Voice

• Harsh, hoarse, croaky, strained or rough voice quality.
• High or low pitch of voice.
• Loud or whispery voice.
• Hyper-nasal (in other words, too much air coming through the nose) or hypo-nasal voice quality (in other words, like they have a blocked nose).
• Loss of voice during the production of specific sounds.
• Periods of time when voice is lost completely.

• Mild to severe difficulties may occur in isolation or alongside a speech and/or language disorder. This may have an impact on the child’s speech intelligibility.
• May have an effect on the child’s confidence in speaking situations or their ability to communicate with others. 
• May lead to voice difficulties in adulthood as most voice difficulties are known to begin in childhood.
• There are also some rare medical conditions that may cause voice disorders in children. 

The larynx and vocal tract change significantly from infancy to adulthood. When an infant is born the larynx is positioned very high in the neck, which facilitates the coordination of respiration and swallowing during feeding. As a child grows, the larynx descends, which enhances the voice's quality by adding depth, richness, and clarity. The laryngeal structure also changes.

Laryngeal growth is related to overall body growth. Growth accelerates from birth to age 3, then decelerates and finally enters a rapid growth phase during adolescence and puberty, particularly observed in boys. Until puberty, the larynx is similar in size for boys and girls and voices do not greatly differ.

If your child has a hoarse or harsh voice that is not getting better or is getting worse and/or if you are concerned about your child’s voice for any reason, see your GP for advice. Your child may also be referred for further examination by an ear, nose and throat (ENT) specialist.

Following the ENT examination your child may be referred to a speech and language therapist.

The following are some effective strategies that parents, caregivers and educators can implement to promote a healthy voice use among children.

Encourage healthy vocal habits

One of the most crucial aspects of prevention is teaching children to use their voices correctly. Parents and caregivers should encourage children to speak at a comfortable volume and avoid shouting or whispering, as both can strain the vocal cords. Simple reminders about proper posture while speaking can also contribute to better breath support and vocal control.

Promote hydration

Adequate hydration is vital for maintaining vocal health. Children should be encouraged to drink plenty of water throughout the day to keep their vocal cords lubricated. Educating them on the importance of hydration, especially during activities that require prolonged speaking or singing, can help prevent voice strain and hoarseness.

Limit vocal strain

To prevent vocal strain, children should be taught to take regular vocal breaks, especially during periods of extensive speaking or singing. Incorporating restful periods into their daily routine can help reduce the risk of overuse injuries. Additionally, avoiding speaking over loud noises or in environments with significant background noise can help children use their voices more effectively without strain.

Educate on vocal hygiene

Vocal hygiene involves practices that promote vocal health. This includes avoiding throat clearing and coughing whenever possible, as these actions irritate the vocal folds. Teaching children to use a soft, gentle voice when they need to speak softly can also help preserve their vocal health. Moreover, reducing exposure to irritants such as smoke, allergens, and excessive dust can further support vocal health.

Monitor and address symptoms early

Parents and caregivers should make note of changes in their child's voice, such as hoarseness, breathiness, or pitch changes. Early identification of potential voice issues allows for timely intervention, significantly improving outcomes.

A variety of leaflets and factsheets for children are available on the website of the British Voice Association .

Here are some useful videos on common voice disorders:

• Nodules
• Muscle tension dysphonia
• Spasmodic dysphonia
• Vocal cord palsy
• Encouraging your child to produce a healthy voice

Further resources are available on the British Laryngological Association.