This page explains about encouraging your child to produce a healthy voice and what to expect when your child comes to Great Ormond Street Hospital (GOSH).
There are many reasons why children’s voices may sound different in quality, loudness or pitch, to those of their friends, brothers and sisters.
Your child’s speech and language therapist and/or ENT doctor will explain the specific reason why your own child is having voice difficulties. Whatever the reason, we know that there are certain things that your child can do to make the most of his or her voice. There may also be things that he or she is doing that make the problem worse.
Why is voice care important?
Our voice box (larynx) is vulnerable to wear and tear. Children’s vocal cords are particularly delicate and very small (approximately 3-8mm in length). They vibrate together every time a child talks, shouts, laughs, coughs and makes other noises. When young children talk, their vocal cords vibrate together about 300 times a second. This vibration occurs using air from the lungs and small muscle adjustments in the voice box. If the vibration is forced or strained then the vocal cords can become sore and red.
If the voice is not rested, or it has been strained or used for a long time, it becomes difficult for the redness and swelling to settle down. The sound of the voice may also change because of this.
Some of this advice will help your child to reduce the strain or damage to his or her vocal cords. Our vocal cords do have some protection against soreness and swelling. This is provided by mucus (similar to saliva in your mouth) which covers the vocal cords and acts as a protective coating. This mucus should be thin and clear. If it becomes dry, thick or sticky then the protection to the cords is lost and vibration of the vocal cords is more difficult.
Some of this advice is designed to help your child produce healthy mucus.
Reducing the strain and damage to your child’s voice box
The most helpful thing you can do as a parent is to provide a good role model for healthy voice use. All the advice given in this leaflet is of value to all of us, children and adults alike. Think about your own voice use and those of other children and adults who have regular contact with your child.
Wherever possible, try to make the recommended changes together as a family. This will make it easier for your child to understand what is expected of him or her and to see the advice as supportive rather than punishing.
You may also find it helpful to discuss this advice sheet with your child’s teachers, as they can be very helpful in encouraging healthy voice use at school.
Avoid shouting and loud voice
Reduce the amount of background noise at home. For example, turn the television, radio or music system down to a level where you and your children can speak softly and still be heard.
Avoid calling out to each other from room to room or up the stairs. Aim to be face to face when you are speaking to each other.
Loud singing and drama can also strain the voice. If your child takes part in these activities, you should ask his or her speech and language therapist for advice.
Encourage your child not to use strange throat noises and not to imitate characters with unhealthy voices
Many characters in films and on children’s television use unhealthy, strained voices. If you try to imitate these voices yourself you will feel how much it strains your own voice. If your child is imitating a favourite character, or making robot or dinosaur noises or something similar then try and explain that this can damage his or her voice box.
Reinforce good voice use with a sticker chart (see last page for an example of the type of chart you could use) and/or lots of praise. You may find a character that your child likes who has a healthier voice and you can encourage them to imitate this character instead.
Avoid coughing and throat-clearing
This may be a habit but people sometimes do it because their vocal cords are dry and sticky. If your child coughs and clears his or her throat a lot then try to encourage him or her to have a sip of water or to swallow the irritation away. It can be difficult for children to remember to do this to start with and they may need reminding. A reward chart may also help.
Avoid long conversations or other prolonged voice use
This includes conversations on the telephone or in the home or school.
Encourage quiet play activities
It is important for your child to have time in the day when his or her voice is able to rest and recover. Activities such as building games, puzzles, sticking, art activities and looking at books can all be done quietly. You may need to be with young children during these games. This is a good time for you to use a soft, smooth voice as an example for your child to follow.
It is useful to encourage quiet play after more vocally demanding activities, for example, playing football or swimming in a noisy pool. Quiet periods will allow the vocal cords to rest and recover.
Encourage the use of smooth, easy voice
Your child’s speech and language therapist will demonstrate this type of voice to you. It involves easy breathing, gentle voice and a quiet conversational volume.
This can tire the voice and dry out the protective mucus that coats the vocal cords.
Our voices respond to how we feel
Our voices work most efficiently when we are energised and happy. As adults, we often know when someone is tired and unhappy by the way his or her voice sounds. If your child is tired or upset, he or she may find it more difficult to monitor their voice or to use a smooth, easy voice. When your child is tired, it is best for him or her to play quietly and to avoid straining their voice.
Some children find it difficult to say how they are feeling. They may strain their voices to communicate their emotions. It would be helpful for you to discuss this with your child’s speech and language therapist if you feel this is a difficult area for your child.
Keeping the voice box protected with healthy mucus
Once again, it is helpful for the whole family to follow the advice below. Your child’s school will also need to be involved.
Drink lots of water
Water helps the body to produce clear, thin mucus. If your mouth feels dry, then your throat and vocal cords will also be dry. Young children should typically drink between one and one and a half litres per day depending on his or her size. Children over 14 years should drink approximately 2 litres a day.
Two to three drinks of juice a day can be incorporated into this quota but too much juice may cause an upset tummy. Your child will need to drink regularly at school as well as at home. We recommend you discuss how much your child should drink with your speech and language therapist or doctor.
Avoid coke, tea and coffee
These contain caffeine, which acts as a diuretic, that is, it encourages the body to get rid of water. Limit your child’s intake to no more than one small drink of this type a day.
Be aware that certain medicines can encourage drying and dehydration
Inhalers for asthma, antihistamines for allergies and some other drugs can make the mucus on our vocal cords dry and sticky. It is important to try to thin the mucus as much as possible by drinking regularly. Inhalers may be used with a spacer device that your GP can prescribe. Using this can reduce the drying effect of the asthma drug. Rinsing the mouth with water after using an inhaler can also help.
Older children may find steam inhalation helpful using a bowl of hot water and a towel. You should always supervise your child when he or she is doing this to avoid accidents. We do not recommend that you alter the medication that your child is on unless it is in consultation with his or her doctor.
Keep the air in your home healthy
Central heating and closed windows encourage dehydration. You can combat this by placing small bowls of water or damp towels on radiators so that the moisture is carried into the air you breath. You can buy small humidifiers to put in rooms where your child spends a lot of time.
Smoke, dust and chemical fumes are strong irritants to the vocal cords. Discourage people from smoking around your child and avoid places where there is a lot of smoke. Make sure you remove dust from your child’s bedroom on a regular basis, vacuuming his or her mattress, pillows and other bedding. Ventilate rooms where there are paint fumes, cleaning fluid smells, smoke and similar potential irritants.
Keeping track of your child’s voice care
It can take a while for your child and your family to make changes to how they use their voice. Start with a few changes and reward your child’s progress. Sticker charts can be a useful way of you checking how your child is progressing and can be a positive way of encouraging them to make further changes week by week. On the back of this leaflet is an example of a sticker chart that you could use with your child.
Please note this is a generic GOSH information sheet. If you have specific questions about how this relates to your child, please ask your doctor. Please note this information may not necessarily reflect treatment at other hospitals.