By Sarah Avery

It's common for kids to scream and overuse their voices, which can sometimes lead to problems with hoarseness. However, doing so repeatedly, could do some damage to their vocal cords, making it difficult for them to repair themselves and for the hoarseness to go away. When should you become concerned?

Here, Eileen Raynor, M.D., pediatric ear, nose and throat surgeon at Duke, and Hilary Bartholomew, M.S., review the common questions they gets from parents, and offer advice on when to seek professional help.

Q: If my child develops hoarseness that isn’t related to a cold or other illness, is it cause for concern?

A:  Occasionally children get hoarse; however, persisting or recurring episodes of hoarseness are more concerning than the occasional voice loss associated with a cold.  Frequent hoarseness in young children can be related to how the child uses their voice (e.g. yelling or excessive talking) that causes damage to the vocal folds.  These children risk permanent hoarseness and lifetime limitations to their voice that can affect social, educational, and behavioral development.

Q: What are some things to look for that suggest this isn’t just a passing issue?

A:  Hoarseness that persists for longer than 2 weeks is never normal.  If your child has always been hoarse, sometimes it is hard to appreciate this.  Often, teachers, doctors, or other adults are the first to point out a difference in a child’s voice compared to their peers.  However, parents may notice other symptoms, like a child talking less due to a tired voice, often needing to repeat him or herself because they are not understood, or limited participation in fun activities like chorus or sports.

Q: My child has a weak, breathy voice.  Is this a sign of problems?

A: Some children are natural introverts and may speak quietly; however, they are able to raise their voice if needed.  The concern is with children that can never produce a louder voice.  If the onset happened after a surgery, there may be a nerve injury affecting the voice.  In some cases, the body can recover, but other times intervention is needed.  At the very least, recovery should be monitored by a doctor.  There may also be swallowing problems like coughing or choking when drinking, which should not be ignored. 

Q: Do I need to see a specialist, or is this something my child’s pediatrician can diagnose and treat?

A: Your child’s pediatrician may be able to treat this initially but if the symptoms are not improving after 2 weeks of treatment (usual course of laryngitis is 7-12 days) then a specialist referral would be indicated to look at the vocal cords and identify any other causes for the hoarseness.

Q: Are there any drug side effects, such as with ADHD medications, which might cause these problems?

A: There are many medications that can affect the voice, usually due to drying of the mucus which lubricates the vocal cords.  These include some asthma medications, allergy medications such as antihistamines and over the counter cold medications.  Asthma medications should not be changed or discontinued without the direction of the physician who prescribed it.  Drinking plenty of water can help combat the problem related to dryness.

Q: How prevalent are these problems, and why can they be overlooked?

A:  Voice problems in children are more prevalent than it might seem (as high as 23%) and since children may be vocal over-users many parents feel this a normal part of childhood.  Issues arise when the hoarseness does not improve on its own or is affecting the child’s communication ability.

Q: How are voice problems treated?

A:  Voice problems rarely occur because of a single factor, therefore treatment requires attention to all contributing factors.  Intervention may include vocal health recommendations, medical management (medicine or surgery), and/or voice therapy.  Vocal health involves behavioral and lifestyle changes to be implemented by the child and family.  Voice therapy modifies how the voice is used to improve the current hoarseness and prevent future problems.