Voice Disorders in Children
The voice is a marvellous and unique part of being human. It’s a significant part of what makes you, you! Just like a fingerprint stamp of identity, your voice is uniquely yours. No one has the same exact voice. Given your voice is one-of-a-kind, it’s incredibly important to look after it! Your voice box is made up of muscle and cartilage, and, just like any other part of your body, it needs to be looked after so it can do its job right!
What is a voice disorder?
Voice disorders are common in childhood, with about 5-9% of Australian children experiencing a significant problem with their voice at any given time (Speech Pathology Australia, Royal Children’s Hospital). This is not related to other speech and language difficulties and can happen to any child.
As we all know, the voice is the sound we use for talking and communicating. It involves the vocal folds (voice box), which vibrate and create the sound; the vocal tract, which includes the throat, mouth, and nose; and the oral structures within the mouth, such as the tongue, lips and soft palate. The vocal tract is responsible for the ‘resonance’ (energised/strong/clear) of the voice.
A voice disorder may sound like your child’s voice is:
· too high or too low compared to other children of the same age and gender
· too quiet or too loud compared to their peers
· harsh or hoarse (like a sore throat)
It may also sound like your child:
· has a constant cold
· has air escaping from their nose while they talk
· needs to cough or clear their throat during or after talking
· becomes tired after a lot of talking
What causes Voice Disorders?
It is important to understand that there are different types of voice disorders.
Some are caused by physiological changes to the vocal folds (such as nodules or polyps), which interfere with how the vocal folds work and result in changed voice quality. For nodules, surgery is NOT recommended and is considered a last resort. In this situation, Speech Pathology is your first port of call. Nodules are like callouses on the vocal folds, and the use of gentle voice techniques can help them ‘rest’ and heal.
Polyps can also be treated with Speech Pathology but are more likely to require surgery in some circumstances. An Ear, Nose and Throat (ENT) doctor is the specialist for this and will evaluate the vocal folds through nasoendoscopy (placing a camera down the throat to observe the vocal folds (rigid) or through the nose (flexible)).
Other possible physical changes might include the soft palate (roof of the mouth at the back) not working as well as it should be. This can result in a voice that sounds nasally. Speech Pathologists can work on remediating this through behavioural approaches to change the way the voice is used. However, Speech Pathologists are not able to physically change or manipulate a person’s voice or vocal tract.
Other voice disorders can be caused by physical injury, overuse, or even environmental irritants. Similarly, there are usually evaluated by an ENT and treated by a Speech Pathologist. Sometimes, a medical condition can temporarily cause a change in the voice, but this is NOT a voice disorder – for instance, sounding like you have a cold when you actually have a cold is normal. It is only when this voice change continues for an extended period that it is likely to require professional help.
Voice disorders in children are usually caused by lots of shouting or hoarse/harsh sound effects in play or other activities, such as overuse in sports. Sometimes, although not usually, the voice disorder is caused by a more serious medical condition, and the involvement of your GP or the ENT may be necessary.
What can I do to avoid a Voice Disorder?
Using good voice care practices can help avoid voice disorders and damage to the vocal folds. Protecting your voice revolves around hydration, reducing certain voice behaviours and avoiding irritants.
These include management strategies such as….
• drinking water regularly to keep the vocal folds moist and prevent them drying out
• using supported airflow to project your voice rather than relying on too much exertion from the vocal folds - learning how to do this can also be invaluable for teachers and other professional voice users!
• avoiding shouting too much to gain attention (instead, use a whistle, clap or microphone)
• learning to speak loudly more effectively
• avoiding smoke and other polluted environments
• allowing for 1 hour of vocal rest throughout the day after periods of overuse (that football final, for instance!)
• warming up the voice before using it
• avoiding certain foods if you feel they negatively impact your ability to voice freely
However, these strategies will depend on individual needs. Your Speech Pathologist will help you decide which strategies are best and the right fit for you.
Treatment for Voice Disorders
Voice therapy involves learning techniques to allow your child to use their voice without further damaging their vocal folds and/or constricting or tensing their vocal tract. Voice exercises may be used to build up strength or to promote relaxation to help with overall muscle tension.
Even though your child’s voice problems might sound just like another child’s (hoarse or harsh for instance), the treatment may vary because the underlying cause of the voice disorder is different.
Treatment may include working on:
1. Breath-flow and support
2. Establishing efficient voicing
3. Muscle relaxation and tension management
4. Improving the resonance (energy and projection) in your voice
5. Articulating sounds and speaking with ease, confidence, and freedom
6. Working on and exercising your pitch range, volume, and strength of voice
7. Learning to use your voice efficiently in different contexts
8. Voice hygiene (care and education for your voice)
When to seek help:
You should consider seeking medical advice from a GP or ENT when…
• you notice your child does not sound like other children the same age and gender and that this has been going on for an extended period of time (not just while they have a cold or after a lot of yelling at the sports day at school)
• they repeatedly have problems with their voice after overuse, such as shouting, even if the change doesn’t last for long
• it’s been more than a few weeks, and the symptoms haven’t gone away
Usually, before seeing a Speech Pathologist, your child will need to be scoped (have a camera look down their throat at their vocal folds) by an ENT. This is to rule out or confirm the presence of a voice disorder and to diagnose the problem. Your treating Speech Pathologist will then further assess and treat your voice with this information in mind.
If you would like to book an initial consultation with a Speech Pathologist from our team, please contact us on 1300 086 280 or at [email protected].
· Voice handout, RCH Kids Health Information : Voice disorders (rch.org.au) accessed 19/7/2022
· Shewell, C., (2009) Voice Work, UK, Wiley-Blackwell
· Voice Handout, SPA Fact Sheets (speechpathologyaustralia.org.au) accessed 19/7/2022