Published: Feb. 3, 2011
Updated: Aug. 4, 2011
Speech pathologists in Duke Voice Care Center are trained to evaluate and treat voice problems in children.
This care guide covers the following topics related to pediatric voice problems:
Spend a few minutes on the playground and it will be easy to see (or hear) how susceptible children can be to acquiring voice disorders.
Most childhood voice problems result from phonotrauma (trauma related to how the voice is being used). Types of phonotrauma include incorrect yelling, shouting, excessive talking, or a harsh or strained vocal technique.
Voice problems are further impacted by other medical issues, such as allergies or reflux, that can intensify vocal symptoms. Vocal hygiene, such as hydration, can also positively and negatively influence the voice depending on how well a hygiene regimen is followed.
There are also voice problems occurring independently of how a child is using his or her voice. These can be congenital (present at birth) or acquired.
Serious medical conditions may require surgery, leading to a voice disorder, such as a unilateral or bilateral vocal fold paralysis due to a cardiac or thoracic surgery.
Other medical conditions, including papilloma, laryngomalacia, subglottic stenosis, glottic web, and velopharyngeal insufficiency (nasality) can affect vocal production, in addition to possible breathing and swallowing problems. These can result in long-term changes affecting the voice through childhood, adolescence, and into adulthood.
Children with voice problems may develop the following symptoms:
The evaluation for a pediatric voice problem is similar to that of adults, with a joint visit scheduled with the otolaryngologist (ENT) and the speech-language pathologist on the same day. This allows for a thorough medical evaluation and a complete voice evaluation.
The voice evaluation includes a parent interview to discuss concerns and vocal habits of the child.
In addition to typical questions about the onset of symptoms, the following observations are useful in diagnosing a voice problem and determining a treatment plan:
Depending on the situation, formal testing may include videolaryngostroboscopy or acoustic and aerodynamic measurements.
This determination will be made based on the nature of the symptoms, the need for visualization of the larynx as requested by the physician, and the child’s age, but is not limited to these factors.
Additional details can be found on our appointments page.
Voice therapy is most appropriate for children at least four years of age (or a very mature three year old) so that they are able to follow directions and complete the exercises.
This is also the age when voice use becomes more important as they begin preparing for school or pre-school and socializing more with other children.
Regardless of age, the goal for therapy is to produce a clear voice with minimal effort. The specific activities, though, are catered to the individual and are age-appropriate to promote learning and improvement.
A standard course of treatment is eight sessions, with adjustments made for more or fewer sessions based on progress. Therapy focuses on education about healthy voice use, teaching vocal technique, rehabilitating damaged vocal folds due to benign lesions (like nodules or polyps), and reducing strain and effort with speaking.
Parents, siblings, and caregivers are included in the education portion to promote incorporation of strategies at home. Success in therapy depends upon a child’s motivation and maturity and the family’s level of participation and support.
The larynx changes shape and length with age, and the vocal folds mature into their distinct layers from birth through puberty.
Infancy through adolescence is when the larynx experiences the greatest change it will have as part of human development. Therefore, when vocal surgery is considered, careful thought is given to the best procedure and the optimal time for any surgery.
If there are more pressing medical issues, such as breathing or swallowing problems, surgical intervention is more likely to be recommended and necessary for the child to thrive.
Strategies you can implement to promote vocal health in your children include: