“My voice gets a horse, and I sound like raspberries.” Although a child may not understand the terminology, he/she will certainly be able to notice that their voice doesn’t sound “normal.” Our voice is produced when air from the lungs is passed upwards through the larynx, also called the voice box. Within the larynx are two vocal cords, bands of muscles that make a sound when vibrated from the air. A childhood voice disorder, or dysphonia, is often characterized by vocal fatigue, temporary loss of voice, hoarseness, raspiness, inappropriate pitch, or unnecessary loudness.
It may seem like a diagnosis to overlook, as many parents assume that their child’s voice will regain strength with time. But delaying treatment can harm your child’s future. What if you child wants to be an actor or singer when they grow up? What if it causes low self-esteem and interferes with public speaking or giving a classroom presentation? What if the symptoms continually get worse?
Types of Voice Disorders
- Laryngopharyngeal Reflux (LPR). Noted by morning hoarseness or bad breath in the morning. This may or may not be paired with heartburn or coughing during sleep.
- Paradoxical Vocal Cord Dysfunction. This is often described as asthma, with wheezing and difficulty breathing. However, it occurs when the vocal cords close during breathing, when they are supposed to be open.
- Spasmodic Dysphonia, or Laryngeal Dystonia. Uncontrollable spasms of the voice box (larynx), which cause the voice to be strained or tight.
- Laryngitis Inflammation of the vocal cords that produces a raspy or hoarse voice. Laryngitis is caused by vocal overuse, an infection, or reflux.
- Vocal Nodules and Polyps. Growths on the vocal cords that are caused by overuse and characterized by low, breathy, and hoarse voice. Symptoms tend to be worst at the end of the day.
- Paralysis. Malfunction of one or both of the vocal cords that allows food or drink to go into the trachea and lungs, instead of the esophagus. Sometimes this is mild, but it may also become life threatening. A child experiencing paralysis may have trouble swallowing and coughing.
A range of 6-23% of school-aged children experience a voice disorder.
The most common cause of a voice disorder is vocal strain, which may include: yelling, speaking too loudly or softly, using too high or low of a voice, or speaking too much. Incorrect singing, inefficient breath support, chronic clearing of the throat, or speaking too much over background noise are additional causes. Nodules, which are calluses on the vocal cords, are the primary cause for chronic hoarseness in children. Underlying allergies, reflux, and respiratory issues may contribute to vocal disorders as well. It is not unusual for a child with a voice disorder to also be diagnosed with an articulation disorder, language difficulty, or hearing problem.
Signs and Symptoms
- Hoarse or raspy voice that seems natural for your child
- Others suggest that your child’s voice sounds older or deeper than his/her age
- Daily or weekly strain of the voice
- Intermittent loss of voice after singing, cheering, sports activities, or camps
- Difficulty singing high notes
- Symptoms of laryngitis lingers long past an upper respiratory infection
If your child has experienced a vocal change that has lasted longer than two weeks, it is time to visit your pediatrician. The doctor will likely perform either a GRBAS scale (Grade, Roughness, Breathiness, Asthenicity, Strain) or a CAPE-V (Consensus of Auditory Perceptual Evaluation of Voice) assessment. The doctor may also perform an acoustic or aerodynamic exam to measure airflow and airway resistance, or may view your child’s upper trachea and laryngeal using a flexible endoscope.
A multidisciplinary approach to include a physician or ENT is recommended, in order to prescribe medication or treat underlying conditions. Sometimes a surgery to remove tissue from the vocal cords, or to maintain an open airway is necessary. No matter what the treatment options, there are two primary goals: to improve the quality of voice and to reduce strain or fatigue.
Voice therapy is a common first choice of treatment for vocal nodules. This has been known to shrink or eliminate nodules by reducing vocal strain or abuse. The therapist will help to recognize unhealthy vocal habits and teach new alternatives. Breathing, vocal loudness, lip trills, stretching, and vocal speed are also targeted during treatment. Goals include decreasing tension, improving breath support, and strengthening the closing of vocal folds.
Resonance training, which involves learning how to properly project their voice rather than straining it, is another common pediatric approach. It focuses on oral sensations, phonations, and how to properly form basic speech sounds.
Vocal Hygiene and Prevention Ideas
One of the best ways to help your child’s voice is to keep your child hydrated. Discuss the importance and value of water for a healthy body. Resting their voice, learning healthy techniques for speaking or projecting, and finding ways to become intrinsically motivated will set your child up for success.
Educate your child about their anatomy. Teach them the location and function of the larynx, vocal cords, lungs, throat, and other related organs. It would be helpful to include how the body’s vocal folds produce sound, and the relation of breathing and resonance to the production of our voices.
Discuss how your child can actively prevent reflux or allergies. This could include diet, medications, environments, and behaviors.
Horses and Raspberries
Remember to meet you child at their level, even if that means they describe their voice with horses and raspberries. Treatments are successful in helping patients overcome voice disorders. Observe your child, listen to their voice, and remember that vocal disorders will not improve with time.