Merck Manual

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Communication Disorders in Children


Udayan K. Shah

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Sep 2020| Content last modified Sep 2020
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Communication in children can be disordered because of a problem with voice, hearing, speech, language, or a combination. Diagnosis involves evaluation of each of these components.

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 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. 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.

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 or other structural abnormality that prevents normal closure of the soft palate with the pharyngeal wall (velopharyngeal insufficiency).

  • 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 causes of stuttering are less common.

  • 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 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 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, intellectual disability, hearing loss, neglect or abuse, autism, attention-deficit/hyperactivity disorder).

Children may benefit from language therapy. Some children with specific language impairment recover spontaneously.


Parents can be taught 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.

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