Child with a hoarse voice when they aren't sick? Read a Voice Expert’s Advice

‘Don’t shout! You’ll hurt your vocal cords!’ I heard myself ‘shouting’ at my ten-year-old recently. Perhaps I didn’t shout it, but he wasn’t in the same room as me, and it surely wasn’t an easy resonant voice I used. Why was he shouting…? He was just playing with his friends. This article will explore why a child might have a hoarse voice when they aren't sick and gives 5 top tips for promoting healthy voice in children.

Written by Tor Spence, Voice & Upper Airway Specialist and Speech Therapist.

What is your voice?

At the front of your neck, you have a voice box, called the larynx. Inside are two vocal cords. These are tiny muscles that sit open when you breathe. When you talk, they start to open and close very quickly as you breathe out. This makes the air vibrate and that is your voice! You use your lips and tongue to turn your voice into speech sounds.

I would say my son more than most, is aware of the delicate nature of the voice, at any age, including as it develops in childhood. Given his mother is fully focused on vocal health and treating children with voice disorders for a living, he has listened to me promoting it over the years. I am regularly explaining why his voice needs protecting and that boys his age are the most prone to getting vocal cord nodules! We talk about voice a lot and he sees me warming up. Usually much to his embarrassment but I have got him trilling and voicing through straws and having fun with it!

What is a voice disorder?

Voice disorders are a range of conditions that affect the larynx (voice box). They can cause changes to the voice called dysphonia or loss of voice aphonia. These changes can affect the way the voice sounds, for example, making it sound hoarse, croaky, strained, breathy or weak. Voice disorders can also make the throat feel different, for example it might feel sore, achey or dry.

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Why do children need to take care of their voices?

Children are children. It’s very important they are children and have the freedom to express themselves vocally in a spontaneous way. Their voices need to be able to express their emotions and form relationships with others and learn. They are exploring life, communication, friendships, and interests.

You read about the more common risk factors for children developing voice disorders. These include children in larger families with siblings, children playing a lot of team sports, and children with allergies, hearing problems or being prone to nasal issues.

90% of the children I see in the clinic are described by their families as a ‘chatter box’. Promoting good vocal health in these children is NOT about changing their personalities or important natural aspects of their communication styles. The way I approach it is through fun learning and building awareness of voice and how it works. Allowing the child to feel more knowledgeable and in control. I want them to form their own decisions about what is safe and happy for their voice vs what might cause discomfort or change to occur.

Here are 5 tips and strategies for promoting a positive vocal health environment for all children:

In particular for those who are at risk or already experiencing fluctuating voice changes or throat symptoms.

1. Get the whole family involved so you are learning about voice together and so that positive vocal behaviors are modeled throughout the home environment.
2. You could explain that shouting and screaming should be kept for occasional and emergency situations.
3. Compare the effect of shouting on the vocal cords to loud and fast clapping and the heat and sensation this can create on the palms of your hands. The same heat and sensation can happen on the vocal cords.
4. Model quieter talking and reinforcing this message throughout the house is helpful.
5. We can’t stop children shouting entirely, nor would we probably want to. But if they can think about it twice on a few occasions then it’s helpful. And if they see parents avoiding shouting as well, that’s a positive message.

For more tips and information about how the voice works and voice care strategies for children, you might find this leaflet a helpful guide. This was created in collaboration with Charlotte Hall from Speech Therapy with Charlotte and is aimed at children aged 5 to 12.

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When to seek help for voice

It is very important that voice change and throat symptoms that persist for more than 3 weeks, are investigated by a medical professional. In the UK, see your GP, who might refer you to an ENT consultant for further investigation.

Tor Spence works as a voice and upper airway specialist speech therapist with children and adults. She worked in the NHS for fifteen years in Berkshire, Buckinghamshire, and Oxfordshire including in specialist voice clinics. In 2020 she founded VoiceFit services, based in West Berkshire and now works as a full-time independent therapist, clinical supervisor, and voice therapy skills trainer. She creates online and social media content @voicefituk about voice and vocal health. She is passionate about helping her clients find their voices and about supporting everyone to maintain a healthy voice.