Voice Disorders in Children

An estimated 6-23% of school-aged children experience voice disorders. Voice disorders are defined as any deviation in pitch, loudness, variability or vocal quality relative to a child’s age, gender and cultural background.

Voice disorders can impact a child’s participation in the classroom in the following ways:

• Difficulty in being heard in and out of the classroom
• Limited classroom participation (oral reading, discussions, oral presentations) in an effort to conceal vocal differences
• Impaired social interactions
• Reluctance to participate in extracurricular activities
• Negative attention from teachers, as well as peers.

Do you have concerns about your child’s voice? Does it sound husky or cause them pain when they speak? If you have answered yes to any of these questions, then a voice assessment is the next step to find out more about what is going on with your little one’s voice.

What does a voice assessment look like at Cooee?

Before a voice assessment at Cooee you will be asked to fill out a case history form. This will include questions such as:

1. When did the issues with your child’s voice start?
2. How has your child’s voice been progressing (e.g. it has been getting huskier over the last few months)?
3. Does your child have reflux? Acid reflux can irritate the vocal cords which are the delicate structures that we use to create our voice. This can result in a huskier voice or persistent cough. If your child does have reflux the Speech Pathologist will ask more about certain triggers (e.g. spicy food, soft drinks) and provide information regarding reflux management.
4. Does your child use medications such as decongestants or inhalers? These can have a drying effect on the vocal cords and, as such, can contribute to irritation.
5. How does your child use their voice at home and at school? Does your child tend to yell often in these environments? What is their voice like when they leave for school v.s. come home from school? The answers to these questions will provide your Speech Pathologist information on your child’s vocal behaviours and areas which we can work on together to help reduce vocal strain (e.g. using a whistle to gain attention in the playground rather than yelling).
6. How many glasses of water does your child drink in a day? Hydration is an important factor in maintaining a healthy voice.
7. Has your child had a hearing test recently? Have they had a history of hearing loss? Hearing loss can cause a child to speak louder or with higher intensity than necessary which can contribute to a strained voice.
8. Perception of voice. What is your/your child’s/your child’s teacher’s perception of your child’s voice. This will help inform the Speech Pathologist about the functional impact of any voice issues for your child.

Your Speech Pathologist will talk through the potential causes of voice disorders. These can be divided into 2 main categories:

1. Voice Misuse e.g. yelling, excessive talking, excessive crying, chronic coughing, throat clearing, poor hydration, misuse of pitch, chronic exposure to irritants, excessive muscle tension

OR

2. Structural issues e.g. nodules, cysts, polyps, laryngeal webs, stenosis, chronic upper airway impairment, limited breath support for speech, inflammation due to acid reflux, laryngeal papilloma

85-90% of voice issues in school age children are related to vocal misuse or chronic upper airway inflammation.

What happens next?

The Speech Pathologist will then conduct a variety of assessments in order to determine your child’s vocal quality as a baseline for therapy as vocal function can be determined by assessing physical measures of pitch, loudness and breath support. These assessments may include:

• Getting your child to read a passage with all speech sounds present.
• Checking how long your child can sustain a /s/ and a /z/ sound as an indicator of their breath support.
• Assessing your child’s pitch with a rising and falling pitch siren sound.
• Assessing loudness by counting from 1 to 5 while gradually increasing volume.

These exercises will be recorded with your consent so that the Speech Pathologist can review the information when writing the assessment report.

After the session, your Speech Pathologist will provide an assessment report which will detail the severity of your child’s voice disorder and any defining characteristics e.g. breathy, rough etc. Your Speech Pathologist may recommend a referral to an Ear Nose and Throat specialist to investigate any potential structural concerns, depending on their findings. Finally, educational material about healthy voice behaviours will be provided.

The final step will be to discuss the goal for therapy (e.g. to develop the best possible voice quality by eliminating voice misuse and developing breath support). Your Speech Pathologist will also discuss any barriers that might be present when it comes to achieving this goal (e.g. time for homework practice) and problem solve them with you. If you would like to get in touch with a Speech Therapist to ask more questions or seek support for your child please do not hesitate to contact our team via email on [email protected] or call us on (07) 3265 4495.

Kaitlin Davey

Speech Pathologist