The sudden, rhythmic spasm of a newborn’s diaphragm can be alarming for parents, leading to questions about the baby’s health. While infant hiccups are an extremely common occurrence, the worry often intensifies when considering more serious possibilities, such as withdrawal from substance exposure. Understanding the typical causes of this reflex and how it relates to broader health concerns can help caregivers assess the situation with accuracy.
Understanding Normal Infant Hiccups
Hiccups in newborns are a frequent and generally harmless phenomenon rooted in the immaturity of the infant’s nervous system. The reflex begins with an involuntary spasm of the diaphragm, followed by the rapid closure of the vocal cords, which produces the characteristic “hic” sound. This reflex arc, involving the nerves that control the diaphragm, is not yet fully regulated in the first few months of life.
The most common trigger for hiccups is related to feeding habits, such as swallowing air during a bottle or breast feed. This air causes the stomach to distend, pressing against the diaphragm and stimulating the muscle to spasm. Overfeeding or eating too quickly can also lead to this result, making hiccups frequent immediately after a meal. These episodes typically resolve on their own within minutes and are a benign part of early development.
What Neonatal Withdrawal Syndrome Is
Neonatal Abstinence Syndrome (NAS) is a treatable condition that occurs when a fetus is exposed to certain substances in the womb. Substances like opioids, selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, and alcohol can pass through the placenta, causing the developing baby to become physically dependent. After birth, the baby is cut off from the substance supply and experiences a withdrawal process as the drug clears from the body.
The onset of withdrawal symptoms depends on the half-life of the substance involved. For example, withdrawal from short-acting opioids like heroin typically begins within 48 to 72 hours after delivery. Exposure to longer-acting drugs like methadone or buprenorphine may delay the appearance of symptoms until five to ten days after birth. This withdrawal process primarily affects the central, gastrointestinal, and autonomic nervous systems, resulting in a cluster of physical and behavioral signs.
Key Signs of Neonatal Withdrawal
To determine the severity of withdrawal and guide treatment, healthcare providers use standardized tools like the Finnegan Neonatal Abstinence Scoring System (FNASS). While hiccups may be observed in infants experiencing nervous system irritation, they are not listed as a specific or scorable item on the primary Finnegan tool. Other symptoms, such as frequent yawning and sneezing, which reflect central nervous system over-excitation, are scored on the scale.
The diagnosis of NAS rests on observing a combination of pronounced and sustained symptoms. These major signs include:
- Tremors, which are often moderate to severe even when the baby is undisturbed.
- An excessively high-pitched, continuous cry.
- Gastrointestinal issues like vomiting and diarrhea.
- Uncoordinated, frantic sucking that interferes with feeding.
- Autonomic instability, manifesting as fever, sweating, mottling of the skin, and a rapid respiratory rate.
Next Steps When Withdrawal Is Suspected
If a parent or caregiver suspects a baby is experiencing withdrawal, or if there is a known history of substance exposure during pregnancy, immediate communication with a healthcare provider is necessary. Withdrawal is defined by a cluster of symptoms, not just one minor sign like hiccups, and requires professional evaluation. A pediatrician or neonatologist will monitor the infant using a standardized scoring system and may also test the baby’s urine or meconium to confirm substance exposure.
Non-Pharmacological Care
Treatment begins with non-pharmacological supportive care, which is effective for many infants. This includes swaddling, minimizing light and noise, and practicing skin-to-skin contact. These methods help calm the baby and promote better sleep and feeding.
Pharmacological Intervention
If withdrawal symptoms are severe enough to cause weight loss, dehydration, or seizures, medication may be necessary. Drugs such as oral morphine or methadone are administered to ease discomfort and then slowly weaned over time. Families receive support and education on managing symptoms after hospital discharge.