Speech-Language Pathology

Voice Disorders in Children

What is a Voice Disorder?

Voice problems in children are caused by behaviours that are harmful to the vocal cords. Everyday misuse of the voice can lead to swelling of the vocal cords. If these behaviours persist, small growths called nodules may develop on the vocal cords. Swollen vocal cords or nodules result in a voice that is hoarse or harsh sounding.  

The only way to help reduce the swelling or minimize the nodules is by eliminating the behaviours that are harmful to the vocal cords. Voice therapy with a speech-language pathologist can help to educate the parents and the child on how best to eliminate these misuses. The child can also be taught how to speak in a gentler, less damaging way.

What are Damaging Behaviours and Misuses of the Voice?

Everyone sometimes misuses their voice, however, it becomes harmful when misuse of the voice becomes a habit.

Harmful misuses of the voice include the following:

1. frequent shouting, screaming or crying

2. speaking with excessive force or ‘pushing’

3. talking too much

4. constant throat clearing or coughing (e.g., with chronic asthma or respiratory infections)

5. straining the voice to imitate noises like cars and planes, sirens and screeching breaks when playing

6. speaking to loudly

7. speaking with too high or too low pitch e.g. when imitating animal noise or voices when playing

8. talking over background noise e.g. at a sporting event or park; in a noisy classroom/daycare

How Can You Help Reduce Your Child’s Vocal Misuses?

Older preschooler children and school-age children can be encouraged to develop good voice habits. However, children under four years of age will need continuous reminders as they have not yet developed enough self-control to be able to implement these changes into everyday life. The following are basic activities you can try with your child:

1. Identify instances of vocal misuse – Make a list of situations when vocal misuse occurs.  Be an observant listener.  Does your child shout a lot when playing outside?  Do you hear frequent ‘silly voices’ where his/her pitch and volume changes when playing with toys?  Does your child frequently cough or clear his/her throat? Provide this list to your therapist to get suggestions on how to minimize the misuses in these specific situations.

2. Discourage use of loud, effortful speaking – Remind your child to use a soft and easy voice when talking.  Show your child what you mean by giving them an example in your own speaking.  You will need to give this reminder to your child several times throughout the day so come up with a silent signal you can use.  For example, tugging your ear or tapping your chin.

3. Suggest alternatives for voice use – Instead of yelling to a friend across the park, suggest your child go directly to that person.  If they have to raise their voice to be heard, they are too far away.  Whistle to get someone’s attention instead of shouting their name.  Instead of yelling and cheering at a soccer game, bring noise makers. 

4. Eliminate sources of background noise – For example, turn the volume down on the radio or TV when speaking.

5. Discourage making non-speech noises – Children often make sound effects during play by imitating screeching brakes, deep growly dinasaur voices etc.  Explain to your child how these can hurt the voice and suggest other types of less harmful sounds.  For example, blowing air in a “shh” sound is better than a high-pitched “eeee” screech.

6. Praise your child for the use of good vocal habits

7. Be a good model – Try to keep your own voice at a normal pitch and loudness.  Remind all the members of your family to take turns during speaking, instead of yelling to get each other’s attention. 

8. Be aware of heath issues – Frequent colds or upper respiratory infections can harm the vocal cords and your child’s voice.  Children with asthma or allergies are also at a greater risk for voice problems.  Consult your physician whenever you suspect such conditions.