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In utero hiccups are common. Most moms report feeling their baby hiccup at least once while in the womb. Babies hiccuping is also common. Tongue-ties (limited/restricted tongue mobility) are likewise common affecting probably 25% of babies, and some would say even higher. 

So not every time a baby hiccups in utero (in the womb) does it mean there is a tongue-tie (and conversely if there are no in utero hiccups, it does not mean they won’t have a tongue-tie). However, it does seem that some babies hiccup more frequently than others, and therefore we need a better explanation than “they’re practicing breathing” which is the only explanation given by OBs or Dr. Google. So it could be entirely normal for the baby to have hiccups occasionally, but the more hiccups there are (probably 3x a day or so), those babies should be closely checked for tongue-ties. Ideally, all babies would be checked at birth for ties, but a systemic lack of education on the topic means most are not examined properly. If your baby has feeding struggles (bottle or breast), is gassy, fussy, spitting up, always hungry, colicky, or you’re on the “struggle bus” then definitely get an exam by a provider experienced in treating ties! 

The connection between in utero hiccups and tongue-ties has been an evolving discovery for the last few years, as we have started asking every patient that comes to see us for a tongue-tie release (1000+ a year), if their baby had in utero hiccups, how often they hiccup currently, and then a week after the procedure, if the hiccups improved, worsened or stayed the same. What is interesting is that once we started looking for it, there does seem to be a connection between excessive in utero hiccups, and then the baby experiencing lots of hiccups after birth and up until the point of tongue-tie release, and then in the next few days after release the hiccups go from 8 times a day to once a day, or not at all. The hiccups are also reported by parents to be much shorter in duration and severity after a proper tongue- and lip-tie release. 

So any explanations given for in utero hiccups must include something other than simply “practicing breathing” in our differential diagnosis. One hypothesis is that a tongue-tie or tongue restriction causes a dysfunctional or funky swallow and through a series of nerves (vagus and phrenic nerves mainly) triggers a hiccup response in the baby. This dysfunctional swallow persists outside of the womb and continues (for months for some babies) until acted upon by an outside force (Newton’s 1st law of motion), in this case, a tongue-tie release. After treatment, the hiccups typically go away or significantly improve (fewer during the day, shorter duration, less noticeable). 

Often in children and adults, hiccups are thought to come from eating too quickly, feeling nervous, fearful, or stressed, swallowing air, and eating too much. These babies with tongue-tie do typically have a higher sympathetic tone (are in fight-or-flight mode), are experiencing difficulty swallowing and eating (fear, stress, etc.) eat too quickly, and definitely swallow air, so there are many reasons a tongue-tie could cause increased hiccups in babies. Often just time and gripe water are recommended, but a tongue-tie release can also help.

I had never thought to connect tongue-ties and hiccups until patient after patient reported that the hiccups in their baby improved significantly after the procedure. Once this happened dozens of times (I guess I was dense) we added it to the assessment and follow-up forms, and hiccup improvement has been one of our most consistent findings after a tongue-tie release. Excessive in utero hiccups just might be the first sign of a tongue-tie in babies. 

Do I have a double-blind randomized controlled trial to prove that hiccups in utero are caused by a tongue-tie, and improve after tongue-tie release? No. Maybe we will in the future. Recently though, Dr. Ghaheri published a randomized controlled trial with bottle-feeding babies and posterior tongue-tie and did see improvements in the treatment group with less severe and less frequent hiccups. So there are signs pointing this way, but we need a bigger study to confirm the association. 

However, if mothers express to their obstetricians, midwives, mid-level providers, heck even their mother-in-law that they experienced a lot of hiccups in utero, then the baby should at least be screened properly for a tongue restriction. Especially since the symptoms and struggles of tongue-ties can go undiagnosed for months and years, a quick check for higher risk babies (those that hiccup a lot) should be performed and tongue-tie should be added to the differential diagnosis of in utero hiccups instead of just “practicing breathing.”

If your baby had lots of in utero hiccups, currently has lots of hiccups or other feeding struggles, then it’s worth getting them properly checked for a tongue-tie and lip-tie. We would be happy to help you with that, just give us a call at (205) 419-4333 or send us a message

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