Hoarseness in children


Our voice comes from the larynx, which is the top end of our windpipe in the throat. There, the two vocal folds and their free edges, the vocal cords, form the so-called glottis.
The voice is formed by moving the vocal folds. These consist roughly of muscles, joints and cartilage that move towards each other when speaking and almost completely close the glottis apart from a small gap. When you exhale, air flows through this crack, causing our vocal cords to vibrate. This process creates our tones and sounds. He enables us to speak.
If this process is disturbed in any way, so-called hoarseness occurs. The hoarseness is a voice disorder that is associated with changes in the sound of the voice and a loss of volume. Typical is the rough, smoky voice up to and including loss of voice. Those affected are often only able to whisper.
The hoarseness is not an independent disease, but a symptom that indicates a disorder in the area of ​​the vocal cords of the larynx. Usually the hoarseness in children and adults is harmless. So it sounds worse than it is. Nevertheless, you should see a doctor with your child if the hoarseness persists for more than one to two weeks and does not change.


General causes

The reasons for hoarseness are many and range from harmless to serious causes.

The hoarseness in children is often caused by a cold. These are mostly upper respiratory infections caused by viruses.
The pathogens cause the mucous membrane of the vocal cords to swell, which disrupts its proper function. A respiratory infection caused by viruses that typically affects children between the ages of one and five is so-called pseudo croup. This disease is often mistakenly called croup in society.
True croup, however, is a bacterial infectious disease that has increasingly disappeared thanks to vaccinations.
The viruses cause inflammation of the larynx, swelling of the lining of the vocal cords and narrowing of the upper airways.

The children show the typical dry barking cough, accompanied by hoarseness. The hoarseness usually precedes the cough for some time. The pseudo croup is usually harmless. However, there is always the risk of the larynx swelling and thus dangerous shortness of breath for your child. So be careful and go to the doctor with your child in good time. Another disease in childhood that leads to hoarseness is inflammation of the epiglottis, which is very red. When hoarseness, children also show symptoms such as fever, sore throat and shortness of breath.
Be sure to contact a doctor here; because it can lead to life-threatening attacks of suffocation.

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  • Cold in the baby
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Hoarseness with no accompanying cold

But the cause of a hoarseness does not always have to be a cold. An underactive thyroid can also lead to hoarseness in children. The hypofunction can be congenital or acquired. In the congenital form, the organ in the neck area is poorly designed and its function is impaired. The acquired form can be traced back to so-called autoantibodies, which are wrongly produced by the body against its own tissue and which destroy it. The second, acquired form is also called Hashimoto -Thyreoditis designated. Often the children are overweight, tired and show dry skin due to the disease.

An abnormal enlargement of the thyroid gland can also lead to the symptoms of hoarseness. In our part of the world it is mostly caused by iodine deficiency. The increase in size results in one-sided pinching of the nerves supplying the vocal cords and thus hoarseness.

Hoarseness can also be caused by operations in the neck area (for example an operation on a diseased thyroid gland) or by intubation, the artificial ventilation of the patient through a tube.

Hoarseness from screaming

Overloading the voice, by shouting or singing frequently, can also lead to hoarseness. Usually it is a chronic hoarseness that lasts longer than three months.

The incorrect use of the vocal cords leads to the formation of so-called scream nodules on the vocal cords. They are also known as singers knots. These are benign changes that lead to thickening of the vocal cords. It almost always occurs on both sides. The nodules limit the ability of the ligaments to vibrate and thus lead to hoarseness. Normally, the screaming nodules do not require any therapy, because they disappear by themselves by the onset of puberty. The children should only protect their voices and avoid loud talking or singing. Often the hoarseness is the result of incorrect use of the voice and the following rule applies: the older the child, the more difficult it is to break the habit of incorrect use of the voice.

Read more on the topic: Symptoms of vocal cord inflammation

Pseudo croup

Pseudocroup is an infectious disease caused by viruses and mainly affects children.
A typical symptom of this disease are violent fits of coughing (the so-called croup), which are often accompanied by hoarseness. The infection causes the mucous membrane in the throat, pharynx and vocal cords to swell. The swelling affects the vocal cords and the children's voices fail. Pseudo croup usually heals on its own and does not need further treatment.

Read more on the subject at: Pseudo croup


The diagnosis of hoarseness in children is made by the doctor by examining the throat with a spatula or mirror, based on the typical changes in the mucous membrane of the vocal cords with reddening, swelling and possible deposits.

This examination with the classic sticking out of the tongue and the "Ah-saying" is mostly very unpleasant for children due to the unintentionally evoked gag reflex and should be carried out by the examiner last. In addition, the doctor will be interested in the type and duration of the complaints. If a closer and clearer examination of the vocal cords is necessary, a so-called endoscope, a tube-shaped medical instrument for examining body cavities, can be pushed forward to the larynx for the child in the hospital under anesthesia. Here the vocal folds can be viewed directly under a microscope and, if necessary, tissue samples can be taken.
If there is a suspicion that the hoarseness is caused by a thyroid dysfunction, a blood test with a determination of thyroid hormones is recommended. These indicate the functionality of the thyroid gland.


If the cause of the hoarseness in the child is a cold, it is often accompanied by a runny nose, cough, fever or sore throat.
A child with hoarseness is most noticeable for being silent. Talking with hoarseness is tedious and difficult for children. The sound of the voice changes and is mostly rough, shaky, scratchy and thick. The voice can fail completely. So the children have no “voice”.

More on this: Cough in child

Hoarseness with cough

Persistent dry cough as part of an infectious upper respiratory disease is arguably one of the most common causes of hoarseness in children. The vocal folds are irritated by the strong urge to cough and the voice becomes rough and hoarse.
The inflammation can also spread to the vocal cords, which is then referred to as vocal cord inflammation (laryngitis). As a result of the inflammation, the lining of the throat and the lining of the vocal cords swell, which means that the vocal cords can no longer vibrate freely.

Read more on the subject at: Hoarseness and cough

When should I see a doctor with my child?

Hoarseness in children is in most cases harmless and usually goes away on its own.
However, if your child's hoarseness persists for more than a week without having a cold or cough, you should consult a pediatrician to be on the safe side. The doctor may examine the throat to see what is causing the hoarseness. If, in addition to the hoarseness, severe pain, high fever or shortness of breath occurs, a doctor should be consulted immediately.


Usually, a mundane hoarseness in children goes away on its own after a few days.

If your child suffers from an infection and therefore from hoarseness, offer your child plenty to drink. For example, herbal tea with honey, chamomile or fennel tea to rinse the throat free of the pathogens. Warning: Do not give mint tea to children under three years of age.
The essential oil of peppermint can cause life-threatening larynx cramps in young children! Avoid dry rooms. Cool, moist air is good for your child with hoarseness. If it is an acute (pseudo-) croup attack, you can hold your child in front of an open refrigerator and the symptoms will improve with the supply of moist, cold air.
In such cases, try to remain calm yourself, because your nervousness is projected onto your child. If you are unsure of how serious your child's hoarseness is, don't hesitate to see a doctor.

If the hoarseness is based on overloading the vocal cords, it is advisable to take care of the voice. Loud talking and singing should be avoided. In exceptional cases, surgery of the vocal cords or voice exercise treatment by a speech therapist may be necessary.

Read more on the topic: What to do if my baby is hoarse

When does my child need an antibiotic?

Antibiotics must be taken for bacterial infection that causes hoarseness. Antibiotic drugs are ineffective for diseases that are caused by viruses (this is the case with the majority of diseases). If a bacterial trigger is suspected, the doctor can take a swab of the lining of the throat, examine it for laboratory diagnostics and prescribe an appropriate antibiotic.
Diseases that lead to hoarseness and must be treated with antibiotics are, for example, purulent tonsillitis, larynx infections or pneumonia.

It is important that the parents give the antibiotic for as long as the doctor has prescribed it.
If the intake time is not adhered to, resistance to antibiotics can easily develop, which means that the drug is no longer effective if the same pathogen is infected again. In general, due to the possible side effects and the risk of developing resistance, a doctor will carefully consider whether to prescribe antibiotic treatment for the sick child. In the case of certain diseases, however, antibiotics must be administered in order to ensure effective therapy and uncomplicated healing of the infection. The advantages of antibiotics are that they work quickly and, in most cases, work very efficiently against the pathogen. The children feel better within a few days of taking the first tablet. The drugs are also available in the form of drops or juice for small children.

Homeopathy for a child's hoarseness

Homeopathy is widely used, especially in the field of paediatrics, due to its often low side effects.
Different remedies can be found for hoarseness, which are selected according to certain criteria. Choose a homeopathic remedy that suits your child's overall situation.
In addition to the hoarseness, you should pay attention to additional symptoms and situations associated with improvement or deterioration. The homeopathic remedy is usually prescribed in the form of so-called globules, small sugar-like balls.

If the throat scratches, the voice is rough and thick and it is difficult to swallow, the intake of three times three globules a day for infants and three times five globules for school children and adolescents is advisable. For infants and toddlers, the globules can be dissolved in water or tea and poured in with a plastic spoon. Older children can simply let the globules melt in their mouths.

An often used lay homeopathic remedy for hoarseness is the toe root (Arum triphyllum). It is used for a rough voice and sore throat as well as for colds and a heavily stressed voice.
Calcium sulphurous liver (Hepar sulfuris) helps with dry barking coughs, sharp sore throats with hoarseness and yellowish coatings.
If the hoarseness is due to an underactive thyroid, potassium iodate or potassium bromate are suitable. A suitable homeopathic remedy can be found for almost every individual appearance of your child's hoarseness.

Seek advice from your pediatrician or pharmacist. However, if your child suffers from shortness of breath or if the tonsils are covered with pus, you should definitely consult a doctor!

Home remedies for a child's hoarseness

Above all, your child needs a lot of rest to cure the hoarseness. Physical exertion, such as exercise, should be avoided.

Give your child enough to drink. Either simple herbal teas, such as chamomile or fennel, but also milk with honey is often drunk by the little ones when they are hoarse.
To do this, simply add two teaspoons of honey to around 150 ml of warm milk. Warning: honey is not suitable for infants and babies under one year of age! You can also offer your child lozenges with Emser salt or Icelandic moss, but also sage sweets, which are more popular with children.
You should also make sure that your child spares their voice, but not by whispering! Whispering requires the vocal cords to use much more force to produce the desired sounds, which in turn only makes the hoarseness worse.

Warmth is good for the child's throat. Make sure that your child wears a scarf to keep their neck warm if they are hoarse. So-called potato wraps are available from the medicine cabinet, which have a warming and pain-relieving effect.
To do this, you need six unpeeled soft-boiled hot potatoes, a cotton towel, plus a kitchen towel and kitchen paper. Spread out the cotton cloth and the inner cloth over it. Mash the hot potatoes between two layers of kitchen paper and wrap the inner cloth around them. It is essential to check the temperature before placing the compress on your child's chest or back. The upper body is tied with the cotton cloth and the child is covered. The wrap should be applied for as long as the temperature is perceived as comfortable, but for a maximum of one hour. Then give your child 15 minutes of rest.

In general, irritants such as spices and smoke should be avoided with hoarseness. Never smoke in the presence of your child and always ventilate rooms that have been smoked before your child is there. This could further irritate the throat and make the hoarseness worse. You can also ensure that the room air is moist by hanging up damp cloths in the room or placing a bowl of water on the heater.

If you are unsure about your child's hoarseness, do not hesitate to consult a doctor.

Read more on the topic: Medicines for hoarseness

Duration of hoarseness in children

The duration of hoarseness in children depends on the underlying cause.
If crying for too long is what triggers the loss of voice, the symptoms usually go away after a few days. Even after a flu-like infection or a cold, children can suffer from hoarseness. As soon as the infection has healed, the hoarseness usually disappears quickly. If the hoarseness persists in your child for more than a week, a pediatrician should be consulted. They can determine if there is another cause of the loss of voice, such as voice nodules. These are benign changes in the vocal cords that can lead to hoarseness and problems speaking.

Can my child be hoarse without being sick?

Children can also be hoarse without being or having been sick. Long crying or loud screaming can overstrain the vocal folds. The vocal folds swell and can no longer vibrate freely, as a result the voice fails and the child is hoarse. In such a case, the child should be careful with their voice and not speak if possible, but neither should whispering be used. Whispering puts even more strain on the vocal cords, which can delay the swelling. Therefore, the child should only speak in a voice that is as normal as possible when absolutely necessary. Other causes of hoarseness are certain external influences, such as cigarette smoke, dry air or exhaust fumes, which can impair the voice. Usually the symptoms go away on their own after a few days and the child can speak normally again.

If the hoarseness persists for several weeks for no apparent reason, so-called vocal nodules or screaming nodules can be behind it. Regular overuse of the voice causes small knots to form on the vocal cords, which interfere with speaking and lead to persistent hoarseness. A pediatrician or an ENT specialist can determine if your child has these benign screaming nodules and prescribe appropriate treatment. Most of the time, the nodules disappear on their own by taking care of them. But voice therapy with a speech therapist can also be considered. Only in very rare cases do the screaming nodules need to be surgically removed.

Read more on the subject at: Vocal cord nodules

Features of hoarseness in the baby

Hoarseness can also affect babies. The voice then sounds croaky, even when sleeping, a slight snoring can often be noticed. Babies are often affected by hoarseness, especially in winter. The reason for this is the dry heating air, which leads to the drying out of the mucous membranes and irritates the vocal cords. Other causes can be mechanical overuse from long crying or a respiratory tract infection. Thrush can also be a cause of hoarseness in babies. This is an infection with yeasts, which can also be deposited on the vocal cords, impair their function and thus lead to hoarseness.

The hoarseness usually goes away on its own after a few days. However, if the hoarseness persists over a longer period of time or the baby also has a high fever and shortness of breath, the parents should immediately visit a pediatrician or the nearest hospital. To treat hoarseness, it is important that the baby drink enough fluids. In addition to breast milk, lukewarm herbal tea such as chamomile or fennel tea is particularly suitable for this. In addition, parents should make sure that the air in the room is not too dry. Regular ventilation and heating that is not set too warm can increase the humidity. Humidifiers or wet towels on the heater also help to optimize the humidity.

Read more on this topic at:

  • Hoarseness in the baby
  • Oral thrush in babies