Voice disorders in children are common, though they are woefully under-researched and often under-diagnosed.  Research tells us that anywhere between 6 and 36% of children have voice disorders, though no-one knows for sure.

Clinical signs of a voice disorder include increased effort to speak, vocal fatigue, a breathy voice, a voice that is unusually low or high in pitch, periods where the child loses his or her voice, hoarseness and/or strain.

Voice problems are the most common communication problem for children, and they can have a major effect on how a child functions, e.g. at school and in sport, and on the child’s quality of life.

Known risk factors for a voice disorder include having older siblings, being a boy, and spending long days in large groups (e.g. in the playground and at after-school care) or in places with high levels of background noise.  Having asthma or a tonsillectomy may also increase the risk of voice disorders.

It’s always a good idea for children with potential voice problems to be assessed by an Ear Nose and Throat Specialist (ENT).  ENTs can inspect, take pictures and videos inside the voice box to see what’s going on and to rule out very rare but life-threatening conditions like human papillomavirus (HPV), which, over time, can block the airway.

Many children with voice disorders are diagnosed by their ENT as having vocal nodules.  Nodules are small nodes that sit opposite each other on the vocal folds (also known as “vocal chords”) in the voice box.  Nodules usually develop due to constant and traumatic collision of vocal folds.  They are often associated with:

  • lots of screaming and yelling;
  • recurrent infections of the upper airway; and/or
  • reflux: acid laryngitis due to a gastric content rise.


Traditionally, voice therapy for children has centred on “voice preservation”, sometimes referred to as a “vocal diet”, as well as on educating the child with  “vocal hygiene tips”, e.g. on the benefits of drinking more water and not yelling too much at soccer practice.  The main challenge with this therapy is to get the child to actually yell less in the real world!

Very recently, some new approaches have been developed based on principles of motor learning and an understanding of the biomechanics of optimal voice production.  Aims include allowing the child to maintain (or regain) a relatively strong voice, but learning and using techniques to minimise vocal fold impact and to reduce pressure/constriction within the voice box.  It’s early days with some of these techniques, but they are promising and, in our experience, more likely to be used in the real world than some of the more traditional methods.

If you are concerned that your child may have a voice problem, you should speak with your GP about getting a referral to an ENT.  After assessing your child, the ENT may recommend a block of voice therapy with a qualified speech language pathologist.

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Banter Speech & Language Banter Speech & Language
Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Rhodes, Strathfield and all other suburbs of Sydney’s Inner West.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).

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