Recognizing and Treating Voice Disorders in Children
Voice disorders in children are often overlooked, yet they can significantly impact a child’s communication and social development. From chronic hoarseness to difficulty controlling pitch or volume, issues with a child's voice can cause frustration and concern for parents.
Fortunately, with timely diagnosis and the proper intervention, voice issues can be effectively treated.
Key Takeaways:
Recognizing Voice Disorders: Voice issues in children often impact vocal quality, pitch, or loudness, which can affect how effectively they communicate with others.
Common Symptoms: Typical signs include ongoing hoarseness, breathiness, strained or high-pitched voice, frequent throat clearing, vocal fatigue, and discomfort in the throat.
Understanding Causes: Voice disorders can stem from factors like vocal strain, respiratory issues, reflux, neurological or congenital conditions, and stress or emotional influences.
Available Treatments: Treatments range from voice therapy with speech therapists, medical intervention for physical concerns, strategies to promote healthier voice habits, and, when necessary, assistive tools for communication.
Common Types of Pediatric Voice Problems
Recognizing the Signs and Symptoms of Voice Disorders
Common Causes and Risk Factors
The Diagnostic Process of Voice Disorders
Treatment Approaches for Pediatric Voice Disorders
Preventative Measures and Voice Care Tips
Frequently Asked Questions About Voice Disorders in Children
How Connected Speech Pathology Can Help with Pediatric Voice Therapy
Common Types of Pediatric Voice Problems
Pediatric voice issues often arise from strain or specific health issues affecting vocal cords. Here’s an overview of common types:
Hoarseness or Strained Voice (Dysphonia): This makes a child’s voice sound rough, scratchy, or weak. It often happens when children talk or yell too loudly or for too long, which can wear out the vocal cords. Some may experience temporary discomfort, while others may need extra support to recover.
Vocal Nodules or Polyps: These are small, soft bumps on the vocal cords that form from frequent, loud speaking, shouting, or throat clearing. Nodules or polyps make it harder for kids to communicate clearly, often leaving their voices raspy or hard to hear. Treatment for these can involve rest, voice therapy, or learning to use their voices in a healthier way.
Vocal Cord Paralysis or Weakness: When one or both vocal cords have difficulty moving, children may sound very breathy or weak and find it challenging to be heard, especially in noisy environments. This condition can be caused by nerve issues or, sometimes, by other medical factors.
Resonance Disorders: Resonance problems are related to how sound flows through the nose and mouth. Children with resonance disorders may sound overly “nasal” (too much sound through the nose) or “stuffy,” affecting the clarity of their speech. This can be due to structural differences in the mouth, throat, or nasal passage.
These conditions can impact a child’s social and academic life by making them less confident in their voice. Early treatment with a speech therapist can provide exercises and strategies to improve the quality of their voice, helping them feel more comfortable and understood in everyday situations.
Recognizing the Signs and Symptoms of Voice Disorders
Identifying pediatric voice disorders can be challenging because symptoms may seem subtle or be mistaken for a "normal" change, like when a child is tired or recovering from a cold. However, if you notice the following symptoms over a more extended period, it may indicate a voice disorder:
Hoarseness or Scratchiness: A child's voice may sound rough or strained over an extended period, even when not sick, indicating a hoarse voice.
Breathiness or Weak Voice: A voice that sounds faint or breathy, especially when your child tries to be heard, may indicate a problem with vocal cord movement or strength.
Frequent Throat Clearing or Coughing: Constant clearing or coughing, especially without any sign of illness, might mean your child struggles to keep their voice clear.
Loss of Pitch Range: If your child cannot reach higher or lower pitches than they once could, it could be a sign of vocal cord tension.
Throat Pain or Discomfort: If your child often mentions feeling pain or soreness in their throat, especially after talking or singing, it could be a sign that their vocal cords are strained or irritated.
Voice Fatigue: If your child’s voice seems to tire quickly or your child loses their voice often after talking, singing, or shouting, this could indicate that the vocal cords need support.
Consistent throat pain and voice fatigue can be signs of vocal strain, especially when unaccompanied by other cold-like symptoms. If you notice these symptoms, seeking advice from a speech-language pathologist specializing in voice rehabilitation is a good idea.
Common Causes and Risk Factors
Pediatric voice problems can arise from various causes, often related to how they use their voice daily or due to underlying medical conditions.
Vocal Strain, Misuse, or Overuse: Vocal strain from frequent shouting, screaming, or loud talking can lead to issues like nodules on the vocal folds. When someone raises their voice forcefully, the vocal cords close more intensely, causing them to “bang” into each other.
This repeated impact can injure the delicate tissue of the vocal cords, resulting in small growths, or nodules, that make it harder for the cords to vibrate smoothly. Over time, this leads to a hoarse or raspy quality of a person's voice.
Respiratory Infections: Common illnesses such as viral, flu, or sinus infections can inflame the vocal folds, leading to temporary voice changes, such as hoarseness or loss of voice. A condition like asthma can also have a longer-lasting impact on vocal health, but most children recover from their cold or upper respiratory infection without developing symptoms.
Allergies: Allergies can cause postnasal drip, congestion, and throat irritation, affecting a child’s vocal quality. The constant need to clear the throat can further strain the vocal folds.
Gastroesophageal Reflux (GERD): Acid reflux is a significant cause of pediatric voice disorders. When stomach acid travels up the esophagus, it can irritate the vocal folds, leading to inflammation and changes in voice quality.
Nodules or Polyps: Vocal nodules are small growths on the vocal folds within the larynx (voice box). These nodules can develop from repeated vocal strain, such as frequent loud talking or shouting, which prevents the vocal cords from vibrating smoothly. This often leads to a hoarse or raspy voice, as the nodules interfere with the cords' normal function.
Environmental Factors: Exposure to secondhand smoke, pollutants, or even arid air can irritate a child's throat and larynx (voice box), increasing the risk of voice issues.
Neurological Conditions: Neurological disorders, such as vocal fold paralysis, can weaken the muscles involved in voice production. For instance, conditions like vocal cord paralysis or other neuromuscular issues may lead to a breathy or weak voice, affecting the vocal cords' ability to close fully and create clear, robust sound.
Trauma or Surgery: Accidental injury to the throat or surgical procedures that affect the airway or vocal cords can lead to scarring or damage, which may result in long-term voice problems.
Psychological Factors: Emotional stress or trauma can sometimes manifest as a voice disorder, where no physical cause is present. In some cases, children may develop functional voice disorders related to anxiety or stress, where the vocal cords don’t function properly even though they are structurally sound.
Addressing these causes often involves a combination of voice therapy, medical treatment, and lifestyle adjustments to support a healthy voice.
The Diagnostic Process of Voice Disorders
The diagnostic process for identifying voice disorders involves a few key steps:
Initial Screening: This step includes observing the child’s voice quality and behaviors and gathering information from caregivers on any concerning symptoms, like hoarseness or vocal fatigue. Parents' observations about their child's vocal habits and any noticeable changes in their voice play an essential role in early identification.
Laryngeal Examination: An ear, nose, and throat (ENT) specialist may perform a laryngeal exam to assess the health of the vocal cords. This usually involves using a small camera to directly view the larynx (voice box), helping to identify any physical changes or growths, like nodules or swelling.
Speech-Language Pathologist (SLP) Evaluation: After a physical examination, an SLP assesses the child’s voice quality, resonance, and articulation. This evaluation helps determine the specific voice issues, such as breathiness, harshness, or nasal tone. The SLP may also examine the child’s articulation skills to see if other speech factors contribute to the voice disorder.
Together, these steps provide a complete picture of the child's vocal health, guiding the best treatment approach.
Treatment Approaches for Pediatric Voice Disorders
Effective treatment for pediatric voice disorders focuses on the child’s age, the specific type of voice disorder, and the characteristics of the sound produced. Each child is unique, and treatment approaches are tailored to their needs.
1. Voice Therapy
A speech-language pathologist (SLP) specializing in pediatric voice disorders teaches strategies for gentle voice production to reduce strain. The child learns to adjust their voice and avoid habits like excessive shouting. Techniques will be adapted depending on the child's age.
SLPs incorporate exercises to help the child talk with appropriate pitch and volume.
2. Environmental Modifications
Reducing background noise can encourage a child to talk at a comfortable volume, minimizing strain on their vocal cords. This approach is particularly effective for children in noisy environments, where vocal strain can be expected.
3. Medical and Surgical Interventions
Medical interventions may sometimes be necessary as voice disorders result from structural abnormalities, such as vocal cord nodules or polyps. If a child has these structural abnormalities, surgical intervention may be required.
An otolaryngologist (ear, nose, and throat specialist) can perform these surgeries to remove obstructions and restore normal voice function. Post-operative voice therapy is often recommended to help the child recover and prevent the recurrence of the disorder.
4. Parent and Caregiver Involvement
Training parents to model healthy vocal habits and encourage vocal rest helps children avoid overuse and strain, supporting healing. Educating caregivers on voice-friendly practices aids in creating a supportive environment for the child’s voice therapy journey.
Each treatment approach aims to restore and enhance the child’s voice quality, supporting better communication while promoting long-term vocal health.
Preventative Measures and Voice Care Tips
Here are some effective strategies that parents, caregivers, and educators can implement to promote healthy voice use among children.
Encourage Healthy Vocal Habits: One of the most crucial aspects of prevention is teaching children to use their voices correctly. Parents and caregivers should encourage children to speak at a comfortable volume and avoid shouting or whispering, as both can strain the vocal cords. Simple reminders about proper posture while speaking can also contribute to better breath support and vocal control.
Promote Hydration: Adequate hydration is vital for maintaining vocal health. Children should be encouraged to drink plenty of water throughout the day to keep their vocal cords lubricated. Educating them on the importance of hydration, especially during activities that require prolonged speaking or singing, can help prevent voice strain and hoarseness.
Limit Vocal Strain: To prevent vocal strain, children should be taught to take regular vocal breaks, especially during periods of extensive speaking or singing. Incorporating restful periods into their daily routine can help reduce the risk of overuse injuries. Additionally, avoiding speaking over loud noises or in environments with significant background noise can help children use their voices more effectively without strain.
Educate on Vocal Hygiene: Vocal hygiene involves practices that promote vocal health. This includes avoiding throat clearing and coughing whenever possible, as these actions irritate the vocal folds. Teaching children to use a soft, gentle voice when they need to speak softly can also help preserve their vocal health. Moreover, reducing exposure to irritants such as smoke, allergens, and excessive dust can further support vocal health.
Monitor and Address Symptoms Early: Parents and caregivers should be vigilant about changes in their child's voice, such as hoarseness, breathiness, or pitch changes. Early identification of potential voice issues allows for timely intervention, significantly improving outcomes. Regular check-ups with a speech-language pathologist can ensure that children maintain healthy vocal practices and receive support when needed.
When to Seek Help: If a child experiences prolonged hoarseness, frequent voice loss, or complaints about vocal discomfort, it may be time to consult a professional. These symptoms lasting more than a few weeks can indicate an underlying voice disorder that requires attention.
Early intervention is essential, as it can prevent potential long-term damage to the vocal cords and support the development of clear communication skills. Consulting a speech-language pathologist or an ENT specialist can help diagnose and manage the issue effectively, fostering a healthier voice for the child.
Frequently Asked Questions About Voice Disorders in Children
1. What are common signs of a voice disorder in my child?
Frequent hoarseness, breathiness, voice loss, or complaints of throat discomfort can indicate a voice disorder. If these signs persist for over two weeks, it may be time to consult a professional.
2. At what age can children begin voice therapy?
Children as young as preschool age may benefit from voice therapy if they show signs of a voice disorder. Treatment is always adapted to the child’s age, developmental level, and specific needs.
3. How can I help my child maintain a healthy voice?
Encourage your child to use a moderate volume, avoid shouting, and drink plenty of water. Limiting vocal strain, like excessive yelling, can help protect their vocal cords and prevent potential issues.
How Connected Speech Pathology Can Help with Pediatric Voice Therapy
Connected Speech Pathology specializes in helping children with voice disorders through remote voice therapy sessions and essential parent coaching. Our licensed voice therapists create customized plans that include fun, effective exercises to improve your child’s vocal quality while prioritizing healthy vocal habits.
Our remote setup ensures accessibility, making it easy for families to receive high-quality care from their homes. Parent coaching is vital to our approach, empowering caregivers with strategies and knowledge to support their child’s progress between sessions.
Parents learn how to reinforce therapy techniques at home, helping children practice voice care and use positive vocal behaviors in daily life. Together, we work to make voice therapy a supportive and effective experience for the whole family.
Summary
Recognizing and addressing voice disorders in children is essential for fostering effective communication. Early intervention can prevent these disorders from escalating into more significant speech and language challenges, empowering children to express themselves confidently.
About the Author
Allison Geller is a speech-language pathologist (SLP) and the owner of Connected Speech Pathology. She obtained her Bachelor’s and Master’s degrees from the University of Florida in Speech-Language Pathology. Allison has practiced speech therapy in a number of settings including telepractice, acute care, outpatient rehabilitation, and private practice. She has worked extensively with individuals across the lifespan including toddlers, preschoolers, school-aged children, and adults. She specializes in the evaluation, diagnosis, and treatment of a variety of communication disorders including receptive/expressive language disorders, articulation disorders, voice disorders, fluency disorders, brain injury, and swallowing disorders.
Allison served as the clinical coordinator of research in aphasia in the Neurological Institute at Columbia University Medical Center in New York. She is on the Board of Directors for the Corporate Speech Pathology Network (CORSPAN), a Lee Silverman Voice Treatment (LSVT) certified clinician, and a proud Family Empowerment Scholarship/Step-Up For Students provider. Allison is passionate about delivering high quality-effective treatment remotely because it’s convenient and easy to access. What sets us apart from other online speech therapy options is—Allison takes great care to hire the very best SLPs from all over the country.
