SLPNarrative ReviewJournal of voice : official journal of the Voice Foundation2025

The Pediatric Vocal Mechanism: Structure and Function.

Robert Brinton Fujiki, Anumitha Venkatraman, Elizabeth S Heller Murray

PMID 40187973

WHAT IT FOUND

Children's vocal folds are structurally and functionally different from adults, with shorter length, undifferentiated tissue, and higher subglottal pressure.

Voice measures change predictably with age and sex, so clinical assessment must use pediatric-specific norms rather than adult standards.

Key findings

01Infant vocal folds are an undifferentiated monolayer that begins to differentiate at two months and approximates adult structure around 11 months, with continued development through childhood.

02Children have higher subglottal pressure and laryngeal airway resistance than adults, suggesting less efficient vocal production, likely due to smaller airway anatomy.

03Voice disorder risk factors shift across childhood, with school-age males at higher risk than females, and vaping or high-demand activities like singing linked to increased voice problems in adolescents.

STILL TO COME

How it was doneWhat they foundWhat it means for SLPs

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What it does not show

This is a narrative review, not a systematic review, so it may not capture all relevant studies. Much of the underlying data comes from animal models or cadaver studies, which may not fully reflect live pediatric physiology. Normative data for many voice measures are still limited, and the clinical significance of changes in these measures is not well established.

Declared interests

The authors declare no competing financial interests or personal relationships.

The easy way to misread this

Do not apply adult voice norms to children. The pediatric larynx is structurally and functionally distinct, with higher subglottal pressure and different tissue properties, so acoustic and aerodynamic measures must be interpreted using pediatric-specific references.

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