My child’s voice sounds rough or croaky (hoarse voice)

The information here is not a substitute for medical consultation or examination, nor is this material intended to provide advice on the medical treatment appropriate for individual children.

If your child has a persistent hoarse, rough or croaky voice, we advise that you take your child to see your GP who may then make a referral to Ear Nose and Throat (ENT) to find out about any underlying cause.

The information on this page has been adapted from the Great Ormond Street Hospital website by the Cardiff and Vale Children’s Speech and Language Therapy team.

How the voice works

Human respiratory system showing open and closed vocal cords in the neck's larynx

Our voice box (larynx) is vulnerable to wear and tear. Children’s vocal cords are particularly delicate and very small (approximately 3 to 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. 

Mucus (like saliva in our mouths) does cover the vocal cords and give some protection against soreness and swelling. 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 the advice below is designed to help your child produce healthy mucus.

Reducing the strain and damage to your child’s voice box

Provide a good role model for healthy voice use and make the recommended changes together as a family. This will make it easier for your child as they will feel supported.

Share this advice with your child’s teachers, as they can be very helpful in encouraging healthy voice use at school.

Key tips for a healthy voice

Whatever the reason for the hoarse, rough or croaky voice, there are certain healthy voice habits that you and your child can focus on as well as certain behaviours to try to avoid.

  • Reduce the amount of background noise at home. For example, turn the television 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 they may need some further advice.
  • Encourage the use of a smooth, easy voice. Try a gentle voice with quiet conversational volume. Pause regularly between phrases to allow the lungs to refill as effortlessly as possible.

It is important for your child to have time in the day when their voice is able to rest and recover. Think of quieter activities such as puzzles, art activities and looking at books. If you are playing with your child it 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. Quiet periods will allow the vocal cords to rest and recover.

This can tire the voice and dry out the protective mucus that coats the vocal cords.

This may be a habit but people sometimes do it because their vocal cords are dry and sticky. If your child coughs and clears their throat a lot then try to encourage them to have a sip of water or to swallow the irritation away. This will ‘water’ the vocal cords rather than dry them further. 

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.

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 1 to 1.5 litres per day depending on their 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 doctor.

Avoid long conversations or other prolonged voice use. This includes conversations on the telephone, gaming, or in the home or school.

Avoid cola, tea, coffee and some energy drinks. 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.

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 to explain that this can damage his or her voice box.

Reinforce good voice use with a sticker chart and/or lots of praise. You may find a character that your child likes (or make one up) who has a healthier voice and you can encourage them to imitate this character instead.

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 family doctor (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.

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 breathe. 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. Ventilate rooms where there are paint fumes, cleaning fluid smells, smoke and similar potential irritants.

Our voices work most efficiently when we are energised and happy. If your child is tired or upset, they may find it more difficult to monitor their voice or to use a smooth, easy voice. They may strain their voice when emotional. When your child is tired, it is best for them to play quietly to minimise voice strain. Instead of telling a child that they should do this, have some one-to-one quiet calm time where you model short comments and do not ask questions but instead follow the child’s lead and add long pauses to give plenty of thinking time.

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