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Health Information For Parents
A hoarse voice is when someone sounds rough, raspy, or breathy when speaking. Hoarseness happens because the vocal cords are strained. In kids, this can happen from everyday things like cheering loudly at a ballgame, belting out a favorite song in the shower, or calling out to friends on the playground.
Sounding hoarse for a few hours or the day after a big game is nothing to worry about. Usually, the voice returns to normal on its own.
hoarseness can lasts for days, weeks, or even months. If this happens, a child needs to be checked out by a doctor. Speech therapy may be needed to get the vocal cords back into perfect pitch.
The vocal cords are delicate bands of tissue in the larynx (LAIR-inks), or voice box. When we speak, air pushes out of the lungs. In the larynx, the vocal cords — a “V”-shaped band of muscle — prepare to make sound by tightening up and moving closer together. As air passes through them, they vibrate. This vibration, combined with the movement of the tongue, lips, and teeth, is what makes the sound of the voice.
Chronic (long-lasting or ongoing) misuse of the vocal cords — from things like a lot of yelling or using the voice in an unnatural way — puts excess wear and tear on the vocal cords. They may stretch too far or rub together, causing small irritations. If these aren’t allowed to heal, they turn into small calluses, or vocal cord nodules. Vocal cord nodules are the top cause of chronic hoarseness in children.
Nodules can happen when kids do things like these for long periods:
Other causes of hoarseness include:
Doctors will want kids with chronic hoarseness to be checked by an otolaryngologist (an “ears, nose, and throat” specialist, or ENT). The ENT will:
The diagnostic test options include:
Flexible laryngoscopy. During this exam, a tiny, flexible fiber-optic tube with a camera attached to the end (called a scope) is passed through a nostril and into the throat. It gives a magnified view of the larynx. Kids are asked to speak, sing, sniff, cough, and make other sounds that make the vocal cords vibrate. Movements are recorded on a computer monitor so that specialists can analyze them later.
Rigid laryngoscopy. This can be done in the office for older kids, but very young children and others who can’t tolerate a flexible laryngoscopy will have this test in an operating room under general anesthesia. The rigid scope passes through the mouth to provide the best view of the vocal cords. Images of the vocal cords at rest are recorded.
Laryngeal stroboscopy. To get an accurate view of the vocal cords in action, doctors pass either a rigid or flexible scope attached to a strobe light into the throat. The strobe light flickers in sync with the vibration of the vocal cords as a person speaks. This makes it easier for doctors to determine the frequency of movement. Because individual vibrations are too fast for the naked eye to see, the strobe technology projects the vibrations in slow motion.
Treatment for hoarseness caused by vocal cord nodules involves making behavioral changes so that the vocal cords can heal. Speech therapists work one-on-one with kids and their families to promote good vocal habits, or what’s called “vocal hygiene.”
A typical vocal hygiene program involves:
It might be hard for kids with established bad habits — like talking loudly when they’re excited or clearing their throats when they’re nervous — to make changes. The first step is to make kids aware of the behavior and see how often they do it.
Older kids might learn to keep track of how often they engage in the behavior (perhaps keeping notes in a diary), which many do without realizing. Then they can practice the skills they’ve learned in therapy when at home, at school, and spending time with friends.
Parents can encourage good vocal habits by setting a good example themselves. For example, rather than calling to kids from another room, walk into the other room to talk to them. Promote quiet times (perhaps for half an hour each day) and using an “inside voice” when indoors.
Reward systems that encourage these new behaviors can help elementary school-age kids succeed. Offer stickers, tokens, extra TV time, a later bedtime, or similar “prizes” to get kids on board with the new, healthier habits.
Working with a certified speech-language pathologist can help a child with speech or language difficulties.
When symptoms of heartburn or acid indigestion happen a lot, it could be gastroesophageal reflux (GER). And it can be a problem for kids – even newborns.
A tic is a sudden, repetitive movement or sound that some people make, which can be difficult to control.
Gastroesophageal reflux disease doesn’t just affect old people who eat too much while watching TV. Active, healthy teens can have GERD too.
Yesterday, your son sounded like he’s always sounded – like a boy. But today, you heard that first crack in his voice. It’s the larynx (or voice box) that’s causing all that noise.
Knowing what’s “normal” and what’s not in speech and language development can help you figure out if you should be concerned or if your child is right on schedule.
Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
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