Having a healthy voice

Common illnesses e.g. coughs and colds can affect how the voice sounds. We might lose our voice after a period of illness however this often recovers once we have recovered.

However, some children’s voices may sound different to other children all of the time e.g. it may be husky or croaky, or sound strained, and some children may frequently lose their voice.

If your child has a persistently hoarse or husky voice, a strained voice, or loses their voice frequently (or at a time when they do not have an illness e.g. a cough or a cold) they may need to see a Speech and Language Therapist and an Ear, Nose and Throat (ENT) doctor about this, to identify some of the reasons why they are having difficulties with their voice.

Our voice is made by the vocal folds (vocal cords) vibrating in the voice box in the throat. The air is pushed up from the lungs through the windpipe and the voice box. The air passes the vocal folds inside the voice box which makes them vibrate. Our voice is the sound made by our vocal folds vibrating, this then travels up and out of our mouth.

Our vocal folds are very small and delicate. They vibrate hundreds of times per second when we speak. They also vibrate together when we laugh, cough, or make other noises.

There are lots of things that can affect a child’s voice.

For some children the sound of their voice may be affected by how they use their voice.

Children use their voices for lots of reasons and in lots of different ways e.g. talking, singing, shouting, screaming, squealing, laughing, and making funny noises in play. This means they are using their vocal folds a lot throughout the day.

If children strain or use their voices too much, or in the wrong way, the vocal folds can become sore, swollen and red, which in some cases can lead to vocal fold nodules and affects how the voice sounds.

For some children, voice difficulties may be due to a physical reason, affecting how the vocal folds work e.g. a polyp or cyst on the vocal folds, vocal fold palsy, papilloma or a congenital condition which affects the vocal folds. These are less common.  Some voice difficulties can be associated with psychological issues. This is also less common.

A husky voice can sometimes be a symptom of reflux.

Reflux is the backflow of stomach acid up into the oesophagus (food pipe) and / or throat. There are 2 types of reflux. Gastroesophageal reflux which leads to symptoms of heartburn and indigestion, and silent reflux that can affect the throat and the voice.

Symptoms of silent reflux might include.

• A feeling of a lump or something stuck in the throat
• Excess mucus in the throat
• Excessive throat clearing
• Coughing
• Some people may experience heartburn but not always
• A hoarse voice – due to the acid causing irritation in the voice box which can affect how the voice sounds.

The Speech and Language Therapist will carry out an assessment with the child’s parent/carer and the child. This involves gathering information about the child’s communication skills and their voice difficulties through discussion with parent/carers and observations of the child. 

In order to gain a picture of how the child uses their voice, the type of difficulties they are having and possible factors that may be affecting how the voice sounds, the therapist will ask a range of questions about the child’s development for example

• medical history
• routines and interests
• communication skills.

The therapist will observe the child’s voice through play or conversation. They might ask the child to carry out some simple talking tasks so that they can listen to how the voice sounds and changes when your child is talking.

The therapist will give you some advice on how to support the child to look after their voice and if felt appropriate will arrange some therapy sessions to help you and your child understand and help your child’s voice difficulties.

If the child has not yet been seen by an Ear Nose and Throat (ENT) doctor the therapist may discuss a referral on to the ENT service for further investigation into the child’s voice difficulties.

The Ear Nose and Throat (ENT) Doctor will take a history of the child’s difficulties and if possible carry out an examination of the child’s voice box using a nasendoscopy (this is a small camera passed through the nose and down the throat) or a rigid stroboscopy (this is a small camera put into the mouth to look down the throat). The outcome of this assessment will help to inform the child’s ongoing care.

Parents / carers, nursery and school staff can really help children to look after their voice. 

 

Things to try and avoid:

Vocal behaviours that can put a strain on the vocal folds such as;

• Talking continuously
• Shouting, cheering, and making sudden hard noises with the voice
• Whispering
• Making silly noises in play
• Screaming
• Continuing to talk when running out of breath; take extra breaths to speak[CC1] .

Also;

• Coughing and throat clearing - try and have a sip of water instead.
• Cough sweets, fizzy drinks and caffeine can dry out the vocal folds.
• Some medications can also have this affect, therefore if your child is having voice difficulties and takes regular medication it may be useful to review this with their GP.
• Smoky, dusty, dry environments.

 

Things to try and do:

• Drink plenty of water. Take regular sips of water throughout the day.
• Encourage the child to rest the voice, especially if your child has been using this a lot in the day. Choose a time and activity e.g. watching TV or reading when home from school, when your child can rest their voice by not speaking or making any sounds.
• Try to use a ‘gentle’ or ‘indoor’ voice.
• Remove background noise e.g. turn the TV or radio volume down if you want to talk so that you don’t have to shout to be heard.
• Get other’s attention by going over to them or waving at them rather than shouting.

The therapist will provide information and exercises to help you and your child understand about their voice and how they can look after this.

Topics we might cover include.

• How the voice works
• How we use our voice
• Things that can affect how the voice sounds
• Hydration
• Posture, tension and relaxation
• Breathing
• Different ways to look after our voice. This might include strategies and activities for you and your child to put into place at home, and in some cases vocal exercises for your child to practise.

 

Useful leaflets

• Looking After Your Voice - Advice Booklet for Parents in Nottingham City[pdf] 218KB
• Looking After Your Voice - Advice Booklet for Schools[pdf] 215KB

If you or a parent/carer has concerns about a child’s voice you /they can

• Make a referral to the Speech and Language Therapy service for an assessment and advice here.

And

• Speak to the child’s GP who can refer them on to the Ear Nose Throat team for investigation into their child’s voice difficulties.

 

For further information on voice difficulties see:

• www.britishvoiceassociation.org.uk   
• https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/encouraging-your-child-produce-healthy-voice/