Voice disorders are fairly common in children, with about five per cent of children experiencing a chronic (long-lasting) voice disorder.

A voice disorder is when the quality of a person’s voice is noticeably different to the voices of others who are the same age and sex. Children with voice disorders may have harsh or hoarse voices, or voices that are too high or low, too loud or too nasal.

Most voice disorders are harmless and disappear on their own, though some require the help of a specialist.

Signs and symptoms of voice disorders

If your child has a voice disorder, their voice may sound:

• harsh or hoarse
• too high or too low
• too loud or too quiet, or they may have ‘lost’ their voice entirely
• as though they are speaking through a blocked nose
• as though too much air is coming down through the nose during speech.

Children with voice disorders often have voices that tire easily or they have difficulty projecting their voice.

Poor voice quality may make it hard for your child to communicate effectively, and may make them lose self-confidence or affect the way other people see them.

Infants with voice disorders may have a cry that is weak or has a harsh or hoarse quality, or they may have noisy breathing.

When to see a doctor

If your child has a hoarse voice that is getting worse or not getting better, or if you are concerned about your child’s voice for any reason, see your GP for advice. Your child may be referred to a speech pathologist or specialist doctor, such as a paediatrician or ear, nose and throat (ENT) specialist.

What causes voice disorders?

A person’s voice is the sound produced by the vocal folds in their larynx (voice box). The vocal folds are thin muscle bands that produce vibrations (sound) used for speaking. Voice disorders often involve problems with the vocal folds.

Voice disorders in children are usually caused by:

• excessive shouting or loud talking
• excessive use of harsh voice ‘sound effects’ during play
• common childhood infections.

There are also some rare medical conditions that may cause voice disorders in children.

Hoarse voice

Hoarseness is quite common in children. If your child has a hoarse voice, a joint assessment by an ENT specialist and a speech pathologist in a voice clinic may be needed.

Hoarseness is usually related to the way children use their voices, rather than a serious illness. Other common causes of hoarseness in children include:

• Vocal nodules/cysts/polyps: these are known as benign lesions (areas of damage that are not cancer) of the vocal folds, and they are caused by tissue stress during excessive voice use, such as screaming or prolonged loud talking or crying. Encourage your child to rest their voice by not talking loudly or shouting. In some instances, lesions may need surgical removal.
• Infections: a hoarse voice often happens when a child has a viral infection, such as a cold or laryngitis (inflammation of the voice box). This hoarseness will be temporary and usually disappears when the infection clears. Encourage your child to frequently sip fluids and rest their voice until they get better.

Less common causes of hoarseness in children include Recurrent Respiratory Papillomatosis (a viral infection in the vocal folds caused by the human papillomavirus) or, in extremely rare cases, tumours or cancers. An ENT specialist will manage treatment of these conditions.

Weak voice

A weak voice is often the result of poor vocal fold movement or incomplete closure of the vocal folds during speech. Causes may include vocal fold paralysis or narrowing of the larynx. Children who have had a breathing tube during a period of illness (or due to prematurity) are at higher risk of weak voice, and may experience long-term voice problems.

There are some surgical procedures that are used to correct vocal fold paralysis in adults, but these are not commonly done for children. Voice therapy is sometimes used for children with weak voices.

Abnormal-sounding cry or noisy breathing in infants

If your infant’s cry is weak or has a harsh or hoarse quality, they need to be assessed by a paediatrician or ENT specialist.

Laryngomalacia (larin-go-mah-lay-shia), or floppy larynx, is a common cause of noisy breathing in infants. It generally resolves by itself by the time your child is two years old, and your child will not experience any long-term voice problems. If your child has laryngomalacia, they will be closely monitored by doctors to make sure they are breathing well. If the condition is severe, an operation may be necessary.

Caring for your child’s voice

These suggestions can help your child take good care of their voice:

• Encourage your child to get closer to the person they want to speak to instead of yelling across distances.
• Schedule short periods of voice rest or quiet time during the day and night.
• Play around with different voices with your child so they become more aware of different levels of loudness, pitch and clarity. For example, start speaking very softly to them, and then build up gradually until your voice is loud. Talk about voice sounds being very soft, a bit louder and loud, and discuss which level of loudness is the best to use for talking in different situations. Use the same method to contrast gentle and harsh/rough voices.
• Praise your child when you hear them using their gentle voice.
• Discourage yelling, screaming, excessive shouting, talking over people or background noise (e.g. the TV) and speaking in a screechy and harsh manner.

There are a number of other things that may have a negative effect on the voice:

• smoky, dusty and polluted environments
• not drinking enough fluids – encourage your child to have regular, small sips of water, rather than the occasional guzzle
• excessive coughing and throat clearing
• increased stress/anxiety.

Key points to remember

• Most voice disorders are harmless and disappear on their own or with the help of a specialist.
• Encourage your child to rest their voice by not shouting or talking loudly and keeping their throat moist by frequently sipping on fluids (especially after an infection).
• Your child may need an assessment by an ENT specialist and a speech pathologist if they have a hoarse or weak voice that is getting worse or not getting better.
• Some voice disorders need surgery, although this is uncommon.