stopped in 5 to 10 minutes. This guide covers why babies hiccup, what helps, which remedies to skip, when frequent hiccups may point to reflux, and the few signs that need a doctor.

Why do babies get hiccups?

A hiccup is a reflex your baby can't control. The Australian Government's Pregnancy, Birth and Baby explains that the diaphragm suddenly contracts or spasms, which causes a sharp intake of breath; the vocal cords snap shut, making the "hic" sound. It's not clear exactly what sets off the nerves that trigger it.

In babies, a few things seem to make hiccups more likely:

• A full tummy. The AAP's newborn behaviour guide says hiccups are often caused by overeating.
• Swallowed air. Cleveland Clinic explains that if a baby overfeeds or gulps air while feeding, the stomach can expand and press on the diaphragm.
• A little stomach acid. The AAP notes hiccups can also come from a little acid irritating the lower oesophagus (food pipe), which is why they sometimes go with spitting up.

Are baby hiccups normal, and do they hurt?

Yes, they're normal. The NHS Nottingham and Nottinghamshire guide to what's normal in a new baby says it's common for newborns to sneeze, stretch and hiccup, and the AAP says most babies hiccup from time to time.

Hiccups can look dramatic. The Australian guide notes that your baby's whole body may seem to move with each hiccup, and the sound can be quite loud. But it says your baby is unlikely to feel any pain, and hiccups don't bother most babies. The AAP puts it simply: hiccups usually bother parents more than babies.

The exception is a baby who has been diagnosed with gastro-oesophageal reflux disease (GORD). The Australian guide says these babies may feel some discomfort if acid comes up at the same time as hiccups.

Can babies hiccup in the womb?

Yes. Australia's Pregnancy, Birth and Baby says babies can hiccup in the uterus, and many people describe it as a series of small, jerky, rhythmic movements that feel different from kicks. It isn't fully understood why, but it may be linked to the development of the lungs and diaphragm. Womb hiccups are nothing to worry about, but contact your midwife or doctor straight away if you notice any change in your baby's usual movements or pattern. See baby movements in pregnancy.

How can I stop my baby's hiccups?

Most of the time, you don't need to do anything. Australia's Pregnancy, Birth and Baby says there's little you can do other than sit your baby upright and try burping them, and that hiccups usually stop within a few minutes. If they're interrupting a feed or your baby seems unsettled, try these steps:

1. Pause the feed. The AAP suggests changing your baby's position, trying to burp them, or helping them relax.
2. Sit them upright and burp. Hold your baby upright on your shoulder or sitting on your lap, supporting their head and chest, and gently pat or rub their back. Burping and wind shows each hold.
3. Wait a few minutes. The AAP suggests waiting until the hiccups have gone before carrying on with the feed.
4. If they keep going, feed again. If they haven't stopped in 5 to 10 minutes, the AAP suggests feeding for a few minutes, which usually stops them.
5. Try a dummy if your baby uses one. Cleveland Clinic says the sucking motion can help relax the diaphragm. See dummies for safe use.

If none of this works, it's fine to let the hiccups run their course while you cuddle or settle your baby.

How can I make hiccups less likely during feeds?

The AAP says that if your baby gets hiccups often, feeding them when they're calm and before they're extremely hungry usually makes hiccups during feeds less likely. A very hungry, crying baby tends to gulp. Hunger cues explains the early signs to watch for.

Burping during feeds helps release swallowed air. The AAP's suggested breaks:

For bottle feeds, the NHS bottle-feeding advice is to hold your baby semi-upright with their head supported, and to keep the bottle horizontal, just slightly tipped, so milk flows steadily and your baby takes in less air. It also says to give your baby plenty of time to feed. Paced bottle-feeding slows a fast drinker. If you're breastfeeding and your baby gulps or splutters, latch and positioning covers positions to try.

Which hiccup remedies should I skip?

Many hiccup tricks are meant for older children and adults. The NHS hiccups page, for example, lists sipping ice-cold water, swallowing sugar and holding your breath, and says there's no evidence they work for everyone. These aren't suitable for babies:

• Water. Australia's Pregnancy, Birth and Baby guide to drinks says water isn't recommended for babies under 6 months, because it can upset the balance of nutrients in their blood and fill them up so they drink less milk. The AAP's newborn symptom checker suggests a few swallows of water for hiccups, but this guide follows the stricter advice: offer a short breast or bottle feed instead. See water for babies.
• Sugar or sugar water. The NHS list of foods to avoid says babies don't need sugar or sweeteners.
• Honey, including on a dummy. The NHS says not to give honey until after 1 year. Honey and babies explains why.

Hiccups don't need treatment, so there's no need to try anything that makes your baby uncomfortable.

Can my baby sleep with hiccups?

Yes. Hiccups don't bother most babies and stop on their own, so there's no need to wake your baby or change how they sleep. Keep to safe-sleep basics: put your baby on their back for every sleep, on a firm, flat, level mattress in their own cot or bassinet, with nothing soft or loose around them. The NHS reflux guide is clear that even babies with reflux should sleep flat on their back, not on their side or front, and that you shouldn't raise the head of the cot. Safe sleep has the full checklist.

Could frequent hiccups be a sign of reflux?

Sometimes. Australia's Pregnancy, Birth and Baby notes that hiccups can happen together with spitting up, and the NHS lists "coughing or hiccupping when feeding" among the symptoms of reflux. Other NHS reflux signs include:

• bringing up milk or being sick during or shortly after feeds
• being unsettled during feeds
• swallowing or gulping after burping or feeding
• crying and not settling
• not gaining weight because they aren't keeping enough milk down

The NHS says reflux usually starts before 8 weeks and gets better by the time a baby is 1. Its tips are to hold your baby upright during feeds and for as long as possible afterwards, and to burp them regularly. For babies with GORD who seem upset by hiccups, Australia's Pregnancy, Birth and Baby suggests smaller, more frequent feeds and advice from a lactation consultant or health visitor. Reflux and spit-up covers this in detail.

What's worth noting about your baby's hiccups?

If hiccups seem frequent, jot down when they happen (during, after or between feeds), roughly how long they last, and whether they come with spitting up, coughing or crying. Note whether the feed was bottle or breast and whether your baby was very hungry beforehand. A short video of a hiccup episode, or of any jerking movements you're unsure about, can help a doctor or health visitor.

When should I see a doctor about hiccups?

Hiccups on their own are rarely a reason to see a doctor. Australia's Pregnancy, Birth and Baby says to trust your instincts and have your baby checked when you feel they need it, and the AAP says to call if your baby starts to look or act abnormal in any way.

A hiccup makes the tummy and chest jerk with each "hic". Rhythmic jerking of the arms or legs is different. The NHS Nottingham and Nottinghamshire guide says to call a doctor if your baby's shaking is rhythmic and doesn't stop when you touch them, and the NHS urgent-help guide lists a seizure as a reason to call an ambulance.

Call 999 now if your baby:

• is struggling to breathe, breathing very fast, or sucking in at the tummy or between the ribs
• makes grunting or moaning noises with each breath
• has blue, grey, pale or blotchy skin, lips or tongue (on brown or black skin, check the palms, soles, lips and inside the cheeks)
• stops breathing for more than 20 seconds, or has any pause with a colour change or floppiness (from the AAP's breathing guide)
• has jerking of the arms or legs that doesn't stop when you gently hold them, or may be having a seizure
• is floppy, much sleepier than usual, hard to wake or can't be woken
• has a weak, high-pitched or continuous cry, or a cry that doesn't sound like their normal cry
• has green or yellow vomit, or vomit with blood in it

Get medical help today if your baby:

• had a breathing pause of more than 10 seconds and is now breathing normally (the AAP newborn guide says to seek care now)
• is refusing feeds or feeding much less than usual
• is projectile vomiting, or is very distressed during or after feeds

Talk to your GP or health visitor if:

• frequent hiccups come with spitting up, coughing or unsettled feeds, and the reflux tips above aren't helping
• your baby isn't gaining weight, or reflux starts after 6 months or continues past 1 year (from the NHS reflux guide)
• hiccups last for hours, or come back so often that they disrupt feeds or sleep. The NHS hiccups page, written for all ages, suggests seeing a GP if hiccups last longer than 48 hours.
• you're worried for any other reason (call NHS 111 after hours)