What is the recommended treatment for hoarseness in children during a cold?

Treatment of Hoarseness in Children During a Cold

Voice therapy and supportive care are the recommended first-line treatments for hoarseness in children during a cold, with medications generally avoided due to limited efficacy and potential adverse effects.

Understanding Hoarseness in Children with Colds

Hoarseness during a cold is typically caused by inflammation of the vocal cords (laryngitis) secondary to viral upper respiratory tract infection. This is usually self-limiting but requires appropriate management to prevent complications and improve quality of life.

Recommended Treatment Approach

First-Line Management

1. Voice Rest and Hydration

   • Encourage relative voice rest (avoiding shouting, excessive talking)
   • Ensure adequate hydration to maintain vocal cord moisture
   • Humidification of the environment can help soothe irritated vocal cords

2. Voice Therapy

   • For persistent hoarseness, voice therapy provided by a certified speech-language pathologist is effective across all age groups 1
   • Children younger than two years may not fully participate in voice therapy, but family education and counseling can still be beneficial 1
   • Voice therapy focuses on eliminating harmful vocal behaviors and modifying aberrant features of pitch, loudness, and quality

Medications to Avoid

1. Over-the-Counter (OTC) Cough and Cold Medications

   • Should not be used in children under 6 years due to potential toxicity and limited efficacy 1
   • FDA has warned against using these medications in young children due to safety concerns
   • These medications have not been shown to be effective for symptoms of upper respiratory tract infections in children 1

2. Antibiotics

   • Should not be routinely prescribed for hoarseness or acute laryngitis 1
   • No evidence of benefit for the common cold or persisting acute purulent rhinitis in children 1
   • Can cause significant adverse effects without providing benefit 1

3. Corticosteroids

   • Nasal corticosteroids are not recommended for symptomatic relief from the common cold 1
   • Systemic corticosteroids should be avoided as empiric therapy for hoarseness except in special circumstances (like croup with associated symptoms) 1

Potentially Helpful Remedies

1. Honey (for children over 1 year)

   • May offer more relief for cough symptoms than no treatment, diphenhydramine, or placebo 1
   • Never give honey to infants under 1 year due to risk of botulism

2. Nasal Saline Irrigation

   • Possibly beneficial for relieving symptoms of acute upper respiratory tract infections, mainly in children 1
   • Safe and inexpensive option

Special Considerations

When to Seek Further Evaluation

Laryngoscopy should be performed when:

• Hoarseness persists beyond 3 months
• There are concerning symptoms such as difficulty breathing, stridor, or dysphagia 2
• Hoarseness in a neonate or following neck trauma 2

Red Flags Requiring Immediate Evaluation

• Hemoptysis
• Dysphagia or odynophagia
• Airway compromise or breathing difficulty
• Stridor
• Neck mass
• Hoarseness in an immunocompromised patient 2

Conclusion

The management of hoarseness in children during a cold should focus on supportive care, voice rest, and adequate hydration. Voice therapy is beneficial for persistent hoarseness. Most medications, including antibiotics, OTC cough and cold preparations, and corticosteroids, should be avoided due to limited efficacy and potential harm. Honey (in children over 1 year) and nasal saline irrigation may provide symptomatic relief. If hoarseness persists beyond expected timeframes or concerning symptoms develop, further evaluation with laryngoscopy is warranted.