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Conditions that affect a child’s voice and speech occur when a child has problems creating or forming the speech sounds needed to communicate. The ability to communicate through speech is an important aspect of childhood development, and children who struggle with voice and speech conditions can also face other challenges, such as in their relationships and success at school. If your child has a voice or speech condition, it is important that he or she sees a specialist that can help you address the condition and improve your child’s quality of life.
Voice and speech conditions that can affect children and adolescents include:
Voice disorders. Voice disorders can include hoarseness, vocal fatigue, raspiness, periodic loss of voice or inappropriate pitch or loudness. Most voice disorders result from straining the voice in some way, such as frequent yelling or shouting, speaking too low or high or chronic throat clearing. Symptoms of voice disorders include:
Speech disorders. Common speech disorders include motor speech disorders, such as childhood apraxia of speech (CAS) and dysarthria, and stuttering. CAS occurs when a child’s brain has problems moving the body parts that are needed for speech, such as the lips, jaw and tongue. A child knows what he or she wants to say, but the brain has difficulty coordinating the muscle movements necessary to get out the words. Symptoms of CAS include:
Dysarthria occurs when a child has difficulty moving the muscles required for speech, including the lips, tongue, vocal folds and diaphragm. This condition is caused by damage to the brain either at birth or later by a condition such as cerebral palsy or muscular dystrophy. The symptoms of dysarthria include:
Stuttering occurs when a child’s speech is characterized by interruptions known as disfluencies. In most cases, stuttering impacts at least some of a child’s daily activities. The symptoms of stuttering include:
Juvenile-onset recurrent respiratory papillomatosis. Juvenile-onset recurrent respiratory papillomatosis (RRP) is a rare disorder in which a child develops small, wart-like growths (papillomas) in the respiratory tract. Papillomas can develop anywhere along the tract but most often grow in the larynx and the vocal folds. These benign growths can cause severe, even life-threatening airway obstruction and respiratory complications. RRP is caused by the human papillomavirus (HPV) infection. The symptoms of recurrent respiratory papillomatosis include:
Vocal fold (cord) paralysis or vocal fold (cord) paresis. Vocal fold paralysis occurs due to a nerve problem, a muscle problem or a fixation of the cricoarytenoid joint, which results in the paralysis of the vocal fold (cord) muscles. Paralysis is the total interruption of nerve impulse, resulting in no movement; paresis is the partial interruption of nerve impulse, resulting in weak or abnormal movement of laryngeal muscles. The symptoms of vocal fold paralysis may include:
Vocal fold (cord) webs. Vocal fold webs occur when thin connections form across the front portion of the vocal folds. These webs can either be congenital (present at birth) or caused by trauma, such as previous vocal surgeries or intubation. Small vocal fold webs may not bother a child at all. Larger webs may block airflow and affect the child’s ability to speak normally or breathe adequately. The primary symptoms of vocal fold webs include difficulty breathing or speaking normally.
Doctors at Riley at IU Health make a diagnosis by first narrowing down the likely cause of your child's symptoms. The exams and tests used will depend on which condition the doctor suspects:
Voice disorder. If the doctor suspects your child has a voice disorder, the doctor will begin by thoroughly examining your child’s throat and voice box. The doctor will likely ask you and your child questions about when his or her voice becomes hoarse or raspy.
Childhood apraxia of speech. If your child’s doctor suspects he or she has childhood apraxia of speech (CAS), the doctor will likely recommend assessment by a speech-language pathologist (SLP). The SLP will perform one or more of the following tests to diagnose CAS:
Dysarthria. If your child’s doctor suspects he or she has dysarthria, the doctor will likely recommend assessment by a speech-language pathologist (SLP). The SLP will examine your child’s lip, tongue and facial movements as well as analyze the breath support for speech and voice quality.
Stuttering. If your child’s doctor suspects he or she has a stuttering condition, the doctor will likely recommend assessment by a speech-language pathologist (SLP). The SLP will analyze the frequency and severity of your child’s speech disfluencies as well as how he or she responds to and copes with these occurrences.
Juvenile-onset RRP. Juvenile-onset RRP is diagnosed using a detailed patient history, a thorough exam of the papillomas and specialized tests such as an indirect or direct laryngoscopy, which allows the doctor to closely examine the back of the throat.
Vocal fold (cord) paralysis. If your child’s doctor suspects he or she has vocal fold paralysis or vocal fold paresis, the doctor may run one or more of the following tests to diagnose the condition:
Vocal fold (cord) webs. If your child’s doctor suspects he or she has vocal fold webs, the doctor may recommend a laryngoscopy to determine the size and extent of the web structure.
Voice and speech disorders can usually be treated successfully. Your child’s doctor may recommend voice therapy, which involves meeting with a therapist to learn how to more appropriately use the voice to avoid future strain. If your child has an underlying condition that is causing the voice disorder—such as allergies, acid reflux or a respiratory condition—his or her doctor may prescribe medicines to treat that condition.
If your child has a speech disorder, recommended treatment will likely be frequent (three to five times a week) intensive therapy. You should also practice speech techniques learned in therapy with your child at home. As your child’s speech disorder improves, he or she will need therapy less and less frequently.
There is no cure for juvenile-onset RRP; treatment for this condition aims to remove papillomas, reduce the spread of the disease and create a safe, open airway. Your child’s doctor may recommend surgery to remove the papillomas. Unfortunately, the papillomas do usually return over time, and subsequent surgeries are usually required to keep the airway clear. Sometimes, the doctor may prescribe medicines designed to slow the regrowth of papillomas and to increase the time between subsequent surgeries.
Treatment for vocal fold paralysis or paresis may include voice therapy, bulk injections or other operations or a combination of those treatments. Voice therapy works to strengthen your child’s vocal folds, improve breath control during speech and prevent abnormal tension in other muscles around the paralyzed vocal fold or folds. If your child’s vocal fold paralysis does not go away on its own, the doctor may recommend bulk injections or other operations, which aim to strengthen the vocal folds in various ways.
If your child has small vocal fold webs that are not affecting his or her ability to speak or breathe, no treatment will be necessary. If your child has larger webs that are interfering with his or her ability to speak or breathe properly, the doctor may recommend an endoscopic, minimally invasive operation to reconstruct the front portion of the vocal folds. In extreme cases, open surgery may be necessary.
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