Pediatric Voice Disorders

As kids develop, they learn to use appropriate behaviors at school and at home. Teachers and parents focus on shaping behaviors that encourage children to make healthy and safe choices and develop positive social skills with their peers and adults. Many children who receive speech therapy in school or in a clinical setting, like our San Francisco practice, require assistance in learning how to use their voice properly. According to research, the percentage of children with voice disorders is approximately 6 to 9% (Boone 2014). While some voice disorders are inherited genetically or result from natural or medical causes, most that are treated by SLPs are functional, meaning they are caused by behaviors (Boone 2014).  Here are some common functional voice disorders present in children:

Muscle Tension Dysphonia (MTD)

  • As it’s name implies, MTD is a result of excessive tension on the vocal folds.
  • Signs of MTD include strained voice, breathiness, and vocal fatigue. Misuse of neck and shoulder muscles, vocal overuse, high stress level, and persistent loud voice commonly lead to MTD.

Vocal Fold Nodules

  • Vocal nodules are the most common lesion on the vocal folds, and can range in number from 1-4 nodules!
  • Vocal nodules are most common in boys age 3-10, and are caused by prolonged MTD (discussed above).
  • Voice therapy can reduce the swelling of nodules or resolve them completely in many cases. However, surgical removal is sometimes performed in more advanced cases.


  • Laryngitis is a common condition that results from illness and from vocal overuse; Laryngitis that comes from vocal trauma is called Traumatic Laryngitis.
  • Laryngitis causes hoarse, breathy, harsh, strained, and low-pitched voice abnormalities.
  • Usually traumatic laryngitis is resolved after resting, but excessive speaking above the laryngitis can worsen the condition. Contrary to popular belief, whispering does not relieve any pressure on the vocal folds!


Here are some examples of vocally responsible behaviors we can teach all children at school or home in order to prevent these disorders:

  • On the playground or at sports games…
    • Kids should try not to yell to teammates and friends.
  • In the classroom…
    • We can encourage kids to use “inside voices” when speaking and always raise their hands so they do not have to raise their voices to speak over other students.
    • This behavior is good for kids’ voices as well as keeping the classroom disruption-free!
  • At lunch or recess, and at home during family discussions…
    • Kids should practice taking turns when speaking with their friends and family. That way, they don’t have to speak any louder.
  • When watching TV or listening to music…
    • We can teach kids to turn down the volume when speaking to prevent raising their voices.
  • When getting someone’s attention…
    • Kids can find family members in the house rather than yelling their names.

These are just a few examples of ways to encourage kids to be mindful of their voices. In practicing positive vocal behaviors, mindfulness is key! If there are any concerns of voice disorders, such as changes in hoarseness or breathing that makes a strained sound, parents should consult with a pediatrician for a visit to an otolaryngologist. If a child is diagnosed with a voice disorder, voice therapy may be recommended.

This information is also helpful for parents and teachers to prevent voice disorders. We should ALL model desirable vocal behaviors; it’s a win-win!


Boone, D., & McFarlane, S. (2014). The voice and voice therapy (Ninth ed.).