5 Tips on Treating Vocal Nodules in Kids & Teens

It’s always a challenge to find fun and creative materials to help children and young adults want to take care of their voices. With recent research backing a behavioral approach to treating vocal nodules, versus surgical excision, it’s even more important we keep these clients engaged. Current research by Susan Baker Brehm, Barbara Heinrich and Lisa Kelchner suggests that the most common vocal fold pathology in kids is vocal nodules, and that voice problems can possibly cause negative educational, social and occupational outcomes for children.

It is important to understand that personality characteristics and support system of the child, relationship between them and the therapist, and hope/expectancy make up the largest chunk of what affects treatment outcomes. Therapy techniques account for only 15% effect (Baker-Brehm et al 2018), so it’s important to make these techniques engaging to help buy in so support can be given for home practice and family support.

1. Start Simple: You don’t want to overwhelm your young client with too much information at first, because there’s a possibility of being “tuned out.” Try bubbles in a cup at first to get them interested. This is a very inexpensive way to make voice rehabilitation very fun. First take a cup filled with 1-2 inches of water and put a narrow-diameter straw in it. Make sure no air comes out the nose, and blow bubbles in the water. Slowly add voice until you have the client vocalizing and making bubbles at the same time. This creates inertive reactance (back pressure at the level of the vocal folds) and helps re-educate the muscles during voice production. Need ideas? Try these easy to print interactive products:

Bubbles in Hot Chocolate!Bubbles in Hot Chocolate!

Bubbles in Hot Chocolate!

Straw Phonation characters for decreasing phonotraumaStraw Phonation characters for decreasing phonotrauma

Straw Phonation characters for decreasing phonotrauma

Bubbles in a Cup for introducing Semi-occluded vocal tract exercises.Bubbles in a Cup for introducing Semi-occluded vocal tract exercises.

Bubbles in a Cup for introducing Semi-occluded vocal tract exercises.

2. Remember Breathing and Hygiene: It is important once your client is engaged, that you stress the importance of no stress! Two ways you can do this are by teaching diaphragmatic/abdominal breathing and good vocal hygiene. Breaths supported from the abdomen are much more likely to decrease upper body tension than breaths from the chest and shoulders. You’re fighting gravity when you breathe from your upper body. Staying hydrated by drinking enough water and avoiding caffeine, ceasing yelling at sporting events or on the playground, and resting your voice are all easy ways to keep good vocal health. Get started with these fun additions to your toolkit: 

Elephants Don't Forget Good Vocal HygieneElephants Don't Forget Good Vocal Hygiene

Elephants Don’t Forget Good Vocal Hygiene

Voice-O-Poly: Challenge your Vocal Health KnoweldgeVoice-O-Poly: Challenge your Vocal Health Knoweldge

Voice-O-Poly: Challenge your Vocal Health Knoweldge

3. Vocal Resonance: Humming at the front of your face is a type of semi-occluded vocal tract exercise, better researched for implementation in voice therapy by Joe Stemple and Kittie Verdolini Abbott, but it can get stale in a pediatric speech therapy session quickly. To keep kids engaged find materials that are applicable to lesson plans that they are already doing in the regular classroom. You might also find that sending home fun “hum” activities to try during meal times can help the child remember to practice. Yummy! The following materials can dovetail humming into fun games during your sessions:

Resonant Voice Monkey ManiaResonant Voice Monkey Mania

Resonant Voice Monkey Mania

My Mom Makes Lemon Muffins: Vocal ResonanceMy Mom Makes Lemon Muffins: Vocal Resonance

My Mom Makes Lemon Muffins: Vocal Resonance

For the boys! Resonance FootballFor the boys! Resonance Football

For the boys! Resonance Football

4. Use Stretch and Flow Voice when the laryngeal squeezing is intense. Some clients have struggles with producing sound with “humming” in a healthy way after developing a voice disorder. Flow voice, with roots with Casper, Stone and Casteel, can help break the habit of vocal overcompensation. Kleenex tissue can also be used as great visual feedback to let the client know if the airflow is coming out at the same time as the voice. Find out more and use the following products to teach this type of voicing. 


Stretch your vowels and flow with Frogs and leaping!Stretch your vowels and flow with Frogs and leaping!

Stretch your vowels and flow with Frogs and leaping!

Flow phonation with tissues!Flow phonation with tissues!

Flow phonation with tissues!


5. Straw Phonation is fun and effective for voice therapy. Cheap, easy, fun and full of benefit. Ingo Titze has done an amazing job with researching benefits that come from phonating or making noise through a narrow straw. This is so perfect for children because they can take their straws anywhere and improve their voicing while letting their friends join in. This is even great for your whole classroom, and for teachers to share on the vocal benefits. I take straw phonation breaks all the time. (Plus the OOVOSTRAW company is making necklaces to help save the environment from plastic straws! Keep kids interested with these: 

Climb mountains with straw phonationClimb mountains with straw phonation

Climb mountains with straw phonation

Fly your airplanes with straw phonationFly your airplanes with straw phonation

Fly your airplanes with straw phonation



Baker Brehm S, Weinrich B, Kelchner L. (2018) A practical discussion of current approaches to providing voice therapy to children with dysphonia. ASHA SIG 3 Voice and Voice Disorders, Volume 3, Issue 3, pages 40-46. https://doi.org/10.1044/persp3.SIG3.40

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on vocal health to area choirs and students. She also owns and runs a mobile videostroboscopy and FEES company, Voice Diagnostix. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders, and a member of the National Association of Teachers of Singing and the Pan-American Vocology Association. Knickerbocker blogs on her website at  www.atempovoicecenter.com. She has developed a line of kid and adult-friendly therapy materials specifically for voice on TPT or her website. Follow her on Pinterest, on Twitter and Instagram or like her on Facebook.


Latest Posts

Follow Us On