It’s no secret that kids don’t always use their voices in the best possible way.
Visit any playground during recess, and you’re bound to hear kids using their voices in lots of wild ways—from the kids who speak in a growl to those who are forever imitating any animal sound they hear to the ones who yell everything they say—children take full advantage of their internal instruments.
From the time your child was a baby, they’ve played with their voice. Babies love to explore what their voices can do when they learn to babble. They not only coo and goo—they also growl, shriek, gurgle, and squeal.
Think of it like taking a new car for a test drive—babies need to understand what their voice can really do, so they like to take them out on the open road and really put the pedal to the metal. And that’s all totally normal and an important part of vocal development.
But what happens when your child experiences a vocal issue? How do you know if it’s something to be concerned about or just something that will resolve with time?
Maybe you’ve noticed your child always seems hoarse. Maybe their voice goes in and out. Maybe you worry about the overall quality of their voice and wonder if it’s normal.
This article will help you understand vocal issues in children, how they happen, and what you can do to help protect your child’s voice.
Let’s start by reviewing how our voices work, and why they’re prone to certain issues.
Basic vocal anatomy and physiology
Your voice is the original string instrument.
Your vocal cords (also known as vocal folds) are surrounded and protected in your throat by a structure known as your larynx. This is also commonly referred to as your voice box.
Your larynx hangs suspended in your throat like a Chinese lantern by a piece of flat bone called your hyoid bone.
Fun fact—your hyoid bone is the only bone in your body that doesn’t directly articulate with any other bone. And yes, this has been a Jeopardy question.
Your larynx is made up of several pieces of cartilage and ligaments. It is the house for your vocal cords, which attach in the front to your thyroid cartilage and in the back to two pyramid-shaped pieces of cartilage called your arytenoids. These fun little structures can move and rock in many directions, giving your vocal cords the movement they need to create a wide range of sounds.
Pretty cool, huh?
Your vocal cords are strong strands of muscle fibers that can vibrate to make sound. Because of their cartilage attachments, they’re able to stretch and shorten at will—which allows you to modify your sound and pitch just like tightening and loosening a guitar string alters the pitch of this popular instrument.
While stretching, your vocal cords vibrate and move in and out in a wave motion, much like the winds of a hummingbird. This is the foundation of your voice and how it produces the sounds you shape into speech.
Ready for another fun fact? The primary function of your vocal cords isn’t actually to create sound for speech. Their main purpose is to protect your airway when you swallow. Every time you swallow something, your vocal cords come together tightly to close off your airway so no food or liquid can get inside your lungs.
Okay, one more fun vocal fact. Your vocal cords are the source of all the sounds you produce, but they make a sound that’s like the buzzing of a bee. It’s everything that comes above your vocal cords that shapes the sounds you make into your ability to speak and sing. If it weren’t for your teeth, tongue, hard and soft palate, throat, and nose—you’d sound a LOT different than you do!
Now that you have a better understanding of how your voice works, let’s look at what can happen when your voice doesn’t function as it should.
We’ll explore some vocal issues that are common in children, as well as why they tend to happen. Then, we’ll discuss some things you can do to prevent these issues and reduce their lasting impact on your child's voice.
What are the most common vocal issues in children?
The majority of vocal issues in children are the result of straining or misusing the voice, whether chronically or not.
Phonotrauma is the clinical term for harm to the vocal mechanism that affects how the voice sounds and functions.
Kids can cause harm to their voices in different ways. In some cases, kids yell more than they talk. This can cause the vocal cords to become overworked and inflamed. Yelling can cause the vocal cords to bang into one another, which can lead to redness and inflammation.
When vocal misuse is common and habitual, it can even cause blisters and calluses to form on the edges of the vocal folds. This can lead to vocal changes and can also cause a person to feel as if they have something on their vocal cords (such as mucus). These blisters can make the vocal folds heavier—because this mechanism is designed to be so sensitive, we can keenly feel any changes in this system.
The issue is that this can lead to throat clearing, in an effort to clear the mucus that isn’t actually mucus from the vocal cords. Chronic throat clearing is phonotraumatic, it causes the vocal cords to band into one another. Over time, it can worsen vocal issues and cause vocal nodules to form.
These callus-like bumps can harden over time, becoming a more permanent feature of the vocal mechanism.
In some cases, reflux can cause children to feel like they need to clear their throats regularly.
Acid reflux can cause excess mucus production, as well as damage the delicate lining of the throat, esophagus, and even vocal cords, depending on how severe and far up the reflux travels.
Reflux can result from gastroesophageal reflux (GERD) or laryngopharyngeal reflux (LPR).
To assess and diagnose reflux and its origins, it’s best to confer with a vocal specialist like a speech-language pathologist and to be assessed by an otolaryngologist (ENT), or a gastrointestinal (GI) doctor. These professionals can help you determine the nature of your child’s vocal issues and develop an appropriate plan of treatment to address them.
What does treatment for vocal issues in children involve?
If your child experiences vocal issues that impact or inhibit their ability to effectively communicate, it’s a good idea to get them assessed to figure out what’s going on and what can be done about it.
You can start by connecting with your child’s pediatrician or another trusted healthcare provider. This person can help you determine if the issue warrants further assessment and can likely make appropriate referrals if that’s the case.
A speech and language pathologist can treat many different types of vocal issues in children, but first, they need to know the nature of the issue. This is vital because it not only informs the types of treatment they’ll use but ensures that treatment is appropriate and indicated.
Because you don’t want your child’s vocal treatment to be ineffectual or, worse, to risk harming their voice further.
SLPs who work with voice clients typically insist that their clients are first assessed by an ENT, so they can have a clear awareness of the nature of your child’s vocal symptoms.
In addition to obtaining a medical history and performing a physical exam of their mouth and throat, an ENT may perform an endoscopy to view your child’s vocal cords and throat. This procedure can be done in the office and involves threading a slim, flexible tube down your child’s throat to visualize the vocal cords and how they move.
While the procedure can be uncomfortable, it is not painful, and it does not last long.
An endoscopy can help an ENT determine if your child has vocal cord swelling or nodules. They can assess if their vocal mechanism has excess mucus, signs of reflux, or any structural abnormalities.
This information is all-important in what treatments will be appropriate for your child.
If your child’s vocal issues are appropriate for an SLP to treat, they may work with them and you on understanding and using good vocal hygiene practices.
Vocal hygiene is the foundation of vocal health and wellness. It includes practices like—
Drinking enough water
Avoiding throat clearing
Avoiding yelling and screaming
Take vocal breaks when necessary
Minimize eating spicy or fatty foods
Your child’s speech therapist can also train them in vocal techniques like vocal warm-ups to help prepare their voice for use. They can also teach them techniques to reduce hard vocal onsets, which is a non-optimal speaking pattern that can cause stress and tension in the vocal cords.
Your SLP can involve you in your child’s vocal therapy, by educating you in vocal health and hygiene strategies, training you to support them in their exercises and practice of good vocal habits, and teaching you the role of diet in vocal health so you can support them by preparing foods and drinks for them that will nurture their vocal wellness.
We know how important parental involvement in the therapy process is. We even wrote an article about it! If you’re wondering how and why you should be involved in your child’s treatment process, be sure to check it out!
When you trust The Loop with your child’s speech and language therapy services, we always take care to craft customized treatment plans based on our thorough assessments—so your child's therapy with us is made just for them and never one size fits all.
We’ll be sure to involve you in the therapy process because we value your insight and input and recognize you as a vital member of your child’s team.
We can also collaborate with any relevant medical, healthcare, and educational specialists on your child’s team, including their ENT.
Our therapists are not only experts in their field—they also care deeply about the children and families they’re honored to serve.
We want your child to have a powerful voice in this world—both literally and figuratively. Let’s work together to ensure they learn good vocal habits and strategies, so they can use their voice to speak up for themselves and their needs.
Need someone in your corner to help give a voice to your child’s unique educational needs? The Loop is here for you! We provide Chicago families and private schools with top-quality speech, language, occupational, and behavioral therapy services. We’re also proud to offer a wide range of stellar educational support services, including learning remediation, educational consultancy and advocacy, and executive function coaching.