More than 10% of children have a communication disorder. A disorder in one component may affect another component. For example, hearing impairment impairs voice modulation and can lead to disordered voice. Hearing loss due to otitis media Otitis Media (Acute) Acute otitis media is a bacterial or viral infection of the middle ear, usually accompanying an upper respiratory infection. Symptoms include otalgia, often with systemic symptoms (eg, fever... read more 
can interfere with language development. All communication disorders, including voice disorders, may interfere with academic performance and social relationships.
Voice disorders
More than 6% of school-age children have a voice problem, most often hoarseness. The cause is often chronic overuse of the voice and/or speaking too loudly. The most common corresponding anatomic abnormality is vocal cord nodules Vocal Cord Polyps, Nodules, and Granulomas Acute trauma or chronic irritation causes changes in the vocal cords that can lead to polyps, nodules, or granulomas. All cause hoarseness and a breathy voice. Persistence of these symptoms... read more 
. Other laryngeal lesions or endocrine abnormalities may also contribute. Hearing loss can contribute by impairing the ability to sense voice volume and thus modulate voice force. Nodules usually resolve with voice therapy and only rarely require surgery.
Hearing disorders
For a discussion of hearing disorders, see Hearing Impairment in Children Hearing Impairment in Children Common causes of hearing loss are genetic defects in neonates and ear infections and cerumen in children. Many cases are detected by screening, but hearing loss should be suspected if children... read more 
.
Speech disorders
About 5% of children entering first grade have a speech disorder. In speech disorders, speech production is impaired. Speech disorders include the following:
Hypernasal voice quality: Hypernasality is typically caused by a cleft palate Cleft Lip and Cleft Palate An oral-facial cleft is a birth defect in which the lip, the roof of the mouth, or both do not close in the midline and remain open, creating a cleft lip and/or cleft palate. These defects are... read more
or other structural abnormality that prevents normal closure of the soft palate with the pharyngeal wall (velopharyngeal insufficiency Velopharyngeal Insufficiency Velopharyngeal insufficiency is incomplete closure of a sphincter between the oropharynx and nasopharynx, often resulting from anatomic abnormalities of the palate and causing hypernasal speech... read more ). Stuttering: Developmental stuttering, the usual form of stuttering, typically begins between age 2 years and 5 years and is more common among boys. The etiology of stuttering is unknown, but family clustering is common. Neurologic disorders (eg, stroke, traumatic brain injury) may also cause stuttering.
Articulation disorders: Most children with disordered articulation have no detectable physical cause. Secondary dysarthria can result from neurologic disorders that impair innervation or coordination of speech muscles. Because swallowing muscles are also usually affected, dysphagia Dysphagia Dysphagia is difficulty swallowing. The condition results from impeded transport of liquids, solids, or both from the pharynx to the stomach. Dysphagia should not be confused with globus sensation... read more may be noticed before dysarthria is detected. Hearing disorders and structural abnormalities (eg, of the tongue, lip, or palate) can also impair articulation.
Speech therapy Speech Therapy Speech therapists can identify the most effective methods of communication for patients who have aphasia, dysarthria, or verbal apraxia or who have had a laryngectomy: Expressive aphasia: A... read more is helpful in many primary speech disorders. Children who have lesions that cause velopharyngeal insufficiency generally require surgery as well as speech therapy.
Language disorders
About 5% of otherwise healthy children have difficulty with language comprehension or expression (called specific language impairment). Boys are more often affected, and genetic factors probably contribute. Alternatively, language problems can develop secondary to another disorder (eg, traumatic brain injury Traumatic Brain Injury (TBI) Traumatic brain injury (TBI) is physical injury to brain tissue that temporarily or permanently impairs brain function. Diagnosis is suspected clinically and confirmed by imaging (primarily... read more 
, intellectual disability Intellectual Disability Intellectual disability is characterized by significantly subaverage intellectual functioning (often expressed as an intelligence quotient < 70 to 75) combined with limitations of adaptive... read more , hearing loss Hearing Impairment in Children Common causes of hearing loss are genetic defects in neonates and ear infections and cerumen in children. Many cases are detected by screening, but hearing loss should be suspected if children... read more , neglect or abuse Overview of Child Maltreatment Child maltreatment includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (eg, clergy, coach, teacher) that results... read more 
, autism Autism Spectrum Disorders Autism spectrum disorders are neurodevelopmental disorders characterized by impaired social interaction and communication, repetitive and stereotyped patterns of behavior, and uneven intellectual... read more , attention-deficit/hyperactivity disorder Attention-Deficit/Hyperactivity Disorder (ADD, ADHD) Attention-deficit/hyperactivity disorder (ADHD) is a syndrome of inattention, hyperactivity, and impulsivity. The 3 types of ADHD are predominantly inattentive, predominantly hyperactive/impulsive... read more ).
Children may benefit from language therapy. Some children with specific language impairment recover spontaneously.
Diagnosis
Parents should be advised to seek medical attention if a child has impaired communication (eg, inability to say at least 2 words by the first birthday). Assessment should include neurologic and ear, nose, and throat examinations. Hearing and language are assessed.
Laryngoscopy should be considered if a voice disorder (eg, hoarseness, breathy voice) is suspected.
Key Points
Problems with voice, hearing, speech, and/or language (communication disorders) are common and have academic and social consequences.
Evaluate children whose communication appears delayed (eg, who are unable to say at least 2 words by the first birthday).
Assess hearing and language development and consider laryngoscopy in children with communication disorders.
