| | Voice Disorders in Children Vocal Abuse & Vocal Misuse by Emily Kinsler, CCC/SLP.D Children can use their voices in healthy ways or in ways that can be harmful and result in problems. These problems are particularly prevalent in spring. Outside play, allergies and team sports are a part of life. It is natural for children to yell, cheer, shout and make truck and plane noises while playing. They may even cough or clear their throats excessively due to summer colds. All of these behaviors combine to stress the vocal folds, and when this happens, a voice disorder may result. Your child's voice becomes qualitatively different from how it sounds normally or from how friends his age may sound.
What Are Some Common Causes of Voice Disorders?
The most common causes of voice problems in children include voice misuse, vocal abuse, medical problems and emotional issues. All children engage in these vocal behaviors to some extent, but when these behaviors become habits problems can occur.
Vocal Abuse
Shouting or screaming.
Speaking with excessive force.
Talking too much.
Constant coughing, throat clearing.
Straining the voice to imitate noises like engines or sirens.
Vocal Misuse
Speaking too loudly
Speaking with too high or too low a pitch.Talking over background noise
Speaking without proper breath support. Drinking too many caffeinated beverages and not enough water
These poor vocal habits may cause irritation to the thin layer of mucous membrane that covers the vocal folds. This membrane is similar to the inside of your cheek. Continuous irritation leads to swelling, redness or callous-like growths called vocal nodules. Think about what happens when you clap your hands together for a long time. Your hands start to get red and sore, and sometimes blisters or calluses may develop on your palms. A similar occurrence can happen to your child's vocal folds when he exerts too much effort on them by yelling or talking for too long.
Children may also develop voice problems due to medical issues. Physical or structural defects, neurological problems, upper respiratory infections, allergies or gastrointestinal disorders, as well as some medications, can lead to voice disorders. In the summer, allergies, asthma and long summer colds can be especially hard on the vocal folds.
Emotional issues may also cause voice disorders. Some behaviors affect how the vocal folds work. It is easy to tell if a child is angry or anxious, excited or fearful by the sound of his voice. If a child is living in a continuous state of heightened emotion, for whatever reason, this may negatively impact his voice.
How Do I Know if There Is a Problem?
If your child is displaying some of the following voice qualities, or his voice has changed recently for reasons other than puberty, he may be exhibiting signs of a voice problem:
Frequent coughing
Hoarse or rough sounding voice
Strained quality to voice
Voice lost every time he has a cold
Always sounds as if he has a cold
Voice changes throughout the day
Excessive yelling, screaming or crying
Participation in activities such as sports, cheerleading, drama and singing that involve yelling or excessive use of voice
Dissatisfaction with the sound of his voice
Exposure to smoke or smoking
Part of a family of "loud talkers"
Allergies
Hearing loss
Perception that voice does not sound right
What Should I Do if I Suspect a Problem?
A visit to the Ear, Nose and Throat specialist (ENT) is the first step in determining if there is a physical cause to your child's voice problem. The ENT, or otolaryngologist, will examine his vocal folds using a variety of procedures. One way for the doctor to view the vocal folds is to place a small scope through your child's nose. A second method is to place a small videoscope in his mouth. This technique is called videostroboscopy. Some specialists can view the vocal folds by using a small mirror placed in your child's mouth. None of these procedures is painful or harmful, and your child usually only feels mild discomfort that can be alleviated with a numbing throat spray.
Once the ENT has made a diagnosis and determined the reason for the voice disorder, the next step is a referral for an evaluation by a speech-language pathologist (SLP). The SLP will use the information from the ENT, as well as information gathered in a voice evaluation, to determine the effect of the voice disorder on your child's vocal production. Finally, the SLP, in conjunction with the family, will plan and initiate individualized treatment to remediate the voice disorder.
What Are the Most Common and Effective Treatments?
While the most effective treatment is prevention, other treatments include vocal hygiene programs, direct voice therapy with an SLP and surgery. Training in vocal hygiene helps teach your child how to keep his vocal folds moist by drinking lots of water and staying away from caffeine. Voice therapy teaches your child how to use his voice correctly by teaching him various techniques.
What Can I Do to Help My Child?
By having your child evaluated by a medical professional and assessed by a speech-language pathologist (SLP), you have already begun to help your child. Changing vocal habits is difficult work. It may require the involvement of your child, the SLP and the help and support of the whole family. If your child is school-age you will also want to involve the teacher, as well as any coaches or other important adults in your child's life. Your child's SLP will set up a home program to help him improve his vocal function with exercises and activities specific to his needs. Here are some general tips that a parent can use at home:
Make a list of situations in which your child may misuse his voice.
Become a careful listener (e.g., is there a lot of throat clearing at home or yelling at soccer practice?).
Remind your child to use a softer, gentler voice.
Develop signals to help your child remember to use an appropriate voice (i.e., based on therapy suggestions).
Suggest alternatives to yelling at sporting events (e.g., noisemakers, signs, pom-poms, etc.).
Discourage the use of non-speech noises while playing (e.g., plane sounds, beeping, car noises, etc.).
Turn down radio and TV volume when talking.
Suggest some quiet time activities, if your child is sounding hoarse.
Model good vocal behavior.
If you need more information on voice or voice disorders, contact your pediatrician, ENT or SLP. There are many online, text and reference sources for information in addition to those listed below.
Emily Kinsler, CCC/SLP.D., is the Director of Outpatient Speech-Language Services at The Treatment and Learning Centers (TLC).
The American Speech-Language Hearing Association (ASHA). Questions and Answers about Voice Disorders, 2004. http://asha.org/public/speech/disorders/Voice-problems.htm.
The National Center for Voice and Speech (NCVS). http://www.ncvs.org.
Andrews, M. (1986). Voice Therapy for Children. Longman, Inc.
DeFeo, A. (1988). Protecting Your Child's Voice. Communication Skill Builders.
Lee, L., Stemple, J.C., Glaze, L. (2003). Functional indicators of voice disorders in children and adolescents. Communicare Publishing.
Lee, L., Stemple, J.C. & Glaze, L. (2003). Your Child's Voice. Communicare Publishing.
Lee, L., Stemple, J.C., Glaze, L. & Kelchner, L. (2004). Quick screen for voice and supplementary documents for identifying pediatric voice disorders. Language Speech, and Hearing Services in Schools, 35, 308-319.
Ruddy, B. & Sapienza, C. (2004). Treating voice disorders in school-based setting: working within the framework of IDEA. Language Speech, and Hearing Services in Schools, 35, 327-332.
This article is used with the permission of the editorial staff of Washington Parent.com Read more interesting and fascinating articles about your child's development at the Washington Parent website
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