Screaming may damage a child's voice


October 01, 1991|By Dr. Modena Wilson and Dr. Alain Joffe

Q: Tell me about vocal-cord nodules. My son is 4 years old and he screams constantly. An ear, nose and throat specialist says to try to change his behavior to prevent vocal-cord nodule. Are these dangerous?

A: The vocal cords are two-quarter moons of soft tissue that stretch across the air passages in the larynx. During speech, the cords vibrate and as they do, their edges bang against each other. Shouting, screaming or singing loudly for long periods can cause these banging edges to become swollen. If the vocal cords continue to collide too harshly, scar tissue in the shape of small hillocks (vocal nodules) may develop. Then the vocal cords no longer fit together nicely during speech, making the voice husky. If overuse of the voice is halted, the nodules may go away, but sometimes they persist and must be removed surgically.

You did not say whether your son already has vocal nodules or whether you are just trying to prevent them. If your son truly screams all the time, we would guess you have already tried a number of different techniques to get him to stop. We wonder why he still does it. He may have found it gets him a lot of attention. Does he scream only when you are around? Does it escalate when you are busy with something or someone else? If so, asking him to stop may only encourage the screaming, because he knows it will make you concentrate on him. Try saying to your son softly, "I can't understand you, because you are talking too loudly." Then ignore him, until he reduces his volume. Respond to him immediately whenever he does speak in a normal voice. He will learn that only a soft voice will get him what he wants. But you will need to be consistent with ignoring his screams. Incidently, the screaming may get worse briefly before it gets better as he tests how serious you are about ignoring voices that are too loud.

If your son screams no matter where he is or to whom he is talking, you may need some more help in changing this pattern. A speech therapist, a pediatrician or a psychologist who treats children with behavioral problems may be able to help.

Dr. Wilson is director of general pediatrics at the Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.

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