Pediatric Voice Disorders – What you need to know

Often if children present with a hoarse/raspy vocal quality since early childhood, parents think this is “normal” since they have been speaking like that their entire life. However, this could be an indicator that something is structurally wrong in their vocal anatomy, and/or a sign of other difficulties (e.g. reflux, allergies, or respiratory issues). According to “A voice disorder may be characterized by hoarseness, vocal fatigue, raspiness, periodic loss of voice, or inappropriate pitch or loudness.”  Reflux can be a cause of a hoarse vocal quality – so if your child experienced reflux during infancy and/or exhibited signs of discomfort during feeding, then that may be the cause.

Another common cause may be vocal nodules or polyps. In fact, about 40-80% of hoarseness in children are caused my nodules. According to “Vocal cord nodules are also known as “calluses of the vocal fold.” They appear on both sides of the vocal cords, typically at the midpoint, and directly face each other. Like other calluses, these lesions often diminish or disappear when overuse of the area is stopped.” Whereas ” A vocal cord polyp typically occurs only on one side of the vocal cord and can occur in a variety of shapes and sizes. Depending upon the nature of the polyp, it can cause a wide range of voice disturbances.”

To alleviate symptoms associated – you should try and reduce vocally abusive behaviors. Or, management in diet or medication may suffice if reflux is the cause. This should be done in conjunction with voice therapy by a Speech Language Pathologist. Examples of vocally abusive behaviors are as follows (According to ASHA)

  • allergies
  • smoking
  • tense muscles
  • singing
  • coaching
  • cheerleading
  • talking loudly
  • yelling
  • drinking caffeine and alcohol (dries out the throat and vocal cords)

Therefore, voice disorders in children (and adults) are treatable. 🙂 make sure to contact your pediatrician and/or SLP to explore this further if you suspect you or your child has a voice disorder.

Pediatric Voice Disorders



How diet can affect mental health and overall behavior

There has always been information in the media as to how eating different foods/changing your diet can affect your general mood, attention span, behavior, and overall well-being. However, what about for different disorders. Though this is a recent discovery, it seems favorable that changing your child’s diet may help to manage symptoms associated with ADHD/ADD, Autism, and overall behavior. According to the attached articles written by and, diet is a major factor in managing symptoms associated with the above mentioned disorders.

According to “Dietary intervention is a cornerstone of a evidence-based medical approach, and there is convincing empirical evidence that special diets help many with autism. A group of parent leaders who successfully implemented diets for their children compiled the following information and suggestions. These include references, resources, and links to aid parents as they begin exploring effective, evidence-based treatments.”

According to, ‘What some foods do seem to do, however, is worsen ADHD symptoms or affect behavior that mimics the signs of ADHD in children. “Excessive caffeine and excessive use of fast foods and other foods of poor nutritional value can cause kids to display behavior that might be confused with ADHD,” said Frank Barnhill, MD, an expert on ADHD and the author of “Mistaken for ADHD.”

Terrible foods for children who suffer with ADD/ADHD (and other behavior issues/inattention) include the following:

  1. Candy
  2. Soda
  3. Frozen fruits and veggies that contain organophosphates
  4. Cake mixes and frostings
  5. Energy drinks
  6. Fish and other seafood (with mercury)
  7. Other food sensitivities (e.g. allergies or intolerances)

Therefore, with that said, it is clear that changing your child’s (or your) diet will not solve/cure these disabilities… however, they can help manage associated symptoms, but talk to your pediatrician first 🙂

Childhood Apraxia of Speech – What you need to know…

More and more people are becoming increasingly aware of Childhood Apraxia of Speech (CAS). However, it is important for parents to know about the disorder, so that they can look for any red flags.  Children who experience CAS gave a difficult time saying sounds, syllables, and words. This is NOT because of a muscle weakness, but rather because their brain has difficulties planning for the production of their speech. Think about how many muscles and nerves are involved in speech; what the lips, jaw, and  tongue do to produce even a single sound. In summation, the child knows what he/she wants to say, however his/her brain has a hard time coordinating and planning the muscle movements needed to execute the words.

In order to diagnose CAS the child must first go to an audiologist to rule out any hearing loss. Then, a Speech-Language Pathologist who has knowledge and experience with oral-motor abilities, prosody/melody of speech, and sound acquisition can diagnose CAS. Or, a neurologist can as well.


with knowledge and experience with CAS conducts an evaluation. This will assess the child’s oral-motor abilities, melody of speech, and speech sound development. The SLP can diagnose CAS and rule out other speech disorders, unless only a limited speech sample can be obtained making a firm diagnosis challenging.

Below is a list created by the American Speech and Hearing Association (ASHA) on some signs and symptoms of CAS. 

“Not all children with CAS are the same. All of the signs and symptoms listed below may not be present in every child. It is important to have your child evaluated by a speech-language pathologist (SLP) who has knowledge of CAS to rule out other causes of speech problems. General things to look for include the following:

A Very Young Child

  • Does not coo or babble as an infant
  • First words are late, and they may be missing sounds
  • Only a few different consonant and vowel sounds
  • Problems combining sounds; may show long pauses between sounds
  • Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)
  • May have problems eating

An Older Child

  • Makes inconsistent sound errors that are not the result of immaturity
  • Can understand language much better than he or she can talk
  • Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
  • May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
  • Has more difficulty saying longer words or phrases clearly than shorter ones
  • Appears to have more difficulty when he or she is anxious
  • Is hard to understand, especially for an unfamiliar listener
  • Sounds choppy, monotonous, or stresses the wrong syllable or word

Potential Other Problems

  • Delayed language development
  • Other expressive language problems like word order confusions and word recall
  • Difficulties with fine motor movement/coordination
  • Over sensitive (hypersensitive) or under sensitive (hyposensitive) in their mouths (e.g., may not like toothbrushing or crunchy foods, may not be able to identify an object in their mouth through touch)
  • Children with CAS or other speech problems may have problems when learning to read, spell, and write”