Where everyone has a voice
Voice Problems in Children
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:
Causes of 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.
Typical problems resulting from phonotrauma include benign lesions (nodules, polyps, and cysts) and vocal strain (muscle tension dysphonia).
Congenital or Acquired Causes
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.
Common Symptoms of Pediatric Voice Problems
Children with voice problems may develop the following symptoms:
- Weak cry (in infants and toddlers)
- Hoarseness or frequent laryngitis
- Child complains of a “scratchy” throat or seeks out water to soothe the throat
- Breathy, airy speech
- Trouble being heard or understood, especially in school or group settings
Evaluation of the Voice
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:
- What is the home environment like? Siblings? Excessive noise? Loud talking/shouting?
- Was there harsh or excessive crying as an infant or toddler?
- Are there any harsh or scratchy vocal sounds when playing (i.e. trucks, airplanes, animal noises, vocal impersonations)?
- Is there any loud voice use, excessive voice use, or singing at home, school, sports, or other activities?
- Does he or she sing or perform often?
- Does he or she participate in sporting activities that require yelling and calling?
- Are there any other speech or developmental issues?
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.
Treatment for Pediatric Voice Problems
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 Use of Surgery
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.
Family Strategies for Reducing Phonotrauma
Strategies you can implement to promote vocal health in your children include:
- Let your child's voice take a "vocal nap" every day. This quiet time doesn’t have to be boring or feel like a punishment. Children can do something enjoyable such as watching TV, reading, or playing games. This allows the voice to rest and raises awareness of how continuously we use our voices.
- Reduce noise. We all speak louder when we recognize sound competition, such as the TV, music, or other conversations, so try to keep outside noise to a minimum.
- Have a meaningful conversation with your child every day. This outlet will lessen attention-seeking behaviors and reduce the noise level.
- Institute turn-taking in conversations at the dinner table to minimize attention issues among siblings and to promote a sharing and listening environment.
- No yelling! Discourage yelling in the house and lead by example. Instead of yelling from one room to another, walk to the room where the person is that you want to speak with.
