Hoarseness (abnormal voice changes)

Hoarseness is a condition in which the pitch or quality of the voice changes. The voice may sound weak, breathy, raspy, scratchy or husky. Many health conditions can cause hoarseness.

Children affected by hoarseness range from 3.9% to 23.4% of the population.

Patients can be seen by Texas Children's experts in Ear Nose and Throat (Otolaryngology).

Causes & Risk Factors

The most common cause of hoarseness in children is related to colds or flu that inflame the vocal cords, which causes them to swell.

Causes include:

  • Allergies
  • Infections that involve a runny or stuffy nose that result in secretions draining into the throat
  • Overuse of the voice (such as from yelling, crying or singing)
  • Nodules on the vocal folds
  • Warty growths (papillomas) on the voice box (larynx)
  • Paralysis of the vocal folds
  • Gastroesophageal reflux (also called GERD or acid reflux)
  • Thyroid conditions

Risk factors include:

  • Prolonged loud yelling or crying
  • Gastroesophageal Reflux (GERD), also called acid reflux
  • Frequent respiratory infections
  • Thyroid condition
  • Chronic coughing
  • Prolonged exposure to smoking
  • Previous neck or chest surgery
  • Previous prolonged intubation

Symptoms & Types

Symptoms include:

  • Breathy, raspy, or strained voice
  • Changes in volume or pitch of the voice 

If your child has a hoarse voice for longer than a week, see your child's doctor. If the hoarseness persists, the doctor will most likely refer you to an otolaryngologist, a doctor who specializes in treating the ear, nose and throat.

Diagnosis & Tests

Your child's doctor will do a medical history, family history and a physical examination. The doctor will decide what tests are needed based on the examination results.

Tests might include:

  • Looking at the throat, nasal passages, larynx (voice box), upper airway and vocal cords with a flexible scope that has a tiny camera that is passed through the mouth or nose (flexible laryngoscopy). This procedure is usually done in the office without the need for sedation.
  • Hearing test
  • Blood work (to determine whether a thyroid condition is the cause)

Treatment & Care

Treatment may include:

Living & Managing

If hoarseness is caused by yelling or crying:

  • Encourage your child not to yell and, if old enough, to tone down the pitch of crying 

If  hoarseness is caused by an allergy:

  • Your child may need medication on an ongoing basis.

If  hoarseness is caused by a respiratory infection:

  • Time is needed for the infection to resolve. If your child is old enough, sucking on hard candy or drinking warm liquids can help to alleviate soreness. 

If  hoarseness is because of a growth on the vocal folds or paralysis of the vocal folds:

  • Your child may need surgery. 

If hoarseness is because of GERD (acid reflux):

  • Your child may be prescribed medicine.
  • You will need to identify foods in your child's diet that trigger the reflux and then eliminate these foods. 

If hoarseness is because of a thyroid condition:

Your child may need to take thyroid hormone. A specialist called an endocrinologist will decide what treatment your child needs.