Children can experience a range of speech, language and/or cognitive communication difficulties when admitted to the hospital. Many children with complex medical conditions can experience these impairments as a result of their primary diagnosis, treatment effects, long-term hospitalization, missed school or as a separate condition occurring at the same time as their primary diagnosis.
Children of any age in the hospital may:
- need support in accessing communication (e.g., if they are intubated, have a tracheostomy, or if they need devices to help them communicate)
- experience acute changes to their speech and language abilities associated with their illness or hospital stay
- have pre-existing speech or language concerns in which they can no longer access speech-language pathology (SLP) services in their community
- be at risk of developing speech and language concerns during a prolonged admission for another reason, such as chemotherapy or chronic illness
Prolonged hospital admission
Prolonged hospital admission(s) for any reason can impact language learning. Cognitive development extends throughout a child’s first year of life. Their experiences and environment help children develop reading skills, social skills, memory, attention and focus. Repeated or lengthy hospitalizations may disrupt this process through limited access to family life, peers and play. As a result, children may not meet their speech and language milestones as expected.
This article covers the following procedures and conditions that may affect speech, language and social communication skills:
- intubation
- tracheostomy
- acquired brain injury
- brain tumours
- anatomical or structural difference in the head or neck regions
- respiratory conditions
- heart conditions
- seizure disorders
- other
Intubation
When a child needs help breathing, they may have a tube placed into the windpipe (trachea) through the mouth or nose (intubation). Intubation can make it difficult to talk because the tube limits mouth movements and blocks the vocal cords from closing.
It is common for the tube to irritate the throat and vocal cords. Once the tube is removed, the irritation may persist. It may take a few days for your child’s voice to return, or your child’s voice may sound different (weak, breathy, hoarse). This is usually temporary. In rare cases, one or both vocal cords may become paralyzed. A speech-language pathologist would participate in the assessment and could provide therapy to support improvement in voice quality and stamina. They would also determine if devices or other modes of non-verbal communication would be helpful. Children who are intubated often benefit from using non-verbal communication (i.e., gestures) or augmentative or alternative communication. To learn more about augmentative or alternative communication, please see, The role of a speech-language pathologist.
Tracheostomy
A tracheostomy tube directs air out the tracheostomy rather than through the upper airway and vocal cords. This change in airflow makes it difficult for children with tracheostomies to produce voice. The change in airflow and limited voicing can lead to speech delays, articulation difficulties, expressive language delay and difficulties coordinating breathing with speech production.
Children with a tracheostomy may speak if they generate enough airflow around the tracheostomy tube to pass through the vocal cords. Blocking the tracheostomy tube is the most effective way to produce voicing. This can be done with a one-way valve.
Children who are intubated or have a tracheostomy often benefit from using non-verbal communication (i.e., gestures) or augmentative and alternative communication. Your child may also be followed by a specialized multidisciplinary tracheostomy team.
Acquired brain injury
Changes in brain function can occur as a result of stroke, trauma (e.g., motor vehicle accident, fall), concussion, anoxic/hypoxic brain injury or surgery (tumour resection, arteriovenous malformation repair, etc.). Symptoms can vary depending on the site of the lesion, extent of injury to the brain and the child’s age and stage of development. Children may experience deficits in speech (e.g., slurred speech), language (understanding or expression) and/or cognitive communication (e.g., changes to executive functions such as memory, planning, attention, thought flexibility).
Brain tumours
A child with a brain tumour may have speech and language difficulties depending on the location of the tumour. Their speech and language outcomes and rehabilitation may vary depending on how the tumour is treated. Over 50 per cent of childhood brain tumours originate in the posterior fossa. A potential complication for children who undergo surgery for a posterior fossa tumour is transient cerebellar mutism. It results in the child being unable to speak. Children may also have language difficulties. See Speech and language therapy for mutism after brain tumour surgery for more details.
Anatomical/structural differences
Anatomical or structural differences can impact speech and language development. Some of these differences are congenital (present at birth), including cleft lip and cleft palate, craniofacial anomalies, velopharyngeal insufficiency, dental malocclusion, macroglossia and oral-motor dysfunction. Other anatomical or structural differences can be acquired, such as a tumour in the head or neck region impacting speech or language.
Respiratory conditions
Coordinating breathing and speaking is essential for clear articulation, vocal projection and overall vocal control. Respiratory or upper airway disorders can result in irregular breathing. When a child has irregular breathing or inefficient breathing patterns, they may also have speech challenges such as poor vocal quality, difficulty sustaining speech and/or stuttering.
Heart conditions
Many children with complex congenital heart disease (CHD) have delays or deficits in linguistic skills, oral and motor speech functions, behaviour and attention. There are several factors that impact the likelihood of speech and language deficit, including underlying genetic disorders, heart function before surgery and medical or surgical interventions. Children with transposition of the great arteries have speech abnormalities, including reduced expressive language skills (oral expression abilities) and receptive language skills (ability to understand communication). Children undergoing cardiac surgery are also at risk of vocal cord dysfunction, which could impact voice and speech.
Seizure disorder
Seizure disorders such as epilepsy can affect speech and language, but the extent varies based on the type, severity and cause of seizure disorder. Epilepsy is increasingly being understood as a network disorder, suggesting that even focal seizures can have widespread impact on the brain. Seizure disorders in children likely impact and disrupt typical development of speech and language on several levels.
Other
Other common causes of speech and language concerns in children include developmental delay, intellectual disabilities, prematurity, autism, psychosis, hearing loss, environmental deprivation or traumatic birth history. If you are unsure of the impact your child’s condition may have on their speech, language or cognition, please ask your child’s health-care provider.