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Voice issues are some of the most difficult to remediate in young children. However, speech-language pathologists can address issues pertaining to voice if given a prescription for therapy by an Ear, Nose and Throat Specialist (otolaryngologist).

Many difficulties with voice are due to physical impairment, illnesses or allergies. Many of these issues are due to vocal misuse and abuse, and others are due to emotional/social issues. For these reasons, a recommendation from an ENT is secured prior to therapy to determine the cause of voice problems and rule out serious factors that require medical attention.

Voice disorders occur along several areas:

Pitch --- the voice sounds too high or low for the person’s age and gender

Loudness---the voice is too loud or too soft

Nasality---the voice has a hypernasal quality (too much air coming through the nose) or hyponasal quality (too little air coming through the nose during speech)

Quality---the voice has a persistent hoarse quality, with intermittent loss of speech; harsh---voice is being forced too low, causing a strained, strangled tone to speech; or breathy---sounds whispered and lacks sound quality

Teaching appropriate breathing techniques, vocal hygiene and practice using appropriate voice are targets in voice therapy. A regimen of vocal hygiene is usually the main course of therapy with children. Part of this therapy requires complete vocal rest to allow the vocal folds to heal. In my experience, young children have not responded successfully to this type of therapy. It is hard to keep a child quiet 23 hours a day for several weeks or months!

Teaching the child to self monitor the voice & refrain from activities where the voice is strained (cheerleading, organized sports), can be done, but also requires commitment from the family. Eliminating environmental factors such as caffeine, 2^nd hand smoke, kerosene/coal/woodburning heating sources, and providing humidity also require a commitment from the family.