It is true that in some cases a “child will grow out of it,” depending on the cause or causes of the hoarseness. But many people remain hoarse or have vocal problems their entire lives, which may inhibit their academic, social and professional success. The incidence of chronic hoarseness among elementary school children is 38%, according to one study, but most children with voice disorders are never seen by voice professionals.
A voice disorder is generally characterized by a change in pitch (high or low), loudness and/or vocal quality. A child who doesn’t sound like his or her peers should have a laryngeal exam conducted by a qualified laryngologist (an ear, nose and throat doctor specializing in the voice/airway/throat). If the physician determines that voice therapy can help, he or she will make a referral to a qualified voice therapist, a speech- language pathologist specializing in voice disorders.
The voice therapist will conduct an evaluation to figure out the contributing factors to the voice problem, take measurements of the voice, and conduct “stimulability” testing to see if the child’s voice will improve immediately, even if only temporarily, with a certain technique.
Traditional voice therapy includes raising the child’s awareness of the factors relating to his or her voice problem. For example; too much shouting, excessive talking or singing, or not drinking enough water can be contributing factors. Other therapy includes laryngeal relaxation strategies and vocal exercises and using appropriate “melody,” loudness, rate of conversation, and voice quality in everyday speaking.
Working with children presents its own set of challenges. They do not come to therapy voluntarily. They are often unaware of or unbothered by their voices. Children change rapidly as part of their individual development. They are not little adults, so adult voice therapy techniques are often not appropriate.
Helping Children Make Vocal Changes
To help a child make vocal changes, it has to be fun! If a child loves acting or singing or doing math, I incorporate the favored activity into vocal practice. This keeps the child excited and motivated to participate in voice therapy activities both inside and outside of the therapy room.
The vocal exercises have to be appropriate. Exercises that work for adults will also work for children, but they need to be simpler and relatable.
I also work with the child to find positive, appropriate substitute behaviors for shouting. Using a noisemaker at a sports event to cheer on the team may work for some children, but others may think that it calls too much attention to them.
The family has to be on board to help the child make vocal changes. If the child comes from a “loud” family, I design specific exercises so that everyone in the family can practice and provide a good model for the child. Again, this should be fun for everyone and not tedious.
Context is important. I explore where and when the child is having problems with vocal “misuse.” Is it in the mornings, on the playground, at bedtime? I design techniques for each situation.
Above all, the techniques should empower the child. I allow children to come to their own decisions without providing too much “education.” For example, I may ask a child to decide what behaviors are easy or hard on the voice and give a “thumbs up” or “thumbs down.” We brainstorm to find substitute behaviors for yelling and pick one together as a “technique of the week.” Parents can then reward the child (e.g., with points for something, or a big hug) when they observe the child using the technique. When you give children the tools to help them make their vocal choices, they “own it” and feel the intrinsic satisfaction of a job well done!
Leah Ross-Kugler, MS, CCC-SLP, a speech-language pathologist who specializes in voice disorders, has served many prominent laryngologists in the metropolitan area. She has worked at the Institute for Voice and Swallowing Disorders at Phelps Memorial Hospital for eight years and maintains a private practice in Croton-on-Hudson and Brooklyn, NY. With her background in both music and art (as a former opera singer and a textile designer), she seeks creative ways to help children succeed in changing their voices.